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Antero- vs. retrograde nerve dissection in parotidectomy: a systematic review and meta-analysis

  • Head and Neck
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Abstract

Introduction

The retrograde approach (RP) to nerve identification is a method seldom used in parotid surgery. A systematic review comparing this method to the standard anterograde approach (AP) with respect to facial nerve palsy (FNP) does not currently exist.

Methods

In a meta-analysis according to the PRISMA statement, eight publications, including one randomized controlled trial, were selected. The primary aim was to compare the temporary and permanent FNP resulting from the two dissection methods. Facial nerve function was graded according to the House–Brackmann Scale. The secondary goal was a comparison of the cut–suture times (CST), the volume of healthy tissue (VHT) dissected, the rates of postoperative hematoma (PH), and postoperative infection (PI).

Results

Temporary FNP was noted in 18.2% in the RP group as well as in 34.4% in the AP group. Permanent FNP occurred in 0.9% RPs and 2.4% APs. According to the mixed-effect logistic regression model, there was no significant difference between the two groups in the pooled odds ratio (OR) for either temporary [OR 2.64, 95% confidence interval (CI) 0.97–7.21] or permanent FNP (OR 4.31, 95% CI 0.44–42.28). The CST was significantly shorter in the RP group (p = 0.005), with a significantly smaller VHT dissected (p < 0.0001). There were no differences regarding PH and PI.

Conclusion

The RP is a safe procedure with no significant difference in FNP rates when compared to the AP and, considering the shorter CST and the lesser VHT resected in the RP, it is superior to the AP. Surgeons engaged in parotidectomy should be familiar with both methods of dissection.

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Funding

This project was funded entirely by the Department of Otorhinolaryngology at the Sana Kliniken Leipziger Land, Germany.

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Authors and Affiliations

  1. Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Klinikum Borna, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany

    Petar Stankovic, Jan Wittlinger, Robert Georgiew & Thomas Wilhelm

  2. Institute of Medical Biometrics and Epidemiology, Phillips-University Marburg, Marburg, Germany

    Nina Timmesfeld

  3. Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Phillips-University Marburg, Marburg, Germany

    Stephan Hoch Stephan & Afshin Teymoortash

  4. Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Borromäus Hospital, Leer, Germany

    Thomas Günzel

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  1. Petar Stankovic
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  4. Stephan Hoch Stephan
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Correspondence to Thomas Wilhelm.

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All authors have indicated that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. There was no evaluation or vote of an Ethical Committee necessary because this study was designed as a meta-analysis.

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Stankovic, P., Wittlinger, J., Timmesfeld, N. et al. Antero- vs. retrograde nerve dissection in parotidectomy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 275, 1623–1630 (2018). https://doi.org/10.1007/s00405-018-4982-8

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  • DOI: https://doi.org/10.1007/s00405-018-4982-8

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