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      Evaluation of Salivary Function Post-Partial Superficial Parotidectomy

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          Abstract

          Introduction:

          Parotid pleomorphic adenomas necessitate surgical intervention, with a growing emphasis on preserving salivary function post-surgery due to its critical role in maintaining oral health and overall quality of life. This study aims to evaluate a surgical method meticulously designed to preserve salivary function following partial superficial parotidectomy, utilizing Technetium-99m scintigraphy.

          Materials and Methods:

          This single-center prospective cohort study was conducted in Mashhad, Iran, between 2022 and 2023. The study encompassed 40 patients diagnosed with parotid pleomorphic adenomas, ages 20 to 64, undergoing partial superficial parotidectomy. The salivary function was evaluated using Technetium-99m scintigraphy three weeks post-operation.

          Results:

          Most participants underwent right parotid surgery (62.5%, n=25) instead of left parotid surgery (37.5%, n=15). The outcomes of the partial superficial parotidectomy indicated no complications during the three-week post-operative period. Saliva secretion rates on the operated side were preserved across the cohort. A significant difference in saliva secretion rates was observed between the operated and contralateral sides (P<0.01) for both right and left parotid surgery groups. No significant correlation was found between the time elapsed post-surgery and saliva secretion rates (P=0.48).

          Conclusion:

          Our study demonstrated that the superficial parotidectomy technique is notably effective when focused on preserving the salivary function of the deep parotid gland. Not only does it maintain saliva secretion on the operated side, but it also boasts an admirable safety profile. There were no recorded complications, and duct preservation was achieved in most instances.

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          Most cited references17

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          The role of saliva in maintaining oral homeostasis.

          D Mandel (1989)
          Dental practitioners are becoming more cognizant of the importance of saliva as they treat a greater number of older patients, especially those with medical problems requiring a variety of medications that have xerostomia as a side effect. This article discusses salivary composition and function in a broad perspective, relating them to clinical concerns and current research. Understanding the role of saliva in maintaining health, as well as its relation to oral disease, is vital to the competent dental practitioner.
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            Giant deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space. Report of three cases and review of the diagnostic and therapeutic approaches.

            Aim of the present report is to discuss and underline the diagnostic algorithm and the surgical approach to giant parotid pleomorphic adenomas arising in the deep lobe and growing in the parapharyngeal space. Three cases are described and a review is made of the international literature concerning giant deep lobe parotid gland pleomorphic adenoma. Diagnosis was based on imaging, computed tomography scan and magnetic resonance imaging and upon cytology, by means of fine needle aspiration biopsy. The surgical approach varied according to the location of the tumour. All patients were discharged without complications and no cases of permanent facial nerve palsy were observed. An exhaustive pre-operative diagnostic algorithm is required before approaching this lesion. Fine needle aspiration biopsy is, in our opinion, mandatory to avoid histological surprises. The surgical approach should provide excellent visibility with wide surgical exposure to secure local neurovascular structures.
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              Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables

              Background The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy. Methods A systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data. Results Pathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage. Conclusion Myxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences.
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                Author and article information

                Journal
                Iran J Otorhinolaryngol
                Iran J Otorhinolaryngol
                IJO
                Iranian Journal of Otorhinolaryngology
                Mashhad University of Medical Sciences (Mashhad, Iran )
                2251-7251
                2251-726X
                May 2024
                : 36
                : 3
                : 483-488
                Affiliations
                [1 ] Department of Otorhinolaryngology, Mashhad University of Medical Sciences, Mashhad, Iran.
                [2 ] Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
                [3 ] Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
                [4 ] Department of Forensic Medicine and Toxicology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
                [5 ] Department of Anesthesiology and Intensive Care, Mashhad University of Medical Sciences, Mashhad, Iran.
                Author notes
                [* ]Corresponding author: Department of Otorhinolaryngology, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail: khazaenik@mums.ac.ir
                Article
                10.22038/IJORL.2024.76003.3551
                11090091
                38745682
                b2196447-bdeb-478a-abe8-4825f3f866ea

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 2 December 2023
                : 6 April 2024
                Categories
                Original Article

                parotid pleomorphic adenomas,partial superficial parotidectomy,salivary function preservation,technetium-99m scintigraphy

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