Comparative Study Between Extracapsular Dissection and Superficial Parotidectomy in Treatment of Benign Parotid Tumors

DISCUSSION

The parotid gland is the most prevalent location for salivary gland tumours, accounting for 60-75 percent of all occurrences with 85 percent of parotid tumours occurring in the superficial lobe 11 percent in the deep lobe and 1% in the accessory lobe ⁵. The superficial parotidectomy involves locating the facial nerve trunk, dissecting along all of its branches and removing the parotid's superficial lobe ⁶

Extracapsular dissection (ECD) occurs when the tumour is removed with only the immediate pseudocapsule and the facial nerve branches are not identified or dissected ⁷ In our research, we discovered that 29 patients (58%) in the superficial parotidectomy group were male.21 patients was female 42% with mean age of 36.86± 7.21 years In the extracapsular dissection group, there were 26 patients (52 percent) male and 24 patients (48 percent) female, with a mean age of 38.947.51 years (table 1) However, contrary to the findings of benign parotid tumours were found in 40.8 percent of males and 59.2 percent of women ⁸ Men made up 51.6 percent of the benign parotid tumours and. The average age of diagnosis for benign tumours was 50.7 19.2 years. ⁹A total of 100 instances of parotid gland tumours were examined in this investigation. The average age of parotid gland tumours was 48.58 years, with a range of 18 to 71 years. ¹⁰ In SP, 48 patients (96 percent) were unilateral, 2 patients (4 percent) were bilateral, and 50 patients (100 percent) were unilateral in ECD (table 2) the unilateral parotid gland was more often impacted than the bilateral parotid gland which was found in one patient  and histology confirmed Warthin's tumour in a survey of 100 cases.¹⁰, The most prevalent clinical finding in SP 48 patients (96 percent) is swelling, with 2 patients (4 percent) reporting no swelling, and in ECD 47 patients (94 percent) reporting no swelling. The second most common complain is pain which accounts for sp 3 patients (6%) and 47 patients (94 percent) There is no discomfort in ECD. 4 patients (8%) and 46 patients (92%) had no pain (table 3) Slowly increasing enlargement of the parotid gland was the most frequent clinical manifestation ^11. the first finding in patients with parotid was painless swelling (79%) followed by pressure feeling (10%) and pain (3%).  ^12, the most frequent pathological type in SP pleomorphic adenoma 40 patients (80%) and warthin tumour 3 individuals in our study (6 percent ) Patients with parotid lymph node 3 (6%), and patients with basal cell adenoma 1 (1%). oncocytoma1 patients (2%), cavernous hemangioma2 patients (4%), patients (4%), and ECD pleomorphic adenoma 40 patients (80%) and warthin tumour 4 individuals (8 percent ) Patients with parotid lymph node 2 (4%), basal cell adenoma 2 (4%), oncocytoma 1 (2%), cavernus haemangioma 1 (2%)., (table 4) Pleomorphic adenoma is the most prevalent benign tumour, accounting for 60.9 percent of all cases. followed by Warthin's tumor (30.4%), Basal cell adenoma (6.5%) and hemangioma (2.2%). ¹³, In terms of tumour size, SP 5.12± 1.62 cm and ECD 3.42 ±0.64 cm are comparable. ECD PT was dramatically decreased when compared to that of SP (127.36) minutes vs. ECD 42.80±5.54 minutes. This was expected because to the time it took to first locate the FN stem and then dissect its many branches during SP. ¹⁴, The follow up for  one year with clinical examination and Imaging studies(ultrasound and MRI) to detect complications The occurrence of recurrence in SP 5 patients (10 percent ). patients with ECD 3 patients (6 percent ). (table 7) This is distinct When comparing ECD with superficial parotidectomy, a study from a high-volume parotid facility found no statistically significant difference in capsule rupture (3.4 vs. 1.8 percent ) ¹⁵ A total of 176 patients were tracked for 52 months in this study. When ECD was compared to superficial parotidectomy, the risk of recurrence was 4.5 percent against 3.6 percent. ¹⁶ in our study in S p the Permanent facial nerve dysfunction is 2 %, transient dysfunction 20 % and Frey’s syndrome 20% and in ECD the  Permanent facial nerve dysfunction is (0 %)  transient dysfunction 10  % Frey’s syndrome 4 % this differ from results in sp the Permanent facial nerve dysfunction is reported 4 %, transient dysfunction 25 % and Frey’s syndrome 17 % and in ECD the incidence Permanent facial nerve dysfunction is (2 %)  transient dysfunction 11 % and Frey’s syndrome3 %.17

Summary

Pleomorphic adenoma is the most common benign parotid tumour, followed by Warthin tumour and, less commonly, oncocytoma and basal cell adenoma. The majority of cancers begin in the superficial lobe and manifest as slow-growing masses under the ear. The initial non-invasive method for localising superficial tumours, differentiating solid masses from cystic collections, and guiding fine-needle aspiration biopsy is Ultrasound The superficial parotidectomy is a technique that involves the complete removal of the superficial lobe, dissection and preservation of the main trunk of the facial nerve and its branches, while ECD is a technique that involves a whole excision of the mass. Without planned dissection of the main trunk of the facial nerve, it is surrounded by healthy parotid gland tissue. In our research, we performed ECD on 50 patients and followed them up for a year to determine the recurrence rate and compare it to 50 other patients PS is dune. We used SP to identify recurrence rate after one year after surgery and discovered that ECD had a lower recurrence rate than SP.

CONCLUSION

Conservative parotidectomy has a comparable recurrence rate to superficial parotidectomy and may be a suitable alternative in the treatment of benign parotid tumours that are situated in the superficial lobe, mobile, and tiny (the diameters are less than 5cm).