Comparison of surgical outcomes between anterograde and retrograde approaches for partial superficial parotidectomy in pleomorphic adenoma: A new surgical technique of the retrograde approach guided by the zygomatic branch.

OBJECTIVE: Partial superficial parotidectomy is commonly performed for pleomorphic adenoma of the parotid gland. The Blair incision, frequently used for superficial parotidectomy, provides wide surgical exposure but leaves a visible periauricular scar misaligned with facial skin cleavage lines. To enhance esthetics and reduce invasiveness, we use the anterograde approach (AA) with a postauricular incision or the retrograde approach (RA) guided by either the zygomatic branch (ZB) with preauricular incisions or the marginal mandibular branch (MB) with an arc-shaped neck incision, depending on tumor location. Notably, the RA guided by the ZB with preauricular incision is a novel technique. This study presents a new RA technique and defines indications for AA and RA.

METHODS: The approach varied depending on tumor location. If the tumor was located in the tail or anterior border of the parotid gland, we selected the RA guided by the marginal MB using an arc-shaped neck incision or the RA guided by the ZB using a preauricular incision within the sideburns, respectively. For other cases, AA using a postauricular incision was selected regardless of the tumor size.

RESULTS: Among 241 patients, AA was performed in 195 and RA in 46 patients; MB- and ZB-guided RA were performed in 20 and 26 patients, respectively. The mean operation times for AA and RA were 94.6 and 64.0 min, respectively. The mean operation times for MB- and ZB-guided RA were 77.1 and 53.8 min, respectively. The operation time was significantly shorter in RA than in AA; ZB-guided RA had the shortest operation time in the three groups. The mean bleeding volumes were 43.8 and 11.4 mL in AA and RA cases, respectively. The mean bleeding volumes of MB- and ZB-guided RA were 17.6 and 6.8 mL, respectively. The bleeding volume was significantly less in RA than in AA; ZB-guided RA had the least bleeding volume in the three groups. Complication rates were low, and postoperative incision scars along the postauricular and neck cleavage lines or on sideburns were cosmetically satisfactory.

CONCLUSION: In the present study, we reported a novel surgical technique for RA guided by the ZB. The surgical results and postoperative aesthetic outcomes were favorable, supporting the appropriateness of our surgical indications for AA and RA and the utility of RA guided by ZB with a preauricular incision.