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When dealing with benign parotid pathology, high expectations are placed on the operating surgeon to preserve key neurovascular structures, especially the animating facial nerve, through meticulous dissection. With time, there has been a greater emphasis on improving cosmesis in parotid surgery through minimally invasive techniques. This Korean team reported outcomes of gland sparing benign parotidectomies using a 4cm postauricular incisional approach specifically examining postoperative cosmesis, recurrence and functional complications. Of the 46 patients, 61% were subjected to partial parotidectomy whilst the remaining 39% had extracapsular dissection. This drainless postauricular approach was applied to benign parotid tumours less than 4cm. Following a mean follow-up period of 3.5 years, 100% of the subjects demonstrated an intact facial nerve, 100% had clear resection margins with no recurrence, and greater auricular nerve was preserved in 85% cases. Postoperative haematoma and sialocele incidence was 11% and 7% respectively, with one patient developing Frey’s syndrome. Cosmetically, high levels of patient satisfaction were noted. The median operation time was 54 minutes, highlighting comparable time efficiency to conventional parotidectomy approaches. Encouraging outcomes from the postauricular approach is evident, albeit from a sample size of 46 patients. Hence, expansion of this approach is advocated to observe whether outcomes are replicable in larger cohorts. Endoscopic parotidectomies were first introduced at the start of 21st century which still involve making similar length incisions as in this study. Randomised studies comparing functional outcomes, recurrence, and complications between endoscopic and open postauricular parotidectomies for benign parotid pathology is warranted.

Gland preservation with postauricular sulcus approach for benign parotid tumors.
Roh JL.
2023 [ePub ahead of print].
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Shivanchan Rajmohan

Frimley Park NHS Foundation, UK.

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