| [Background]NSOL is very common in oral and maxillofacial areas and includes all kinds of cysts,vascular malformation and submaxillaritis.Excision via external approach as a routine surgical procedure has been criticized for its invasiveness and providing visible maxillofacial scar.Therefore,how to reduce the facial incision and the surgical trauma is a clinical problem worth studying and solving.Endoscopy-assisted approach(EAA)has been widely used in surgery,gynecology,otolaryngology and other professions,with the development of more than 20 years,it has developed into a well-established approach with some involving small incisions and cosmetic outcomes.However,in the field of oral and maxillofacial surgery,it has not been promoted due to small operation space[1].Since endoscopy was introduced into the fields of craniomaxillofacial and facial plastic surgery,minimally invasive endoscopic surgeries have been applied successfully to various procedures with a great number of advantage over the conventional open operation,including minimal tissue damage,clear surgica.view and excellent cosmesis[2-13].However,the primary tumors of the parotid gland,accessory parotid gland and submandibular salivary gland are almost exclusively pleomorphic adenoma.Intraoperative mucoid spillage of tumors can lead to recurrence of the disease due to incomplete removal of the pseudocapsule and satellitosis of the tumor[7,8,14].Therefore partial excision around extracapsular tissue is recommended in the resection of pleomorphic adenoma[14-20]and subcapsular dissection is not desirable in the endoscope-assisted resection of pleomorphic adenoma[6,17].Given the poor operation field it is technically difficult to complete partial excision around extracapsular tissue in oral and maxillofacial areas.Subcapsular dissection may be sufficient for radical treatment of most of the NSOL,Therefore,we believe that patients specifically suffering from NSOL in face and submandibular areas may significantly benefit from endoscope-assisted surgery.[Objective]To our best knowledge,there are no systematic reports with reference to endoscope-assisted resection of NSOL in oral and maxillofacial areas.In this novel study we describe our technique for resection of NSOL in face and submandibular areas and demonstrate its feasibility and effectiveness.[Methods]Thirty-one patients with different NSOL underwent surgery between November 2012 and April 2016 in the Department of Oral and Maxillofacial surgery,at ourhospital.There were 11 male patients and 20 female patients,with ages ranging from 16 to 68 and a median age of 37 years.EAA were performed on 11 patients with NSOL in oral and maxillofacial areas,of which two patients were diagnosed as submandibular epidermoid cyst,two patients were diagnosed as IVM in front of parotid gland and seven patients suffered from submaxillaritis.The remaining twenty patients were treated with EA and included 5 submandibular epidermoid cysts,3 IVM and 12 submaxillaritis.Computed tomography(CT)scan and/or magnetic resonance imaging(MRI)were used to evaluate the lesions of all the patients prior to surgery.All neoplastic space-occupying lesion or suspected cases of gland tumors were excluded from this study.This study was approved by the Ethics Committee of the Second Hospital of Shandong University.All patients received detailed information about the operative approach and signed informed consent prior to participating in this study.The patients with EAA were all informed that a conventional wide-open operation may be required if any surgical complications were encountered e.g.uncontrolled bleeding that could not be resolved by endoscope-assisted surgery,and that all the excised samples would be diagnosed by fast frozen pathology.If the patient was diagnosed with a tumor,a conventional open procedure would also be carried out.Statistical analysis of all of the data was performed using SPSS for Windows(SPSS Inc,Chicago,IL).Data are presented as mean values ±SD.For all analyses,the statistical differences were considered to be significant if P<0.05.[Results]Clinical data of the patients and statistical analyses of all of the data are shown in Tables 1 and 2.All of the lesions in the 31 patients were resected completely and no patient suffered from complications such as infection,nerve injury or excessive bleeding.All eleven patients with EAA diagnosed by intraoperative frozen sections were treated by resection with the endoscopically assisted system and without having to revert to EA.There were significant statistical differences in the length of the wounds and the amount of intraoperative bleeding between the patients treated with EAA and those with EA(P<0.001).However,the EAA procedure has a longer operation time compared with the EA procedure(90.64 ± 20.87 vs 52.05 ± 6.82 min,P<0.001).Comparison of postoperative drainage of the two methods showed no statistical difference,also there was no significant difference in the postoperative pain score(P = 0.082).The average hospital stay of the patients with the EAA were shorter compared with the EA group(2.91 ± 0.74 vs 3.78 ± 0.70 day,P = 0.003).All the patients with EAA were significantly more satisfied with their cosmetic outcomes than those with the EA(P<0.001).There were no postoperative complications,including recurrence,chronic infection,Frey syndrome or pain in any of the patients followed up for 9-24 months after leaving hospital and good cosmetic results were achieved in the long term follow up.[Conclusion]In this study we performed operations with EAA and EA on patients with NSOL in oral and maxillofacial areas and achieved complete resection of the NSOL.Patients with EAA achieved minimal invasion and good cosmetic results compared with those with EA.Endoscope-assisted resection of NSOL is more practicable for the beginner and so is promising as a standard procedure in the oral and maxillofacial areas. |
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