World Journal of Surgery

, 35:2228 | Cite as

The Extended Indication of Parotidectomy Using the Modified Facelift Incision in Benign Lesions: Retrospective Analysis of a Single Institution

  • So-Yoon Lee
  • Yoon Woo Koh
  • Bo Gyung Kim
  • Hyun Jun Hong
  • Jun Hui Jeong
  • Eun Chang Choi



Recently, the modified facelift incision (FLI) has gained increasing popularity for its cosmetic benefits in parotidectomy. However, many surgeons remain concerned with the adequacy of the exposure and are unwilling to use the FLI for anterior or superior tumors of the parotid gland because these tumors are closer to the superficially positioned facial nerve branch. To evaluate the changing trends in parotidectomy incisions for benign lesions at a single institute, and to compare the surgical outcomes between the modified Blair incision (BI) and FLI, and determine the adequacy and possible indications or limitations of the FLI, especially for tumors located in the anterior or superior parotid gland.

Materials and methods

Retrospective study analyzed 357 patients who had various benign parotid diseases and underwent parotidectomy at Severance Hospital between January 2005 and December 2009. Revisions or recurrences and histologically confirmed malignancies were excluded. Tumor location was divided into superficial and deep lobes. The superficial lobe was subdivided into anterior, superior, inferior, and middle portions. Patients’ profiles, surgical outcomes, and cosmetic satisfaction score on a scale of 0 (extremely dissatisfied) to 10 (extremely satisfied) were compared.


In all, 344 patients underwent BI or FLI. The FLI was performed increasingly each year. For anterior (n = 58) or superior tumors (n = 32), there was no significant difference between the type of incision and tumor size or complications. No facial nerve palsy occurred in either group. For deep-lobe tumors (n = 67), the mean tumor size was significantly larger in the BI group (p = 0.025). There was a significant difference between facial nerve palsy and tumor size (p < 0.001) but no significant difference between facial nerve palsy and tumor location (p = 0.145) or the type of incision (p = 0.530). The mean scar satisfaction score was significantly higher in the FLI group (p <0.001). There was a positive correlation between the scar and deep hollow satisfaction score (Pearson coefficient of correlation = 0.547; p < 0.001)


The modified facelift incision is feasible for most benign parotid lesions regardless of tumor location, even for anterior or superior tumors. Using the modified facelift incision may be extended with a surgeon’s accumulated experience, but for a large deep-lobe tumor, the modified Blair incision is still considered useful.


Facial Nerve Parotid Gland Facial Nerve Palsy Deep Lobe Superficial Lobe 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) and Kyounghee Lee (Coordinator of Head and Neck surgery) for their help with the figures and the survey. The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see:


  1. 1.
    Honig JF (2004) Facelift approach with a hybrid SMAS rotation advancement flap in parotidectomy for prevention of scars and contour deficiency affecting the neck and sweat secretion of the cheek. J Craniofac Surg 15:797–803PubMedCrossRefGoogle Scholar
  2. 2.
    Wasson J, Karim H, Yeo J et al (2010) Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison. Ann J Coll Surg Engl 92:40–43CrossRefGoogle Scholar
  3. 3.
    Meningaud JP, Bertolus C, Bertrand JC (2006) Parotidectomy: assessment of a surgical technique including facelift incision and SMAS advancement. J Crani Maxillofac Surg 34:34–37CrossRefGoogle Scholar
  4. 4.
    Marti PC, Garcia DE, Garcia AL et al (2007) Minimal incision in parotidectomy. Int J Oral Maxillofac Surg 36:72–76CrossRefGoogle Scholar
  5. 5.
    Lohuis PJFM, Tan ML, Bonte K et al (2009) Superficial parotidectomy via facelift incision. Ann Otol Rhinol Laryngol 118:276–280PubMedGoogle Scholar
  6. 6.
    Appiani E (1967) Handling of a parotidectomy and muscular graft. Prensa Med Argent 54:1242–1243PubMedGoogle Scholar
  7. 7.
    Hinderer UT (1977) Prevention of unsatisfactory scarring. Clin Plast Surg 4:199–205PubMedGoogle Scholar
  8. 8.
    Guerrerosantos J, Dicksheet S, Guillen C et al (1982) Hidden incision in surgery of parotid, submandibular, cervical, and cheek benign tumors. Ann Plast Surg 9:402–408PubMedCrossRefGoogle Scholar
  9. 9.
    Terris DJ, Tuffo KM, Fee WE Jr (1994) Modified facelift incision for parotidectomy. J Laryngol Otol 108:574–578PubMedCrossRefGoogle Scholar
  10. 10.
    Nouraei SAR, Al-Yaghchi C, Ahmed J et al (2006) An anatomical comparison of Blair and facelift incisions for parotid surgery. Clin Otolaryngol 31:531–534PubMedCrossRefGoogle Scholar
  11. 11.
    Upile T, K.Jerjes W, Nouraei SAR et al (2010) Further anatomical approaches to parotid surgery. Eur Arch Otorhinolaryngol 267:793–800PubMedCrossRefGoogle Scholar
  12. 12.
    Divi V, Fatt MA, Teknos TN et al (2005) Use of cross-sectional imaging in predicting surgical location of parotid neoplasms. J Comput Assist Tomogr 29:315–319PubMedCrossRefGoogle Scholar
  13. 13.
    Lim CY, Chang HS, Nam KH et al (2008) Preoperative prediction of the location of parotid gland tumors using anatomical landmarks. World J Surg 32:2200–2203PubMedCrossRefGoogle Scholar
  14. 14.
    Biley BJ, Johnson JT (2006) The aging face (rhytidectomy). In: Kridel RWH (ed) Head and Neck Surgery—Otolaryngology, 4th edn. Lippincott Williams & Wilkins, Philadelphia, p 2635Google Scholar
  15. 15.
    Paris J, Richard O, Lafont B et al (2007) Aesthetic parotidectomy: face lift incision and SMAS flap]. Rev Laryngol Otol Rhinol (Bord) 128:261–264Google Scholar
  16. 16.
    Upile T, Jerjes W, Nouraei SA et al (2009) The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study. World J Surg Oncol 7:71PubMedCrossRefGoogle Scholar
  17. 17.
    Biley BJ, Johnson JT (2006) The aging face (rhytidectomy) In Kridel RWH, editor, Head and Neck Surgery-Otolaryngology, 4th edn. Lippincott williams & Wilkins, Philadelphia, p 555Google Scholar
  18. 18.
    Myssiorek D (1999) Removal of the inferior half of the superficial lobe is sufficient to treat pleomorphic adenoma in the tail of the parotid gland. Arch Otolaryngol Head Neck Surg 125:1164–1165PubMedGoogle Scholar
  19. 19.
    Gordon AB, Fiddian RV (1976) Frey’s syndrome after parotid surgery. Am J Surg 132:54–58PubMedCrossRefGoogle Scholar
  20. 20.
    Yu GY, Ma DQ, Liu XB et al (1998) Local excision of the parotid gland in the treatment of Warthin’s tumour. Br J Oral Maxillofac Surg 36:186–189PubMedCrossRefGoogle Scholar
  21. 21.
    Yamashita T, Tomoda K, Kumazawa T (1993) The usefulness of partial parotidectomy for benign parotid gland tumors. A retrospective study of 306 cases. Acta Otolaryngol Suppl 500:113–116PubMedCrossRefGoogle Scholar
  22. 22.
    Wennmo C, Spandow O, Emgard P et al (1988) Pleomorphic adenomas of the parotid gland: superficial parotidectomy or limited excision? J Laryngol Otol 102:603–605PubMedCrossRefGoogle Scholar
  23. 23.
    Guntinas-Lichius O, Gabriel B, Klussmann JP (2006) Risk of facial palsy and severe Frey’s syndrome after conservative parotidectomy for benign disease: analysis of 610 operations. Acta Otolaryngol 126:1104–1109PubMedCrossRefGoogle Scholar
  24. 24.
    Moyer JS, Baker SR (2005) Complications of rhytidectomy. Facial Plast Surg Clin North Am 13:469–478PubMedCrossRefGoogle Scholar
  25. 25.
    Marshall AH, Quraishi SM, Bradley PJ (2003) Patients’ perspectives on the short- and long-term outcomes following surgery for benign parotid neoplasms. J Laryngol Otol 117:624–629PubMedCrossRefGoogle Scholar
  26. 26.
    Curry JM, Fisher KW, Heffelfinger RN et al (2008) Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Laryngoscope 118:210–215PubMedCrossRefGoogle Scholar
  27. 27.
    Wille-Bischofberger A, Rajan GP, Linder TE et al (2007) Impact of the SMAS on Frey’s syndrome after parotid surgery: a prospective, long-term study. Plast Reconstr Surg 120:1519–1523PubMedCrossRefGoogle Scholar
  28. 28.
    Foustanos A, Zavrides H (2007) Face-lift approach combined with a superficial musculoaponeurotic system advancement flap in parotidectomy. Br J Oral Maxillofac Surg 45:625–652Google Scholar
  29. 29.
    Cesteleyn L, Helman J, King S et al (2002) Temporoparietal fascia flaps and superficial musculoaponeurotic system plication in parotid surgery reduces Frey’s syndrome. J Oral Maxillofac Surg 60:1284–1297 discussion 97–98PubMedCrossRefGoogle Scholar
  30. 30.
    Allison GR, Rappaport I (1993) Prevention of Frey’s syndrome with superficial musculoaponeurotic system interposition. Am J Surg 166:407–410PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • So-Yoon Lee
    • 1
  • Yoon Woo Koh
    • 1
  • Bo Gyung Kim
    • 1
  • Hyun Jun Hong
    • 1
  • Jun Hui Jeong
    • 1
  • Eun Chang Choi
    • 1
  1. 1.Department of Otorhinolaryngology (120-752)Yonsei University College of MedicineSeoulKorea

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