Skip to main content
SpringerLink
Log in

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

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

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.

Results

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)

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  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 15:797–803

    Article  PubMed  Google Scholar 

  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 92:40–43

    Article  Google Scholar 

  3. Meningaud JP, Bertolus C, Bertrand JC (2006) Parotidectomy: assessment of a surgical technique including facelift incision and SMAS advancement. J Crani Maxillofac Surg 34:34–37

    Article  Google Scholar 

  4. Marti PC, Garcia DE, Garcia AL et al (2007) Minimal incision in parotidectomy. Int J Oral Maxillofac Surg 36:72–76

    Article  Google Scholar 

  5. Lohuis PJFM, Tan ML, Bonte K et al (2009) Superficial parotidectomy via facelift incision. Ann Otol Rhinol Laryngol 118:276–280

    PubMed  Google Scholar 

  6. Appiani E (1967) Handling of a parotidectomy and muscular graft. Prensa Med Argent 54:1242–1243

    PubMed  CAS  Google Scholar 

  7. Hinderer UT (1977) Prevention of unsatisfactory scarring. Clin Plast Surg 4:199–205

    PubMed  CAS  Google Scholar 

  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 9:402–408

    Article  PubMed  CAS  Google Scholar 

  9. Terris DJ, Tuffo KM, Fee WE Jr (1994) Modified facelift incision for parotidectomy. J Laryngol Otol 108:574–578

    Article  PubMed  CAS  Google Scholar 

  10. Nouraei SAR, Al-Yaghchi C, Ahmed J et al (2006) An anatomical comparison of Blair and facelift incisions for parotid surgery. Clin Otolaryngol 31:531–534

    Article  PubMed  CAS  Google Scholar 

  11. Upile T, K.Jerjes W, Nouraei SAR et al (2010) Further anatomical approaches to parotid surgery. Eur Arch Otorhinolaryngol 267:793–800

    Article  PubMed  Google Scholar 

  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 29:315–319

    Article  PubMed  Google Scholar 

  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 32:2200–2203

    Article  PubMed  Google Scholar 

  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 2635

    Google Scholar 

  15. Paris J, Richard O, Lafont B et al (2007) Aesthetic parotidectomy: face lift incision and SMAS flap]. Rev Laryngol Otol Rhinol (Bord) 128:261–264

    CAS  Google Scholar 

  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 7:71

    Article  PubMed  Google Scholar 

  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 555

    Google Scholar 

  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 125:1164–1165

    PubMed  CAS  Google Scholar 

  19. Gordon AB, Fiddian RV (1976) Frey’s syndrome after parotid surgery. Am J Surg 132:54–58

    Article  PubMed  CAS  Google Scholar 

  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 36:186–189

    Article  PubMed  CAS  Google Scholar 

  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 500:113–116

    Article  PubMed  CAS  Google Scholar 

  22. Wennmo C, Spandow O, Emgard P et al (1988) Pleomorphic adenomas of the parotid gland: superficial parotidectomy or limited excision? J Laryngol Otol 102:603–605

    Article  PubMed  CAS  Google Scholar 

  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 126:1104–1109

    Article  PubMed  Google Scholar 

  24. Moyer JS, Baker SR (2005) Complications of rhytidectomy. Facial Plast Surg Clin North Am 13:469–478

    Article  PubMed  Google Scholar 

  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 117:624–629

    Article  PubMed  Google Scholar 

  26. Curry JM, Fisher KW, Heffelfinger RN et al (2008) Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Laryngoscope 118:210–215

    Article  PubMed  Google Scholar 

  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 120:1519–1523

    Article  PubMed  CAS  Google Scholar 

  28. Foustanos A, Zavrides H (2007) Face-lift approach combined with a superficial musculoaponeurotic system advancement flap in parotidectomy. Br J Oral Maxillofac Surg 45:625–652

    Google Scholar 

  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 97–98

    Article  PubMed  Google Scholar 

  30. Allison GR, Rappaport I (1993) Prevention of Frey’s syndrome with superficial musculoaponeurotic system interposition. Am J Surg 166:407–410

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

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: http://www.textcheck.com/certificate/AYcS8U

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology (120-752), Yonsei University College of Medicine, 250 Sungsan-ro Seodaemun-gu, Seoul, Korea

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

Authors
  1. So-Yoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoon Woo Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bo Gyung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyun Jun Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Hui Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eun Chang Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eun Chang Choi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, SY., Koh, Y.W., Kim, B.G. et al. The Extended Indication of Parotidectomy Using the Modified Facelift Incision in Benign Lesions: Retrospective Analysis of a Single Institution. World J Surg 35, 2228–2237 (2011). https://doi.org/10.1007/s00268-011-1209-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-011-1209-1

Keywords

Search

Navigation