Search

Objectives: Surgery for benign parotid tumours is associated with potential sequelae which may significantly deteriorate patient's quality of life. Sometimes the pursuit of reducing the risk of these complications induces surgeon to limit the extent of the parotid gland removed with a tumour. This may lead to a decrease in tumour local control which is especially true for pleomorphic adenoma. The purpose of this study was to evaluate the incidence of complications after certain types of parotid surgery for primary pleomorphic adenomas and to analyse risk factors related to their occurrence., Materials and Methods: The medical records of 386 consecutive patients (250 women and 136 men) operated on for primary pleomorphic adenoma between the years 1988 and 2008 at the Otolaryngology Department, Medical University of Warsaw, were reviewed., Results: Postoperative facial nerve impairment was the most common complication of parotid surgery for primary pleomorphic adenomas (found in 84 [21.8%] of patients). The other adverse effects of this type of surgery included: sialocele (12.2%), salivary fistula (6.7%), Frey's syndrome (6.2%), and hematoma (2.8%). Significantly more often iatrogenic facial nerve injury was encountered in women and in the elderly. Impaired function of the facial nerve was found more commonly after total parotidectomy (41.9%; p<0.001), and least commonly after extracapsular tumour resection (4.8%; p=0.036). The lack of sialoceles and salivary fistulas after extracapsular tumour resection and isolated deep parotidectomy was symptomatic., Conclusions: Impairment of the facial nerve function is the most common complication of surgical treatment of primary pleomorphic adenomas. Statistically significant risk factors of postoperative facial nerve dysfunction include: female gender; older patient age, tumour location in the deep lobe, type of surgical procedure (total parotidectomy). Some decrease in the incidence of sialoceles and salivary fistulas may be achieved by preservation of the Stensen's duct or by radical resection of glandular tissue., (Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.)

Unlabelled: Negative emotions due to violate facial appearance resulting from dentofacial disharmony may affect psychological status and general life adjustment of the patient. This is the origin of clinicians' great responsibility for satisfying result of surgical treatment in patients with mandibular prognathism. The aim of the study was evaluation of incidence of intraoperative and postoperative complications during surgical treatment of mandibular prognathism with bilateral mandibular sagittal ramus osteotomy or mandibular bilateral vertical ramus osteotomy and defining predisposing factors., Material and Methods: A sample of 37 patients with mandibular prognathism operated in Department of Cranio-Maxillofacial Surgery in Lódź from May 2001 to February 2006 was included into the study. The patients were underwent surgery with mandibular bilateral sagital osteotomy (intraoral approach) or mandibular vertical ramus osteotomy (extraoral approach). Demographic data (gender and age) and medical data (method of surgery, time of hospitalization) were collected. Intraoperative and postoperative complications were recorded as well acceptance of scar., Results: Facial nerve paralysis immediately after surgery and 6 months after surgery was observed in group of patients operated with vertical ramus osteotomy (6 and 3 patients respectively to time), and released completely after 12 months. Early and permanent paraesthesia was recorded more often in group of patients operated with sagittal split ramus osteotomy (respectively 14/17 and 2/17 for early and permanent paraesthesia) in contrast to 3 of 20 patients operated with vertical ramus osteotomy. Permanent (12 months postoperatively) paraesthesia within third branch of trigeminal nerve were diagnosed more often in patients over 25 years old. 3 patients operated with sagittal split ramus osteotomy demonstrated unilateral wound healing problems and 4 patients operated with vertical ramus osteotomy demonstrated wound healing problems and it was related to unacceptable cicatrix., Conclusions: 1. Frequency of intraoperative and postoperative complications in surgical treatment of mandibular prognathism is independent on patients' gender and age. 2. The choice of sagittal split ramus osteotomy is related to higher probability of paraesthesia within lower lip immediately after surgery, but the early risk of facial nerve paralysis is greater after extraoral vertical ramus osteotomy.

Background and Purpose: Facial nerve paralysis significantly decreases the quality of life in patients after skull base tumors surgery. There are different options for surgical repair of the nerve. One of the most effective methods is the anastomosis of the distal trunk of the facial nerve with the proximal trunk of the hypoglossal nerve or with hypoglossal loop., Material and Methods: Thirteen hypoglosso-facial anastomoses had been performed in our department between 1999 and 2003. In all patients the facial nerve paralysis was due to the surgery in its proximity. In one case the patient suffered from petroclival chordoma, in one case ameloblastoma, one was with petroclival meningioma and the rest of cases were after vestibular schwannoma. The follow-up period lasted from 6 months to three years. The final result was expressed in House-Brackmann scale (HB) describing facial muscle strength., Results: In two cases there was no improvement (HB 6), in two cases barely perceptible motion (HB 5), in five obvious weekness with disfiguring assymetry (HB 4) and in four obvious but not disfiguring dysfunction (HB 3). There was only one postoperative complication haematoma at the place of anastomosis requiring evacuation., Conclusion: Hypoglosso-facial anastomosis remains one of the most important techniques of the reanimation of the paralysed face. Its efficacy is limited, but it is a relatively safe procedure.