AUTHOR=Zanghì Antonio , Cavallaro Andrea , Marchi Martine , Marchi Marcello , La Via Luigi , Sanfilippo Filippo , Cappellani Alessandro , Di Majo Simone TITLE=Surgical management of benign tumors of the parotid gland: the advantages of extracapsular dissection compared to traditional surgical techniques JOURNAL=Frontiers in Surgery VOLUME=11 YEAR=2025 URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2024.1415485 DOI=10.3389/fsurg.2024.1415485 ISSN=2296-875X ABSTRACT=

Among all head and neck neoplasms, salivary gland tumors account for only 3% to 6 % of cases. Most salivary gland tumors (70%) are found in the parotid. Their location is mostly in the more abundant superficial portion of the parotid gland, lying lateral to the facial nerve. For many years the presence of the facial nerve between the superficial and deep segments of the parotid gland served as a deterrent to adequate tumor extirpation. Different surgical options are available for treating benign tumors of the parotid gland, but there is still no universal agreement on what the optimal surgical treatment is. In the first half of the XX century tumor enucleation was performed as a standard surgical treatment of parotid tumors to preserve the facial nerve, but high recurrence rates were the main downside of this procedure. In order to improve the outcome, superficial parotidectomy was implemented including in the tumor excision the whole lateral segment of the parotid gland, superficial to the facial nerve. Nonetheless, even this improved surgical procedure may lead to severe postoperative complications in a considerable proportion of patients such as facial nerve paralysis. Over later years more gland-preserving techniques were developed in the quest for reduction of complication rates, improving the safety of procedures and patients' satisfaction, without increasing the risk of recurrence. This study compares our surgical experience with extracapsular dissection-gland sparing surgery (ECD) to more traditional superficial parotidectomy on 56 patients who underwent surgery performed by the same surgical team. The superiority of ECD procedures compared to SP procedures was shown as far as total complication rates is concerned. In this case Fisher exact test statistic value was 0.0043 (significant at p < 0.05). ECD should be applied in properly selected cases and further prospective studies may clarify the optimal indications.