Extracapsular dissection versus superficial parotidectomy: real-world comparison of postoperative complications and facial nerve injury.

BACKGROUND

Superficial parotidectomy (SP), involving routine facial nerve (FN) dissection, is the standard approach for benign superficial parotid tumors. Extracapsular dissection (ECD) offers a less invasive alternative by avoiding formal FN identification, but large-scale comparative data remain limited.

OBJECTIVE

To compare postoperative complication rates between ECD and SP.

METHODS

This retrospective study used the TriNetX database to identify adults with benign superficial parotid tumors who underwent ECD or SP. Propensity score matching (PSM) was performed to balance baseline covariates. Primary outcomes within 30 days included overall FN injury, surgical site infection, wound disruption, postoperative bleeding, and salivary fistula. Secondary outcomes were all-cause mortality, hospital admission, and emergency department visits within 30 days. Facial reanimation procedures were assessed at 180 days, and at 1, 3, and 5 years.

RESULTS

PSM yielded 1839 patients per group. ECD was associated with a significantly lower 30-day FN injury risk than SP (HR: 0.458; 95% CI: 0.273-0.768). No significant differences were observed for surgical site infection (HR: 0.674; 95% CI: 0.325-1.399), wound disruption (HR: 1.521; 95% CI: 0.541-4.273), postoperative bleeding (HR: 0.905; 95% CI: 0.471-1.742), salivary fistula (HR: 0.338; 95% CI: 0.068-1.676), all-cause mortality (HR: 1.014; 95% CI: 0.063-16.21), hospital admission (HR: 0.931; 95% CI: 0.684-1.267), or emergency department visits (HR: 1.259; 95% CI: 0.888-1.784). Facial reanimation rates were comparable at all time points.

CONCLUSIONS

In this large, real-world cohort, ECD significantly reduced the early risk of FN injury compared with SP, without increasing other short-term complications or long-term facial reanimation rates. These findings support ECD as a favorable option for selected patients with benign superficial parotid tumors following shared decision-making.