A modified V-shaped incision combined with superficial musculo-aponeurotic system flap for parotidectomy

Abstract

Background: V-shaped incision (VSI) for parotidectomy had been introduced for cosmetic purpose. Despite having aesthetic superiority, it required excessive retraction or an additional hairline incision for adequate surgical exposure. To overcome these problems, we conceptualized a modified VSI approach combined with a separate superficial musculo-aponeurotic system flap.

Aims: This study aimed to propose this approach and evaluate its technical feasibility and efficacy for excision of parotid tumors.

Materials and methods: This is a prospective, nonrandomized study involving 74 patients with small-to-medium (<4 cm), benign parotid tumors located superficially. The patients were divided into two groups based on the incision techniques used: modified VSI and modified Blair incision (MBI). The clinical outcomes of both approaches for parotidectomy were analyzed.

Results: Thirty-four patients underwent modified VSI approach, while 40 underwent MBI. All parotidectomies with modified VSI were successfully completed without any further incision, and no facial nerve injury or intraoperative tumor rupture complication was reported. There were no significant differences in the complications between both approaches, such as hematoma, infection, wound dehiscence, skin necrosis, sialocele, or sensory disturbance. The modified VSI group showed better cosmetic satisfaction results than did the MBI group (9.2 and 7.8, respectively; p < .001).

Conclusions and significance: The modified VSI approach is safe and feasible for small-to-medium benign parotid tumors. This approach could be a possible option for patients with a high cosmetic demand.

Level of Evidence: 4.

Study design: Prospective pilot study.

Chinese abstract

背景：腮腺切除术中采用V形切口（VSI）是出自外观考虑。尽管它具有美学上的优越性, 但它需要过度收缩或额外的细切口, 以便于充分的手术暴露。为了克服这些问题, 我们提出了一种改进的与一个浅表肌肉筋膜系统皮瓣相结合的V形切口（VSI）。

目的：提出这一方法并探讨它对腮腺肿瘤切除的技术可行性和疗效。

材料和方法：这是一项前瞻性的非随机研究, 涉及74例位于浅表的中小型（<4 cm）良性腮腺肿瘤的患者。根据所采用的切口技术, 将患者分为两组：改进的VSI和改进的布莱尔切口（MBI）。分析了这两种腮腺切除术的临床效果。

结果：34例患者采用改进的VSI; 40例患者采用MBI。所有改进的VSI腮腺切除术均成功完成, 无需进一步切开, 且无面神经损伤或术中肿瘤破裂并发症。两种方法在并发症方面没有显著差异, 如血肿、感染、伤口裂开、皮肤坏死、涎腺或感觉障碍。改进的VSI组比MBI组有更好的外观满意度（分别为9.2和7.8, P < 0.001）。

结论与意义：改进的VSI法对中小型良性腮腺肿瘤是安全可行的。对外观要求高的患者, 这种方法可能是一种可行的选择。

Keywords:

• Parotid tumor
• partial parotidectomy
• V-shaped incision
• minimal incision
• superficial musculo-aponeurotic system flap