The multiplanar analysis of the retromandibular vein in surgical planning for parotid gland tumors
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To analyze the effectiveness of the multiplanar analysis of the retromandibular vein in establishing the position of the parotid gland tumor and its relationship with the facial nerve, together with the most common radiological criteria (facial nerve line, Utrecht line, retromandibular vein and parapharyngeal space variations) using the magnetic resonance imaging.
Tertiary Academic Hospital
Subjects and methods
128 preoperative magnetic resonances were analyzed to study preoperative tumor location (medial or lateral to the expected course of the facial nerve) based on comparison between the radiological criteria and the surgical findings.
FN line had the lowest accuracy at 77%, whereas the retromandibular vein achieved 85% accuracy and the UT line achieved accuracy of 93%. The retromandibular vein could not be identified in 11 cases (9%). The multiplanar evaluation of the retromandibular vein allowed us to identify it on almost all MR images (99% of cases) and reach 87% of accuracy. The parapharyngeal space evaluation achieved 92% of accuracy. In the subgroup of 66 cases where the neoplasms were strictly related to the main trunk, where the surgery entailed manipulation if situated laterally to the tumor, the multiplanar evaluation of the retromandibular vein reached 98% of accuracy and UT line achieved 94%.
The multiplanar modality, combined with the evaluation of the parapharyngeal space, is effective in helping the surgeon to achieve accurate planning: it enables the tumor to be located and the facial nerve course predicted with a good precision.
KeywordsParotid Tumor Facial nerve Retromandibular vein
We thank Dr. Emanuela Morenghi, Biostatistic Dept. Humanitas Clinical and Research Center, Rozzano Milano, Italy
Compliance with ethical standards
We did not receive any funding and had not any sponsor in this study and it was reviewed in accordance with the principles of medical ethics and has been approved by the Ethics Independent Committee of Humanitas Clinical and Research Hospital at number 18/17.
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