Parotidectomy: surgery in evolution

Background: Approximately 15 years ago, Bron and O'Brien described a large Australian series of 248 patients focusing on facial nerve function post parotidectomy performed by a single surgeon over an 8-year period. The primary aim of this study was to assess changes in pathology, surgical approach and outcomes following parotidectomy in a comparable single surgeon series from the same institution. 

Methods: Details of patients undergoing parotidectomy by, or under the supervision of, the senior author (JRC) between February 2006 and December 2013 were retrospectively reviewed. Operative reports and post-operative complications were recorded using standardized templates. Comparison with the Bron and O'Brien outcomes is presented.

Results: A total of 405 consecutive parotidectomies were performed for both benign and malignant disease in 401 patients. Univariable predictors of facial nerve weakness (temporary or permanent) on logistic regression were neck dissection (odds ratio 2.1, 95% confidence interval (CI) 1.23-3.67, P = 0.007) and operation type, with focused tumour dissection having 0.07 times the odds (95% CI 0.01-0.52, P = 0.010) and a limited parotidectomy approach having 0.5 times the odds (95% CI 0.26-0.91, P = 0.024) of facial palsy compared with a complete superficial parotidectomy. 

Conclusion: A number of changes in the management of parotid pathology in Australia have occurred in the last two decades, including improvements in the characterization of malignant parotid tumours, a continuing evolution towards less aggressive surgery, a more selective approach to elective neck dissection and an increasing appreciation of the techniques that can be used to minimize the aesthetic complications of parotid surgery.