Abstract
Objective
Postoperative facial nerve paralysis is the most problematic complication after surgical
treatment of parotid tumors. Localization of tumors is highly relevant for the surgical
approach, but existing classification systems do not focus on the association between
localization and surgical technique. Therefore, we created a new localization-based
classification system for benign parotid tumors and investigated the characteristics
of tumors in each localization and the frequency of postoperative facial nerve paralysis
by retrospectively applying the classification to previous cases.
Methods
First, we defined 6 portions of the parotid gland (upper, U; lower, L; posterior,
P; anterior, A; superficial, S; deep, D) by dividing the transverse plane into an
upper and lower portion at the mandibular marginal branch, the longitudinal plane
into a posterior and anterior portion at the midline of the parotid anteroposterior
diameter, and the sagittal plane into a superficial and deep portion along the course
of the facial nerve. Then, we defined 8 locations by combining the 6 portions in all
possible ways (i.e., U-P-S, U-P-D, U-A-S, U-A-D, L-P-S, L-P-D, L-A-S, L-A-D). We used
this classification to define the tumor localization in 948 patients who had undergone
partial superficial parotidectomy for benign parotid tumors and then investigated
the incidence, histopathological type, signs/symptoms, diagnosis, surgery, and complications
in each area.
Results
Pleomorphic adenomas comprised approximately 70% of tumors in the upper portion but
only approximately 35% in the lower portion. The rate of postoperative facial nerve
paralysis was significantly higher for tumors in deep locations than in superficial
locations (33.9% vs 14.9%, respectively), and the odds ratios for postoperative facial
nerve paralysis in the U-P-D and U-A-D locations were 7.6 and 4.8 compared to the
L-P-S location. When maximum diameter, operation time, bleeding volume, sex (reference:
female), and age were added as control variables, the odds ratios were 4.2 and 3.0.
Conclusion
Determining tumor localization preoperatively with the new localization-based classification
of parotid tumors is helpful not only for predicting the histopathological type but
also for predicting surgical complications, particularly postoperative facial nerve
paralysis.
Keywords
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References
- Tumors of the salivary glands; a clinicopathological study of 160 cases.Cancer. 1950; 3: 445-458
- Evolution and changing trends in surgery for benign parotid tumors.Laryngoscope. 2015; 125: 122-127
- Long-term recurrence rate of pleomorphic adenoma and postoperative facial nerve paresis (in parotid surgery).J Craniomaxillofac Surg. 2007; 35: 189-192
- Current management of benign parotid tumors–the role of limited superficial parotidectomy.Head Neck. 2003; 25: 946-952
- Partial superficial, superficial, and total parotidectomy in the management of benign parotid gland tumors: a 10-year prospective study of 205 patients.J Oral Maxillofac Surg. 2018; 76: 455-459
- Extracapsular dissection for clinically benign parotid lumps: reduced morbidity without oncological compromise.Br J Cancer. 2003; 89: 1610-1613
- Extracapsular dissection for benign parotid tumors: a meta-analysis.Laryngoscope. 2012; 122: 1954-1960
- Surgery of the parotid gland: evolution of techniques, nomenclature and a revised classification system.Clin Otolaryngol. 2009; 34: 303-308
- Surgical options in benign parotid tumors: a proposal for classification.Eur Arch Otorhinolaryngol. 2017; 274: 3825-3836
- Classification of parotidectomies: a proposal of the european salivary gland society.Eur Arch Otorhinolaryngol. 2016; 273: 3307-3312
- MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease.AJNR Am J Neuroradiol. 2011; 32: 1202-1207
- Imaging the major salivary glands.Br J Oral Maxillofac Surg. 2011; 49: 261-269
- Risk factors of postoperative facial palsy for benign parotid tumors: outcome of 1,018 patients.Laryngoscope. 2021; 131: E2857-E2864
- The significance of the margin in parotid surgery for pleomorphic adenoma.Laryngoscope. 2002; 112: 2141-2154
- Parotidectomy for benign parotid disease at a university teaching hospital: outcome of 963 operations.Laryngoscope. 2006; 116: 534-540
- Effectiveness of intraoperative facial nerve monitoring and risk factors related to postoperative facial nerve paralysis in patients with benign parotid tumors: A 20-year study with 902 patients.Auris Nasus Larynx. 2021; 48: 361-367
- Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors.Eur Arch Otorhinolaryngol. 2021; 278: 15-29
- Surgical techniques for benign parotid tumors: segmental resection vs extracapsular lumpectomy.Acta Otolaryngol Suppl. 1998; 537: 75-81
- Description and relationships of the parotid gland levels proposed by the European Salivary Gland Society staging system: an anatomical study.Surg Radiol Anat. 2020; 42: 1101-1107
- A more appropriate clinical classification of benign parotid tumors: investigation of 425 cases.Acta Otolaryngol. 2014; 134: 1185-1891
- Deep lobe parotid tumors: a systematic review and meta-analysis.Otolaryngol Head Neck Surg. 2022; 166: 60-67
- Effective surgical management of anterior tumors of the parotid gland: Main trunk method vs. peripheral method.Am J Otolaryngol. 2021; 42102964
- Values of fine-needle aspiration cytology of parotid gland tumors:a review of 996 cases at a single institution.Head Neck. 2019; 41 (14): 358-365
- Novel differential diagnostic method for superficial/deep tumor of the parotid gland using ultrasonography.Head Neck. 2013; 35: 1153-1157
Article info
Publication history
Published online: February 06, 2023
Accepted:
January 24,
2023
Received in revised form:
December 21,
2022
Received:
November 9,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
