Long-term Follow-up after Extracapsular Dissection of Parotid Pleomorphic Adenomas - A Retrospective Study

Abstract

Introduction: Parotid pleomorphic adenoma (PPA) is the most common benign salivary gland neoplasm. Extracapsular dissection (ED) arose as a conservative surgical technique alternative to superficial parotidectomy to reduce complications.

Materials and methods: Patients who underwent ED for superficial, <3 cm, mobile parotid lumps (Quer I) between 2004 and 2008 were retrospectively analysed focusing on those with histological diagnosis of pleomorphic adenoma. A retrospective cohort study on 50 patients who accepted to undergo ultrasonography and clinical evaluation for at least 10 years since surgery was performed. Clinical data, surgical reports, and validated questionnaires for the assessment of complications, quality of life (QoL) and aesthetic satisfaction were analysed. Recurrence rate and complications after ED, with their QoL and aesthetic impact, were evaluated. Statistical analysis was performed setting α=0.05 as the level of significance.

Results: Low occurrence of complications related to ED was seen. Overall QoL after ED was very good (range 1-7, mean 6,86), due to low complications incidence of complications and their low severity, as assessed by patients through Parotidectomy Outcome Inventory-8 questionnaire. Overall aesthetic satisfaction was high (range 1-10, mean 9,78). Aesthetic satisfaction and QoL was statistically related to onset of complications (P = 0.02504 and P = 0.001859). Tumour localization and dimension was not statistically related to onset of complications (P = 0.8207 and 0.7586). After a mean follow-up of 12.5 years, no recurrences were detected.

Discussion: There is a lack of studies with a long-term follow-up after ED for the evaluation of recurrences and complications. Considering our results, the ED technique should be adopted as the first surgical approach for Quer I PPA without suspicion of malignancy.

Keywords: Extracapsular dissection; long-term follow-up; pleomorphic adenoma; quality of life; recurrences.

Figure 1

Questionnaires used for the assessment of symptom-specific outcomes, overall quality of life and aesthetic satisfaction

Graph 1

Number of extracapsular dissection-related complications detected after surgery

Graph 2

Average perception of the severity of each complication by the patient (severity range 0–5)

Graph 3

Average quality of life during the 1st year after surgery (quality of life range 1–7)

Graph 4

Average aesthetic satisfaction 1 year after surgery (aesthetic satisfaction range 1–10)

Figure 2

Preoperative clinical evaluation of the patient. (a) Parotid region view; (b-d) VII cranial nerve clinical evaluation

Figure 3

Intraoperative view of the extracapsular dissection. (a) Surgical field after the preparation of the skin and superficial muscular aponeurotic system flaps; (b) Identification of the mass and execution of the extracapsular dissection; (c) Surgical field after the removal of the mass; (d) Surgical specimen with a lining of glandular tissue

Figure 4

One-year postoperative clinical evaluation of the patient. (a) Parotid region view; (b-d) VII cranial nerve clinical evaluation