Parotidotomy approach for a midcheek mass: a new surgical strategy.

OBJECTIVES/HYPOTHESIS: To report the feasibility and the results of a new surgical strategy for midcheek masses we called the parotidotomy approach.

STUDY DESIGN: Retrospective consecutive case series.

METHODS: Characteristics, surgical outcome, and cosmetic result of cases managed using the parotidotomy approach were collected by retrospectively reviewing medical records. The standard superficial parotidectomy approach was modified to dissect facial nerve branches selectively to obtain a symmetric facial contour. The parotid gland was fully bisected along the course of the zygomatic and buccal branches of the facial nerve to provide access to the midcheek mass. The bisected parotid gland was repositioned after mass excision.

RESULTS: Seven patients (3 males and 4 females) were included in this study. The parotidotomy approach was accomplished in two cases with a malignant tumor (one acinic cell carcinoma, one low-grade mucoepidermoid carcinoma), four with a benign tumor (two pleomorphic adenoma, one basal cell adenoma, one facial nerve schwannoma), and in one case with a chronic inflammatory lesion (chronic sialadenitis). In no case was facial nerve paralysis or Frey's syndrome noticed after this approach. For the two malignant tumors, there was no evidence of recurrence or metastasis at 2-year and 2.5-year follow-ups. Six of the seven patients were fully satisfied with the cosmetic results of surgery. The remaining patient had a mild sunken deformity of the midcheek where the mass had been located.

CONCLUSIONS: To manage midcheek masses we modified the standard parotidectomy approach. This new surgical strategy, which we named the parotidotomy approach, provides surgically safe and cosmetically excellent results for midcheek masses.