In this study, we reviewed the post-operative complications in parotidectomy and its association with various patient, tumour and surgical factors.

All parotidectomies performed in our regional unit between 2013 to 2020 were identified. Electronic medical record and clinic letters were reviewed for any post-operative complications. A logistical regression model was applied on data collected on twelve patient factors, three tumour factors and four surgical factors.

379 cases of parotidectomy were identified in the eight-year study period. 55% (n = 210) were documented with nine types of post-operative complications. This study identified age >80 (odds ratio = 1.89, p = 0.018), active smoker (odds ratio = 0.94, p = 0.018), total parotidectomy approach (odds ratio = 1.77, p = 0.012), longer operation time (odds ratio = 0.006, p = 0.015) and hypertension (odds ratio = 1.23, p = 0.019) were associated with a higher risk of facial nerve palsy. Predictive factors were also identified for auricular nerve numbness and Frey syndrome.

This study revealed the incidences and potential predictors of post-operative complications in parotidectomy. Notably, the grade of operator (consultants/ registrars) had no effect on the possibility of adverse outcome, reflecting patient safety was not compromised for training. These findings can be used in patient counselling and guide treatment options to minimise post-operative complications.

To analyse the treatment results of bilobed flap reconstruction performed for skin defects after parotid carcinoma surgery.

Ten patients who underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery in our hospital, from 2014 to 2020, were retrospectively enrolled.

All patients underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery. The size of the skin defect was 2.7 × 2.2 cm in the smallest dimension and 9.0 × 6.3 cm in the largest dimension. All bilobed flaps except one healed without any problems. One patient developed partial flap necrosis in the retroauricular region, and was treated with skin grafts after removal of the necrotic tissue under local anaesthesia. All bilobed flaps, including the cases in which skin grafts were performed, survived after post-operative radiotherapy or chemotherapy.

A bilobed flap is a good reconstruction option for skin defects after parotid carcinoma surgery in some cases.

To evaluate the efficacy and safety of segmental superficial parotidectomy in the surgical treatment of benign parotid tumours.

Patients who underwent parotidectomy for benign primary parotid tumours limited to the superficial lobe were retrospectively reviewed. Tumour location, size, surgical procedure, follow-up period, complications and recurrence rates were noted.

The study included a total of 39 patients: 22 underwent segmental superficial parotidectomy (group 1) and 17 underwent superficial parotidectomy (group 2). The mean follow-up period was 41.79 months (range, 13–85 months). There were no recurrences in either group during the follow-up period. No significant differences were found between the two groups in terms of tumour size, complications or recurrence rates.

Segmental superficial parotidectomy is a safe and effective option in the surgical treatment of benign parotid tumours.

To investigate the rate of occult neck disease in patients with metastatic squamous cell carcinoma to the parotid gland following parotidectomy and neck dissection.

A consecutive series of patients treated between 2000 and 2014 for metastatic squamous cell carcinoma to the parotid were analysed. Patients were included if they had no clinical or radiological evidence of neck disease. Pathology of parotidectomy and neck dissection specimens was reviewed. Other variables analysed included patient immune status, surgery type, complications, use of positron emission tomography scanning and treatment with radiotherapy.

Sixty-five patients had no clinical or radiological evidence of neck disease initially. Forty-six patients (70.8 per cent) underwent neck dissection. Occult neck disease was only found in 8 of the 46 patients (17.3 per cent). Occult neck disease was found more often in those with immunocompromise (5.7 vs 38.5 per cent, p = 0.003). Patients who were immunocompromised had a significantly worse disease-specific survival rate at five years (0 vs 92 per cent, p = 0.0001).

Occult neck disease was seen in 17.3 per cent of patients and immunosuppression was a significant predictor for this.

To report three cases illustrating that it is not unusual for a primary eyelid tumour to metastasise to the parotid gland and vice versa.

Two patients with malignant parotid tumours underwent radical parotidectomy and presented subsequently with eyelid lesions. Biopsy showed that both eyelid lesions were histologically similar to the primary parotid tumour. A third patient was noted to have ipsilateral upper eyelid and parotid gland tumours. Histology and immunocytochemistry were used to differentiate the primary tumour and the metastasis.

These cases illustrate that tumours involving eyelids and parotid glands can present simultaneously or sequentially, and either of these structures could be the focus of primary or metastatic tumour. The important message for oculoplastic and parotid surgeons is to routinely assess both the periocular and parotid area when patients present with a mass in either structure.

This study aimed to identify the pattern of post-operative drainage following partial superficial parotidectomy with and without the use of a bipolar vessel-sealing device.

Of the 49 patients undergoing parotidectomies, a bipolar vessel-sealing device was used for 20. Predictive factors included in the analysis were age, sex, body weight, operating time, tumour pathology, and diabetes mellitus, hypertension and smoking status.

In multivariate analyses, body weight (p = 0.026) and non-use of a bipolar vessel-sealing device (p = 0.009) were significantly associated with increased post-operative drainage after 24 hours. There was also a trend towards increased drainage in diabetic patients. Operating times were significantly shorter in the bipolar vessel-sealing device group.

Although 24-hour drainage appears adequate for most patients, in obese and diabetic individuals there is a risk of requiring increased drainage. Therefore, the drain should be left in place for a longer period. The bipolar vessel-sealing device is safe and time-efficient, and decreases the post-operative drainage period.

This study aimed to investigate the impact on patients' quality of life of great auricular nerve sacrifice during parotidectomy.

A retrospective review was conducted of 191 consecutive patients who underwent parotidectomy with great auricular nerve sacrifice between 2006 and 2011. Residual sensory dysfunction and its impact on quality of life was analysed using an eight-item quality of life survey.

In all, 139 out of 191 patients (72.8 per cent) experienced one or more abnormal sensations in the ear or neck region after surgery. There was a moderate inverse correlation between the number of abnormal sensations and time elapsed since surgery. Moreover, the degree of discomfort correlated significantly with the frequency of symptom occurrence (p < 0.001), duration of the abnormal sensation (p < 0.001) and size of the affected area (p < 0.001).

Sacrifice of the great auricular nerve has only a small impact on patient quality of life; their daily activities are not significantly affected.

Post-operative facial palsy is the most important potential complication of parotid surgery for benign lesions. The published prevalence of facial weakness is up to 57 per cent for temporary weakness and up to 7 per cent for permanent weakness. We aimed to identify potential risk factors for post-operative facial palsy.

One hundred and fifty patients who had undergone parotid surgery for benign disease were retrospectively reviewed. Tumour factors (size, location and histopathology), patient factors (age and sex) and operative factors (operation, surgeon grade, surgeon specialty and use of intra-operative facial nerve monitoring) were all analysed for significant associations with post-operative facial palsy.

The overall incidence of facial palsy was 26.7 per cent for temporary weakness and 2.6 per cent for permanent weakness. The associations between facial palsy and all the above factors were analysed using Pearson's chi-square test and found to be non-significant.

These outcomes compare favourably with the literature. No significant risk factors were identified, suggesting that atraumatic, meticulous surgical technique is still the most important factor affecting post-operative facial palsy.

Apart from its role as an inhibitory neurotransmitter, γ-aminobutyric acid is also thought to regulate various stages of cell proliferation and differentiation in the brain and periphery. The present study aimed to assess the levels of γ-aminobutyric acid and its biochemical precursor glutamic acid (glutamate) in benign parotid tumours and in unstimulated parotid saliva.

Unstimulated parotid saliva was collected bilaterally, using the swab method, in 20 patients with unilateral pleomorphic adenoma or Warthin's tumour. Samples of tumour and adjacent salivary tissue were collected during tumour resection.

Concentrations of γ-aminobutyric acid and glutamate, but not aspartate, were significantly higher in the tumour tissue than in the non-tumour tissue. There was no significant difference in salivary concentrations of γ-aminobutyric acid, glutamate or aspartate, comparing the involved and non-involved side.

The present results provide preliminary evidence that γ-aminobutyric acid may be involved in the growth of benign parotid tumours.

The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history.

We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis.

One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607–17.434).

In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.

To establish whether there is a requirement for a network policy on management of suspected intraparotid lymphoma, and to answer the question, ‘Can lymphoma of the parotid region be adequately diagnosed, typed and treated on the basis of a core biopsy, within the West of Scotland?’

We identified 22 patients from the West of Scotland Managed Clinical Network database who had been diagnosed between 2003 and 2005 with lymphoma of the parotid region (nodal or extranodal). These 22 cases were reviewed, assessing specifically their investigation and diagnosis (compared with the World Health Organization classification of parotid lymphoma).

Three of the 22 patients underwent core biopsy to diagnose and type their lymphoma. All these procedures were performed within a single centre.

It is possible to successfully perform core biopsy of parotid lymphoma lesions (generally under ultrasonic guidance). This may obviate the need for open procedures. Close collaboration with haematology, pathology, radiology, and head and neck colleagues is required.

To determine whether ultrasound-guided core needle biopsy is a safe and reliable investigation in cases of parotid swelling in which fine needle aspiration cytology has failed to give a definitive diagnosis.

Analysis of 66 ultrasound-guided core biopsy specimens of the parotid gland (the largest series reported thus far) sample number refers to histological samples throughout the paper.

All the 184 cases of parotid surgery with a histological diagnosis were included.

The sensitivity, positive predictive value and diagnostic accuracy of fine needle aspiration cytology and ultrasound-guided core needle biopsy, as compared with the final histological analysis.

Of a total of 184 patients, 89.1 per cent (164/184) had benign parotid lesions excised. The sensitivity, positive predictive value and diagnostic accuracy of fine needle aspiration cytology for benign lesions were 76.2, 84.2 and 87.5 per cent, respectively, and those of ultrasound-guided core needle biopsy were 91.7, 98.2 and 96.4 per cent, respectively. Twenty of 184 patients (10.9 per cent) had malignant lesions. The sensitivity, positive predictive value and diagnostic accuracy of fine needle aspiration cytology for detection of malignant lesions were 60, 75 and 75 per cent, respectively, while those of ultrasound-guided core biopsy were 89, 100 and 100 per cent, respectively. Non-diagnostic rates were 25.8 per cent for fine needle aspiration cytology and 4.5 per cent for ultrasound-guided core biopsy. Only one case of complications (a sub-clinical haematoma) occurred in the ultrasound-guided core biopsy group.

We propose ultrasound-guided core needle biopsy as a very safe and effective tool in cases of parotid swelling in which fine needle aspiration cytology has failed to give a definitive diagnosis.

To evaluate quality of life after surgery for benign neoplastic disease of the parotid gland.

A quality of life questionnaire, which was created from the Hebrew version of the University of Washington Quality of Life prototype, was applied to 55 patients who underwent surgery for benign neoplastic parotid disease. All patients were examined in Baskent University Adana Teaching and Medical Research Center, where all except 10 subjects (who responded by phone) completed the quality of life questionnaire.

The highest overall score was 96.3 indicating no salivary fistula. Only one patient complained of salivary secretion through the wound scar. The lowest overall score was 59.5 indicating loss of sensation. Although no post-surgical pain was reported by 32 (58 per cent) patients, 16 (29 per cent) patients reported a post-surgical change in their appearance. Scarring and surgical site depression were reported by 26 (47 per cent) and 17 patients (30 per cent), respectively. Facial nerve impairment was reported by seven patients (13 per cent) during the early post-operative period; these patients recovered from that impairment. The only significant statistical correlations were noted between general health and gender, and between post-surgical pain and gender. There was not any statistical correlation between all data and age, tumour type and education level.

The general status of patients who have undergone surgery for a benign parotid neoplasm can be assessed with a quality of life questionnaire. Patients' post-surgical quality of life can be improved by the correct choice of surgical approach and reconstructive method.