RESUMEN
OBJECTIVE: Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. METHODS: We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. RESULTS: The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. CONCLUSION: The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.
Asunto(s)
Traumatismos del Nervio Facial/diagnóstico , Nervio Facial/cirugía , Neoplasias de la Parótida/cirugía , Neoplasias Cutáneas/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Nervio Facial/fisiopatología , Traumatismos del Nervio Facial/etiología , Traumatismos del Nervio Facial/fisiopatología , Traumatismos del Nervio Facial/cirugía , Parálisis Facial/etiología , Parálisis Facial/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glándula Parótida/cirugía , Neoplasias de la Parótida/fisiopatología , Evaluación del Resultado de la Atención al Paciente , Complicaciones Posoperatorias , Estudios Retrospectivos , Neoplasias Cutáneas/fisiopatología , Procedimientos Quirúrgicos Operativos/métodos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
ABSTRACT Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. Objective To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. Methods We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. Results The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. Conclusion The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.
RESUMO A lesão do nervo facial é a principal complicação neurológica relacionada às parotidectomias e, em geral, o ramo marginal mandibular é o mais frequentemente acometido. Objetivo Testar um Sistema Sunnybrook de Graduação Facial modificado (mS-FGS) como uma nova ferramenta para avaliar a função do nervo facial após a parotidectomia, enfatizando o ramo marginal mandibular. Métodos Estudo retrospectivo, baseado em prontuários de 73 casos (40 do sexo feminino, 18-84 anos, idade média = 53,2), submetidos à parotidectomia, com preservação do nervo facial. Todos os pacientes apresentavam neoplasias parotídeas ou câncer de pele avançado, e foram tratados pela autora principal entre 2006 e 2014. Resultados Neste estudo, os músculos inervados pelo ramo marginal mandibular foram os mais acometidos (72,6% dos casos), principalmente nos pacientes que realizaram esvaziamento cervical (p = 0,023). Os Escores de Movimento Voluntário obtidos pelo sistema modificado foram inferiores aos obtidos pelo original (p < 0,001). As melhores pontuações foram observadas em pacientes com tumores benignos parotídeos e os piores resultados, naqueles com câncer de pele. Pacientes que necessitaram de esvaziamento cervical e ressecção de outras estruturas, além da parótida, apresentaram escores menores (p = 0,031 e p = 0,021), evidenciados apenas pelo sistema modificado. Os tumores malignos geraram escores significativamente menores, independentemente do instrumento empregado. A análise pós fisioterapia envolveu 50 casos. Os piores resultados, após a intervenção fisioterapêutica, também foram observados nos músculos inervados pelo ramo marginal mandibular. Conclusão A avaliação da disfunção facial pós-parotidectomia, através do Sistema Sunnybrook com a modificação proposta permitiu uma apreciação mais detalhada do ramo marginal mandibular, sem prejuízo à avaliação dos demais ramos.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Neoplasias Cutáneas/cirugía , Neoplasias de la Parótida/cirugía , Traumatismos del Nervio Facial/diagnóstico , Nervio Facial/cirugía , Glándula Parótida/cirugía , Complicaciones Posoperatorias , Neoplasias Cutáneas/fisiopatología , Procedimientos Quirúrgicos Operativos/métodos , Neoplasias de la Parótida/fisiopatología , Encuestas y Cuestionarios , Estudios Retrospectivos , Traumatismos del Nervio Facial/cirugía , Traumatismos del Nervio Facial/etiología , Traumatismos del Nervio Facial/fisiopatología , Nervio Facial/fisiopatología , Parálisis Facial/etiología , Parálisis Facial/fisiopatología , Evaluación del Resultado de la Atención al PacienteRESUMEN
OBJECTIVE: To evaluate the feasibility and validity of great auricular nerve preservation during parotidectomy. METHODS: Thirty patients with parotid tumors were randomized to 2 groups. Sixteen patients (group A) underwent classic parotidectomy with sacrifice of the great auricular nerve. The surgeon tried to spare the nerve in the 14 patients (group B). Tactile sensitivity, pain sensitivity, and tactile discrimination were evaluated preoperatively and at 7 days, 30 days, 6 months, and 12 months after surgery. The regions examined were the superior helix, lobule, and infra-auricular and posterior auricular regions. RESULTS: After surgery, both groups showed lower levels of sensitivity, mainly in the lobule and in the infra-auricular region. These alterations were less pronounced in group B. Both groups showed improvement over time. In group B the tactile sensitivity reached preoperative levels by 6 months after surgery. The recuperation in group A was partial and stabilized at 6 months after surgery. CONCLUSION: Great auricular nerve preservation is technically feasible during parotidectomy, with a decrease of the sensitivity alterations in the early postoperative period and avoidance of the permanent sequelae that occur when the nerve is sacrificed.
Asunto(s)
Oído/inervación , Oído/cirugía , Glándula Parótida/inervación , Glándula Parótida/cirugía , Neoplasias de la Parótida/cirugía , Adolescente , Adulto , Anciano , Oído/fisiopatología , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Glándula Parótida/fisiopatología , Neoplasias de la Parótida/fisiopatología , Estudios Prospectivos , Recuperación de la Función/fisiología , Reproducibilidad de los Resultados , Factores de TiempoRESUMEN
Se presenta el caso de una mujer de 36 años, asintomática, amigdalectomizada desde la infancia, a quien fortuitamente se le encontró protrusión del lóculo amigdalino derecho. Una resonancia magnética mostró tumoración de 9 X 4 X 2.5 cm en el espacio parafaríngeo derecho, en aparente continuidad con el tejido parotídeo del mismo lado. Los vasos del cuello se encontraban desplazados hacia atrás. A pesar de su tamaño, se logró su extirpación completa por vía transoral, con incisión del lóculo amigdalino desde el paladar blando hasta la base de la lengua. El estudio histológico diagnosticó adenoma pleomórfico salivar. Una nueva resonancia magnética cinco meses después de la intervención mostró ausencia completa de tejido tumoral. El presente caso esl el primer adenoma pleomórfico salivar del espacio parafaríngeo reportado en la literatura médica Mexicana. Se hace revisión d la literatura y se discuten las técnicas vigentes de imagen y de manejo quirúrgico