The Effect of Endoscopy-assisted Transoral Parotid Gland Tumor Excision Compared With Traditional Operation

Overview

Endoscopic-assisted surgery has become a popular technique in salivary gland surgery, particularly for parotid gland tumors. However, this technique has not yet been routinely applied to transoral parotid tumor resection. This retrospective study aimed to evaluate the outcomes of gland-preserving surgery in patients with benign parotid tumors undergoing endoscopic-assisted transoral resection. The study included 30 patients with benign parotid tumors who underwent gland-preserving tumor resection: 15 underwent endoscopic-assisted transoral resection, while the other 15 underwent conventional tumor resection via the Blair S-shaped incision. Surgical feasibility, perioperative variables, postoperative appearance, and functional outcomes were assessed. In both groups, all tumors were completely removed with negative margins. No significant differences were observed between the two groups in terms of intraoperative blood loss, postoperative drainage volume, average incision length, or facial nerve injury. However, the endoscopic-assisted transoral group demonstrated superior cosmetic outcomes. No tumor recurrence was observed during the 1-6 month follow-up period. Therefore, endoscopic-assisted transoral parotid tumor resection is a safe approach for benign parotid tumors, offering both favorable functional and aesthetic results.

The incidence of parotid gland tumors is approximately 1 in 100,000, accounting for 80% of all salivary gland tumors, with about 80% being benign. Parotid tumor resection is a well-established surgical technique. Traditionally, the Blair S-shaped incision has been used, but it leaves noticeable scars on the maxillofacial region, which can be a significant burden for both surgeons and patients. Additionally, postoperative complications such as great auricular nerve injury may occur. In the mid-20th century, the standard surgical approaches for benign parotid tumors included total parotidectomy (with facial nerve sacrifice) or superficial parotidectomy (preserving the facial nerve), which significantly reduced tumor recurrence rates. However, due to the extensive surgical scope, these procedures were associated with a high incidence of complications such as facial nerve dysfunction, Frey's syndrome, salivary fistula, and facial scar deformities. In recent years, with growing interest in minimally invasive surgery, studies have found that subtotal parotidectomy for benign parotid tumors not only reduces postoperative complications but also maintains comparable recurrence rates. To meet patients' aesthetic demands, more concealed hairline incisions have gained popularity, as the scars can be hidden behind the ear. With advancements in minimally invasive techniques for parotid tumor surgery, surgeons have developed various approaches to minimize scarring and reduce complications, including retroauricular sulcus incisions, endoscopic-assisted techniques, and transoral/intraoral resections. Endoscopic-assisted techniques leave minimal or hidden scars postoperatively. The combination of intraoral incisions and endoscopy can further conceal surgical scars, reduce patient trauma, and improve satisfaction-without significant complications compared to traditional transcutaneous approaches.