Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States.
Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States; University of Tennessee, Knoxville, TN, United States.
Am J Otolaryngol. 2024 Mar-Apr;45(2):104185. doi: 10.1016/j.amjoto.2023.104185. Epub 2023 Dec 13.
There has been historical controversy regarding the extent of resection in the management of pleomorphic adenomas. This study aims to evaluate the extent of surgery and short-term postoperative outcomes of partial superficial parotidectomy (PSP) for the management of pleomorphic adenomas at a tertiary, high-volume center.
A retrospective chart review of patients who underwent PSP was performed. Variables included demographics, pre-operative facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence.
151 adults who underwent PSP for pleomorphic adenoma from January 1st, 2000 to December 31st, 2022 were identified. Median age was 55 (IQR 40-66) years with females representing 74 % of the cohort. Median tumor size at presentation was 1.8 (IQR 1.3-2.3) cm. Baseline facial nerve function was excellent for most patients (House-Brackmann I, 99 %). Most patients underwent a superficial inferior parotidectomy (88 %). Modified Blair incision (70 %) was the most common incision. Intraoperatively, the facial nerve was identified in 149 (99 %) patients. The main trunk was identified in 126 (85 %) patients. No patient had tumor spillage. Only two patients required parotid bed reconstruction. The most common complication was ear numbness (60 %). Postoperatively, 114 patients were House-Brackmann grade I at both preoperative and postoperative assessment, 8 went from grade I to II, and 1 went from grade VI to II (Bell's palsy that resolved to grade II following surgery). Median follow-up was 1(IQR 1-5) month.
PSP is efficacious in the management of pleomorphic adenomas with preservation of facial nerve function, and minimal post-operative complications. Future study is needed to assess long term recurrence risk.
在多形性腺瘤的治疗中，切除范围一直存在历史争议。本研究旨在评估在高容量的三级中心，行部分腮腺浅叶切除术（PSP）治疗多形性腺瘤的手术范围和短期术后结果。
对行 PSP 治疗多形性腺瘤的患者进行回顾性病历审查。变量包括人口统计学特征、术前面神经功能、手术技术、术后并发症/面神经功能和复发情况。
2000 年 1 月 1 日至 2022 年 12 月 31 日期间，共确定了 151 例成人因多形性腺瘤行 PSP。中位年龄为 55 岁（四分位距 40-66），女性占队列的 74%。大多数患者（99%）术前面神经功能良好（House-Brackmann I 级）。大多数患者行腮腺浅叶切除术（88%）。改良 Blair 切口（70%）是最常见的切口。术中，149 例患者（99%）识别出面神经，126 例患者（85%）识别出面神经主干。无肿瘤溢漏。仅 2 例患者需要行腮腺床重建。最常见的并发症是耳部麻木（60%）。术后，114 例患者术前和术后均为 House-Brackmann I 级，8 例从 I 级变为 II 级，1 例从 VI 级变为 II 级（术后缓解至 II 级的贝尔麻痹）。中位随访时间为 1（四分位距 1-5）个月。
PSP 治疗多形性腺瘤有效，面神经功能得以保留，术后并发症少。未来需要研究评估长期复发风险。
