| Background:Tumors of the salivary organs account for 3%to 10%of all head and neck neoplasms;75%to 85%of them begin within the parotid organ,and 70%to 80%are generous.Most include the superficial lobe of the parotid,which accounts for 80%of the organ parenchyma.Benign tumors are more common in parotid organ,making approximately 80%of all and 80%of these are pleomorphic adenoma,taken after by Warthin’s tumor and monomorphic adenoma.Uperficial lobe is the most location where around 80%of tumors emerge.The treatment of parotid tumors requires the expulsion of both the tumor and parts of the encompassing parotid tissue.One of the taking after operations is chosen:extra capsular dissection,partial superficial parotidectomy,and superficial parotidectomy,total parotidectomy with or without preservation of the facial nerve,and with or without neck dismemberment.The favored surgical strategies are shallow parotidectomy(SP)and fractional shallow parotidectomy(PSP).The essential distinction between the two methods is that the branching design and area of the facial nerve,instead of the measure and degree of the tumor,decides the greatness of dissection and the sum of parotid tissue that’s removed in SP.To anticipate these complications,different procedures have been created and distinctive materials are being utilized amid the operation.In order to eradicate the incidence of Frey’s syndrome and get superior tasteful comes about after extraction,stern mastoid-muscle transposition has been utilized.Frey’s syndrome,moreover called gustatory sweating or auriculotemporal disorder,comprises facial sweating,flushing,and some of the time torment within the preauricular and transient zones taking after generation of a solid salivary stimulus.This disorder creates following parotid organ surgery and it is characterized by edema and sweating expanded within the parotid organ locale in connection to gustatory jolts.Its prevalence is detailed between 2.6%and 97.6%within the writing.It is thought to happen due to confusion of the thoughtful and parasympathetic nerves within the parotid locale amid the recuperating period.To realize great facial molding free stomach dermal fat unites may be utilized,which decreases the rate of postoperative gustatory sweating without essentially expanding operating time or protracting remain within the healing centre.After a fractional shallow parotidectomy the leftover portion of the parotid organ and the shallow musculoaponeurotic system(SMAS)may be sutured back to the sternocleidomastoid muscle.This SMAS intervention appears to decrease the rate of Frey’s syndrome.At the same time the association between the auriculotemporal nerve and the facial nerve is protected.To anticipate such complications,numerous surgical methods have been presented to avoid unusual nerve associations.Usually more often than not accomplished by setting a physical obstruction such as belt,muscle or manufactured dermal framework between the parotid organ and the skin.The foremost broadly detailed strategy is the arrangement of the AlloDerm sheet over the dismembered plane.In any case,its openness is constrained due to the tall taken a toll and constrained sum of source from cadaveric skin.Permacol(porcine dermal collagen)could be a solid biological,non-absorbable implant with natural properties that make it reasonable for utilize within the maxillofacial region.It may illuminate the postoperative issues of facial molding deformations and Frey’s syndrome,after parotid surgery.A number of past ponders have compared the two sorts of parotid surgery by noticing the rate of postoperative complications,but these ponders did not utilize permacol embed to anticipate Frey disorder.Objective:Comparison of Frey syndrome rates taking after superficial parotidectomy(SP group)and partial superficial parotidectomy(PSP group)by utilizing porcine dermal collagen graft.Material&Methods:It was a hospital based study conducted over a period of two years from January 2018 to December 2019 in oral and maxillofacial surgery department of a tertiary care hospital of Zhengzhou University of China.This study included 250 patients presented with a benign parotid tumor,as assessed by fine-needle aspiration biopsy,CT and magnetic resonance imaging,were enrolled.Patients with malignant salivary gland tumours were excluded.The patients were assigned randomly to one of two groups according to the extent of parotidectomy:125 underwent superficial parotidectomy and 125 underwent superficial partial parotidectomy.All patients were told about the technique and the origin of Permacol,and consented to its use.For the SP technique,the main facial nerve trunk was identified and traced to its branches.The parotid duct was then legated in all cases.Subsequently,the entire superficial parotid tissue region was excised with the tumor en bloc.For the PSP technique,only the branches surrounding the tumor were exposed,and the parotid tumor was excised with a surrounding 0.5 to 1-cm cuff of normal parotid tissue.The parotid duct was preserved in all patients.This method removed only the tumor-bearing area,and avoided the requirement for more extensive facial nerve dissection.After excision,a Permacol sheet was applied so that the perimeter of the tissue deficit was covered.This way the Permacol sheet sets a barrier between the neural fibres of the auriculotemporal nerve and the sympathetic fibres of the overlying sweat-producing glands of the overlying flap of skin.To suture the Permacol implant to the parotid tissue,absorbable 3/0 polyglactin 910(Vicryl)stitches were used.Permacolwas applied with care to avoid injury to the exposed parotid nerve plexus.Care was also taken to ensure that the sheet applied would be tense enough to resemble the contour of the parotid and adequately support the overlying flap.Vacuum suction drains were used in all cases;the skin flap was put back in its place and sutured in layers.Patients were followed up till 6 months to see complications.The patients who underwent superficial parotidectomy were compared to those who underwent partial superficial parotidectomy in terms of Frey syndrome development and recurrence at 6 months.All participants were explained about the purpose of the study.Confidentiality was assured to them along with informed written consent.The study was approved by the Institutional Ethical Committee.Statistical analysis:The collected data were transformed into variables,coded and entered in Microsoft Excel.Data were analyzed and statistically evaluated using SPSS-PC-19 version.Quantitative data was expressed in mean,standard deviation and difference between two comparable groups were tested by student’s t-test(unpaired)or Mann Whitney ’U’ test while qualitative data were expressed in percentage.Statistical differences between the proportions were tested by chi square test or Fisher’s exact test.’P’ value less than 0.05 was considered statistically significant.Results:The SP group included 125 patients(51 women and 74 men)with a mean age of 48.41±9.6 years;the PSP group included 125 patients(77 women and 48 men)with a mean age of 50.2±11.2 years.Most common tumor observed was pleomorphic adenoma followed by Warthin’s tumour,Basal cell carcinoma,myoepithelioma and cystadenoma.The operative time was 136.2±34.5 minutes in the SP group and 95.1±29.6 minutes in the PSP group.Frey syndrome was seen in 3(2.4%)patients in PSP group and in 9(7.4%)patients in SP group.Immediately facial paralysis was significantly more common in SP group(19.2%)then PSP group(4.0%).Conclusion:Compared to the SP group,the PSP group had shorter operative durations and fewer postoperative complications.Therefore,PSP should be considered in suitable cases.Permacol produced good results in both postoperative facial contouring and prevention of Frey’s syndrome. |
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