Partial parotidectomy under local anesthesia for benign parotid tumors - An experience of 50 cases

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Abstract

Purpose

Benign parotid tumors are adequately treated with partial parotidectomy, which is often performed under general anesthesia (GA). We have reported our preliminary results on the feasibility to perform parotidectomy under local anesthesia (LA). We hereby present our accumulated experience of partial parotidectomy under LA to further consolidate its feasibility, efficacy and safety in a larger series.

Materials and methods

Case series review was carried out using our own center patients' database. 50 patients with parotid tumors were treated with partial parotidectomy under LA, using a retrograde nerve dissection approach from January 2006 to October 2016. The inclusion criteria encompassed mobile parotid nodules primarily operated after non-suspicious fine-needle aspiration cytology. Their demographics, complications and outcomes were evaluated.

Results

No procedure required conversion to GA. There were 48 benign tumors and 2 lymphomas based on the histopathologic examination. The commonest pathologies were pleomorphic adenoma (40%), Warthin's tumor (38%) and cyst (8%). The mean tumor size was 2.68 ± 1.5 cm and the mean operative time was 91.5 ± 34.7 min. Forty-two operations were done as day cases. Ten (20%) patients suffered from transient ear lobe numbness and two (4%) patients had sialocele. Transient facial palsy occurred in 2(4%) patients while another patient (2%) had persistent House-Brackmann grade II facial palsy. No tumor recurrence was noted during follow-up period.

Conclusions

Partial parotidectomy adopting a retrograde nerve dissection under LA is feasible and minimally invasive in treating benign parotid tumors. It can avoid the adverse effects of general anesthesia and promote day surgery or minimize hospital stay.

Introduction

Traditionally, head and neck operations are performed under general anesthesia (GA). With the advancement in surgical techniques and better patient selection, there is a growing interest in using LA for thyroidectomy, parathyroidectomy and submandibular sialoadenectomy [[1], [2], [3], [4]]. The complications of general anesthesia can be avoided and patient recovery is enhanced. In our hospital, many patients are frail elderly with multiple medical co-morbidities, rendering them high perioperative risk for general anesthesia. We have therefore endeavored to develop LA approach for head and neck operations in the past decade to minimize their surgical risk [[4], [5], [6]].

Superficial parotidectomy (SP) is classically performed under GA and is effective in treating parotid tumors [7]. Recently, partial parotidectomy (PP) has evolved as equally effective for benign parotid lesions [8]. In partial parotidectomy, the tumor is resected with a lateral margin of normal parenchyma after the facial nerve is found and safeguarded. It is not necessary to remove the complete superficial lobe of the parotid. In our center, we have also promoted PP under LA in the past 10 years. Our early result on 7 cases of LA parotidectomy has been reported in 2013 [9]. Thereafter, more experience of this LA procedure has been accumulated in a total of 50 cases. We would like to present an updated report on the technique, complications and outcome of our series of LA PP.

Section snippets

Patients included and date collection

Patients with clinically benign parotid tumors without signs of fixity, indurated consistency and facial nerve palsy were enrolled for LA PP, after fine-needle aspiration cytology showed no suspicion of malignancy. Patients eligible for evaluation in this trial were retrieved from our hospital computerized database for operations with the keywords of “parotidectomy” and “local anesthesia” from January 2006 to October 2016. Those patients with prior radiotherapy or parotid operation on the same

Results

From January 2006 to October 2016, a total of 50 patients with parotid tumors underwent PP under LA. There were 39 males and 11 females. Patient baseline characteristics and the tumor pathologies were summarized in Table 1 and Table 2, respectively. The mean age of patient at the time of operation was 61.2 years old. The mean duration of operation was 91.5 min and the average blood loss was 8.2 ml. None of the patients required conversion to GA. Forty-two of the 50 operations was performed on a

Discussion

Parotidectomy was commonly performed under GA by head and neck surgeons in treating parotid tumors. This might be problematic to some patients with high anesthetic risk. After the favorable result and experience of using LA for thyroidectomy, parathyroidectomy and submandibular sialoadectomy [[4], [5], [6]], we also explored the feasibility and safety of PP under LA. Our early report on 7 patients is likewise encouraging [9]. There was no conversion to GA and 6 of the 7 operations were day

Conclusion

To sum up, LA PP is a feasible option for treating benign parotid tumors. It is especially beneficial in those cases with high anesthetic risk. The other advantages are low complication rate with express recovery to facilitate day surgery or reduce hospital stay.

Disclosure

The authors had no financial disclosure or conflicts.

References (20)

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