| Objectives This study was carried out to analyze the surgical data,postoperative complications and recurrence rate of extracapsular dissection in the treatment of primary benign lesions in parotid gland region,so as to evaluate the clinical effect of extracapsular dissection.At the same time,the application of extracapsular dissection in parotid gland was prospected according to the experience of clinical practice.MethodsThe clinical data of 295 patients with primary benign lesions in parotid gland region admitted to the Department of Oral and Maxillofacial Surgery of Jilin University School of Stomatology from January 2015 to April 2021 were retrospectively analyzed by means of electronic medical record system,questionnaire,telephone and on-site follow-up.The data of anesthesia method,surgeon,surgical data（operation time,incision length and intraoperative blood loss）,pathological types,maximum diameter,ESGS classification,postoperative complications and recurrence rate were statistically analyzed.Independent sample t test was used to evaluate the difference of surgical data under different anesthesia（local anesthesia or general anesthesia）;χ2 test was used to analyze the influence of surgeon,pathological types,maximum diameter,ESGS classification and anesthesia method on complications,p<0.05 was considered statistically significant.Results1.General information of patients: A total of 295 patients with primary benign parotid lesions were included,including 153 males（52%）,142 females（48%）,and the ratio of males to females was 1.08:1.The age range was 8~86 years old,and the highest incidence was 60~69 years old,with a total of 95 people,accounting for 32.2%;followed by 65 people aged from 50 to 59,accounting for 22.03%.All the patients included in the statistics received postoperative follow-up as required,and the follow-up time ranged from 8 to 83 months,with an average of 45.83±21.16 months.2.Pathological types: The most popular pathological type was Warthin tumor of all pathological types,with 122 cases（41.36%）,followed by 118 cases of pleomorphic adenoma（40%）,29 cases of basal cell adenoma（9.83%）and 7 cases of lymphatic epithelial cysts（2.37%）.3.Location distribution of lesions: There were 117 cases only occurred in the left parotid gland（39.66%）and 160 cases only occurred in the right parotid gland（54.24%）.Moreover,there were 18 cases of bilateral lesions（6.1%）.According to the2016 ESGS classification: The most common classification is level II,with 281 cases（95.25%）,followed by 9 cases of level I（3.05%）,2 cases of level III（0.68%）and 3cases of level V（1.02%）.4.Proportion of multicenter lesions: There were 271 cases of isolated lesions（91.86%）,10 cases of unilateral multicentric lesions（3.39%）and 14 cases of bilateral multicentric lesions（4.75%）.5.The size of lesions was classified according to the maximum diameter: the maximum diameter of lesions was 20~29.9 mm,with 111 cases（37.63%）;followed by 10~19.9 mm,with 92 cases（31.19%）;30~39.9 mm with 68 cases（23.05%）;40~49.9 mm with 21 cases（7.12%）;0~9.9 mm with 3 cases（1.02%）.6.Operation data: The average operation time was 63.06±22.17 min,the shortest operation time was 15 minutes and the longest operation time was 165 minutes.The average length of incision was 5.37±0.67 cm,the shortest incision was 3 cm and the longest was 9.5 cm.The average amount of bleeding was 16.08±11.08 m L,the minimum amount of bleeding was 2 m L,and the maximum amount of bleeding was70 m L.In all cases,69 cases accepted local anesthesia（23.38%）,while 226 cases accepted general anesthesia（76.62%）.The independent sample t test results showed that there was no significant difference in operation time,incision length and intraoperative blood loss under different anesthesia methods.7.Postoperative complications: Facial nerve injury was assessed by House-Brackmann grading.There were 10 cases of transient facial nerve injury（3.39%）,including 6 cases of House-Brackmann II grade and 4 cases of III grade.There were 4 cases of permanent facial nerve injury（1.36%）,including 3 cases of House-Brackmann grade II and 1 case of grade III.Periauricular numbness,sensory abnormalities in 5 cases（1.69%）;there were 2 cases of hematoma（0.68%）.χ2 test results showed that there was no statistically significant effect of the surgeon,pathological type,maximum diameter,ESGS classification and anesthesia method on complications.8.Postoperative recurrence: Only one patient had ipsilateral Warthin tumor at different times.Warthin tumors are multiple tumors and don’t belong to the recurrence.Another patient suffered pleomorphic adenoma initially,and had Warthin tumor on the same side after 22 months,which belonged to multiple primary tumors and was not included in the statistics.All the others showed no recurrence,and the recurrence rate was 0.9.Postoperative satisfaction survey: According to the standardized questionnaire of patient’s satisfaction: 0-dissatisfaction;1-general;2-basic satisfaction;3-satisfaction.Only 7 people chose general（2.37%）;6 people were basically satisfied（2.03%）;the other 282 were satisfied,and the satisfaction rate was 95.59%.10.Exploration of the application of extracapsular dissection beyond benign lesions:Two patients with lymphoma in parotid gland were treated with extracapsular dissection.It can be seen that the trauma of patients is small,which is more conducive to the follow-up treatment of patients,and the prognosis of the two patients is good.Conclusions1.Extracapsular dissection can be used to treat primary benign parotid lesions including pleomorphic adenoma,which reduces the risk of facial nerve exposure and injury,reduces the incision,shortens the time of surgery than SP,has aesthetically pleasing wounds,and has high postoperative satisfaction.At the same time,ECD does not lead to increased postoperative complications and recurrence rates.The occurrence of complications is not related to the surgeon,disease type,ESGS grade,maximum tumor diameter,and anesthesia method.It is expected to be the preferred treatment for primary benign parotid tumors.2.Since there was no significant difference in the operation time,incision length and intraoperative blood loss under different anesthesia methods for extracapsular dissection,local anesthesia can be selected for some patients who cannot tolerate general anesthesia and patients with economic difficulties to reduce systemic stimulation and operation costs.3.Extracapsular dissection can be used to remove lymphoma in the parotid region,reduce surgical injury,and is conducive to the follow-up radiotherapy,chemotherapy and other systemic treatment of patients,with broader indications in addition to benign tumors in the parotid region. |
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