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O.535 Face lift and reconstructive technique in parotid surgery
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Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
O.532 Complications in minimal surgery of benign parotid tumors K. Karavidas, N. Papadogeorgakis, E. Parara, M. McGurk. King’s College London, London, UK Objectives: To study the incidence of complications following two different minimal parotidectomy techniques, extracapsular dissection (ECD) or a partial superficial parotidectomy (PSP). Methods: A total of 231 patients had surgery for a benign tumor by two surgeons independantly (Athens N = 117: London N = 114) over a period of 9 years (1997–2006). In Athens PSP was employed and in London ECD. A total of 97 patients attended an appointment to assess complications and personal satisfaction (visual analogue scale). Results: 50 pts had ECD and 47 PSP (mean age 47.4 yrs and 51.6 yrs respectively), with a mean follow up period per cohort of 39.7 and 47.3 months. There was no recurrence in either series. Frey’s syndrome was encounted in 4 patients in each cohort but the temporary facial paresis was almost double in PSP. There was one case of permanent facial paresis of the frontozygomatic branch of the facial nerve after ECD. One patient developed a sialocele after a PSP while another one had an infection that resolved with antibiotics. Self satisfaction was high in both series with a 8.67 in PSP over a 8.58 in ECD out of a scale of 1 to 10. Conclusion: These two conservative approaches to parotid surgery give similar results. Reduced dissection of the parotid gland produces less morbidity. O.533 Double mandibular osteotomy with coromoidectomy V. Andoniades, K. Andoniades, D. Magoudi, N. Lazaridis. Aristotle University of Thessaloniki, Thessaloniki, Greece Objectives: Tumors in the parapharyngeal space are very uncommon and are diagnosed lately due to the anatomy of the region. The rigid bony walls of the mandible direct tumor growth medially to the parapharyngeal space. This silent anatomical space allows tumor to grow and on routine clinical examination the finding of bulging of the soft palate suggests the diagnosis. Such tumors can be reached by superficial parotidectomy and removed by deep lobectomy. However transparotid and intraoral approaches have limited use. The styloid process, the stylomandibular ligament and the mandible impede access to the parapharyngeal deep lobe parotid tumors. Division of the mandible was first proposed by Ariel. Most of the proposed techniques, involve resection of the inferior alveolar nerve. Seward described a mandibular osteotomy distal to the mental foramen without splitting the lip, to spare the inferior alveolar nerve. We present a new modification of this technique to include coronoidectomy in order to improve access to the parapharyngeal space. Methods: The techinque is used in 3 cases of deep lobe parotid tumors and 2 cases of carotid body tumors which extended towards the skull base, with cooperation with neurosurgeons. Results: After a 2 year follow up performed in all of our cases, the assessment of the ability of the manbible performing functional movements, the sensory function of facial nerve and the sensity of the teeth of the mandible revealed total recover. Conclusion: The double mandibular osteotomy with coronoidectomy gives excellent access and avoids damage to these nerves. O.534 Ectopic thyroid tissue manifesting as a sub-mandibular mass J. Sherman, L. Gillman. Beds, Hearts & Bucks Maxillofacial Network, Luton, UK Non-malignant lateral ectopic thyroid tissue (LETT) is exceedingly rare. Co-existent orthoptic thyroid tissue is seldom present. Aberrant thyroid tissue in the lateral neck should always raise
Abstracts, EACMFS XIX Congress suspicion of a well-differentiated metastatic thyroid follicular or papillary carcinoma. It is important to exclude a completely replaced lymph node or microscopic metastatic deposits. Most ectopic thyroid tissue arises in the mid-line. It is standard practice for mid-line anterior cervical masses to have preoperative thyroid function tests, ultrasound or technesium scans performed, however, this does not routinely apply for lateral neck masses. Most cases of LETT are identified post-surgery. A 65 year old caucasian lady presented with a painless rapidly expanding mass in her left sub-mandibular area. This had a rubbery texture and was suspected of being a salivary neoplasm. Despite imaging and FNAC, no clues were identifiable pre-operatively. She was already receiving beta-blockers for hypertension. Following excision, the mass was found to be a thyroid goitre. The subject required thyroxine supplementation post-operatively. We present her case report and a discussion of the available literature. O.535 Face lift and reconstructive technique in parotid surgery L. Califano, G. Ambrosio, A. Romano, G. De Maria, L. Liccado, L. Lanero. Federico II University of Naples, Naples, Italy Objectives: Our objective is to make a comparative study of the two technique, Blair compared to modified face lift, evaluating surgical time, gland exposure, and surgical area at the maximum retraction of the skin flap, on the other side we evaluate the results on an aesthetic and functional point of view focusing our attention on the histology and consequent reconstructive technique applied. Methods: Various skin incision for the access to the parotid region are described by different Authors, which differ in extension and localisation of the scar. Therefore after parotidectomy, patients are often left with a retromandibular and cervical depression. Maintaining normal facial contour may be difficult in parotidectomy defects, but a good symmetry can and should be achieved when reconstructing the parotid region with a specific approach. From 2007 to 2008 we treated 20 patients for benign parotid tumour comparing two different techniques. We show our experience using and comparing the facelift and Blair incision to improve the aesthetic and functional results and three different techniques for the reconstruction of the parotid region. Results: The results obtained using the modified face lift incision vs. the Blair’s one are satisfying both from an aesthetic and surgical point of view, according to many study in literature. Conclusion: We propose this technique exclusively in the treatment of benign tumours of the parotid gland since it gives as good as surgical exposure as the Blair, and it is extended in a non visible zone of the face and neck. For the same reason this technique is able to avoid the visibility of scar hypertrophy, keloid or unsightly aesthetic scar. We do not use this technique in cases of malignant tumours or in case of huge benign tumours. O.536 Facial reconstruction following parotidectomy M. Fasolis, C. Iaquinta, P. Tosco, S. Berrone. University of Turin, Torino, Italy Objectives: To compare various reconstructive techniques following parotidectomy. Methods: Among 45 patients who underwent parotidectomy 14 were reconstructed with dermofat graft, 9 with sternocleidomastoid muscle rotation and 20 were not reconstructed at all. Minimum follow-up was 6 months. The onset of Frey Syndrome was observed as well as the incidence of salivary fistulae. On the aesthetic side the criteria were patient’s satisfaction and photographic confrontation of the hemifaces. Results: Among the 14 patients who underwent dermofat graft reconstruction 1 had signs and symptoms of Frey Syndrome, 2 had evident signs of facial asymmetry. All patients stated they
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
O.532 Complications in minimal surgery of benign parotid tumors K. Karavidas, N. Papadogeorgakis, E. Parara, M. McGurk. King’s College London, London, UK Objectives: To study the incidence of complications following two different minimal parotidectomy techniques, extracapsular dissection (ECD) or a partial superficial parotidectomy (PSP). Methods: A total of 231 patients had surgery for a benign tumor by two surgeons independantly (Athens N = 117: London N = 114) over a period of 9 years (1997–2006). In Athens PSP was employed and in London ECD. A total of 97 patients attended an appointment to assess complications and personal satisfaction (visual analogue scale). Results: 50 pts had ECD and 47 PSP (mean age 47.4 yrs and 51.6 yrs respectively), with a mean follow up period per cohort of 39.7 and 47.3 months. There was no recurrence in either series. Frey’s syndrome was encounted in 4 patients in each cohort but the temporary facial paresis was almost double in PSP. There was one case of permanent facial paresis of the frontozygomatic branch of the facial nerve after ECD. One patient developed a sialocele after a PSP while another one had an infection that resolved with antibiotics. Self satisfaction was high in both series with a 8.67 in PSP over a 8.58 in ECD out of a scale of 1 to 10. Conclusion: These two conservative approaches to parotid surgery give similar results. Reduced dissection of the parotid gland produces less morbidity. O.533 Double mandibular osteotomy with coromoidectomy V. Andoniades, K. Andoniades, D. Magoudi, N. Lazaridis. Aristotle University of Thessaloniki, Thessaloniki, Greece Objectives: Tumors in the parapharyngeal space are very uncommon and are diagnosed lately due to the anatomy of the region. The rigid bony walls of the mandible direct tumor growth medially to the parapharyngeal space. This silent anatomical space allows tumor to grow and on routine clinical examination the finding of bulging of the soft palate suggests the diagnosis. Such tumors can be reached by superficial parotidectomy and removed by deep lobectomy. However transparotid and intraoral approaches have limited use. The styloid process, the stylomandibular ligament and the mandible impede access to the parapharyngeal deep lobe parotid tumors. Division of the mandible was first proposed by Ariel. Most of the proposed techniques, involve resection of the inferior alveolar nerve. Seward described a mandibular osteotomy distal to the mental foramen without splitting the lip, to spare the inferior alveolar nerve. We present a new modification of this technique to include coronoidectomy in order to improve access to the parapharyngeal space. Methods: The techinque is used in 3 cases of deep lobe parotid tumors and 2 cases of carotid body tumors which extended towards the skull base, with cooperation with neurosurgeons. Results: After a 2 year follow up performed in all of our cases, the assessment of the ability of the manbible performing functional movements, the sensory function of facial nerve and the sensity of the teeth of the mandible revealed total recover. Conclusion: The double mandibular osteotomy with coronoidectomy gives excellent access and avoids damage to these nerves. O.534 Ectopic thyroid tissue manifesting as a sub-mandibular mass J. Sherman, L. Gillman. Beds, Hearts & Bucks Maxillofacial Network, Luton, UK Non-malignant lateral ectopic thyroid tissue (LETT) is exceedingly rare. Co-existent orthoptic thyroid tissue is seldom present. Aberrant thyroid tissue in the lateral neck should always raise
Abstracts, EACMFS XIX Congress suspicion of a well-differentiated metastatic thyroid follicular or papillary carcinoma. It is important to exclude a completely replaced lymph node or microscopic metastatic deposits. Most ectopic thyroid tissue arises in the mid-line. It is standard practice for mid-line anterior cervical masses to have preoperative thyroid function tests, ultrasound or technesium scans performed, however, this does not routinely apply for lateral neck masses. Most cases of LETT are identified post-surgery. A 65 year old caucasian lady presented with a painless rapidly expanding mass in her left sub-mandibular area. This had a rubbery texture and was suspected of being a salivary neoplasm. Despite imaging and FNAC, no clues were identifiable pre-operatively. She was already receiving beta-blockers for hypertension. Following excision, the mass was found to be a thyroid goitre. The subject required thyroxine supplementation post-operatively. We present her case report and a discussion of the available literature. O.535 Face lift and reconstructive technique in parotid surgery L. Califano, G. Ambrosio, A. Romano, G. De Maria, L. Liccado, L. Lanero. Federico II University of Naples, Naples, Italy Objectives: Our objective is to make a comparative study of the two technique, Blair compared to modified face lift, evaluating surgical time, gland exposure, and surgical area at the maximum retraction of the skin flap, on the other side we evaluate the results on an aesthetic and functional point of view focusing our attention on the histology and consequent reconstructive technique applied. Methods: Various skin incision for the access to the parotid region are described by different Authors, which differ in extension and localisation of the scar. Therefore after parotidectomy, patients are often left with a retromandibular and cervical depression. Maintaining normal facial contour may be difficult in parotidectomy defects, but a good symmetry can and should be achieved when reconstructing the parotid region with a specific approach. From 2007 to 2008 we treated 20 patients for benign parotid tumour comparing two different techniques. We show our experience using and comparing the facelift and Blair incision to improve the aesthetic and functional results and three different techniques for the reconstruction of the parotid region. Results: The results obtained using the modified face lift incision vs. the Blair’s one are satisfying both from an aesthetic and surgical point of view, according to many study in literature. Conclusion: We propose this technique exclusively in the treatment of benign tumours of the parotid gland since it gives as good as surgical exposure as the Blair, and it is extended in a non visible zone of the face and neck. For the same reason this technique is able to avoid the visibility of scar hypertrophy, keloid or unsightly aesthetic scar. We do not use this technique in cases of malignant tumours or in case of huge benign tumours. O.536 Facial reconstruction following parotidectomy M. Fasolis, C. Iaquinta, P. Tosco, S. Berrone. University of Turin, Torino, Italy Objectives: To compare various reconstructive techniques following parotidectomy. Methods: Among 45 patients who underwent parotidectomy 14 were reconstructed with dermofat graft, 9 with sternocleidomastoid muscle rotation and 20 were not reconstructed at all. Minimum follow-up was 6 months. The onset of Frey Syndrome was observed as well as the incidence of salivary fistulae. On the aesthetic side the criteria were patient’s satisfaction and photographic confrontation of the hemifaces. Results: Among the 14 patients who underwent dermofat graft reconstruction 1 had signs and symptoms of Frey Syndrome, 2 had evident signs of facial asymmetry. All patients stated they