Does increasing the incidence of extracapsular dissection for benign tumors of the parotid correlate with an increased need for revision surgery?

Objectives: The aim of this study was to investigate the hypothesis of whether extracapsular dissection (ED) of the parotid gland increases the need for revision surgery for benign tumours in comparison to traditional surgical modalities. A further aim of this study was to evaluate and compare the functional outcome of revision procedures after primary ED with other modalities involving the parotid gland in our department.

Materials and methods: All patients who underwent revision parotid surgery after a primary surgical procedure at a tertiary care hospital (University of Erlangen-Nürnberg) between 2000 and 2016 were included in our study. Data concerning the indication for revision surgery as well as the functional postsurgical outcome were obtained.

Results: 2465 cases formed our study sample. In total, revision surgery was necessary in 30/2465 cases (1.2%). 1532 patients underwent primary ED, with 17 cases requiring revision (1.1%), whereas 933 cases were managed by means of other facial nerve dissecting surgical modalities, with the indication for revision surgery in 13 cases (1.4%). Our analysis did not reveal a statistically significantly higher need for revision surgery or a higher rate of facial nerve palsies after revision surgery in the group of patients after primary ED.

Conclusion: The argument in favour of a greater need for revision surgery after primary parenchyma-sparing modalities was not sustained from our data. Due to the low revision rate and the acceptable functional results after revision surgery, we believe that extracapsular dissection is justified in cases where a benign lesion is suspected preoperatively.