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Published on: March 1, 2015
Antegrade Versus Retrograde Facial Nerve Dissection in Benign Parotid Surgery: A Systematic Review and Meta-Analysis
Do Hyun Kim1, David W Jang2, Se Hwan Hwang3
1Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Background:
Parotidectomy for benign tumors requires meticulous facial nerve preservation, yet the optimal dissection technique between anterograde dissection (AD) and retrograde dissection (RD) remains uncertain, prompting this updated meta-analysis comparing their outcomes.
Methods:
Twenty-one studies (1632 patients) were included. Outcomes comprised operative parameters, postoperative complications, and facial nerve recovery. Pooled effects were estimated using odds ratios (ORs) and mean differences with 95% confidence intervals (CIs).
Results:
RD significantly reduced transient facial nerve palsy versus AD (OR, 0.73; 95% CI, 0.54-0.98), with no difference in permanent palsy. Recovery was similar at 1, 6, and 12 months, although AD showed faster recovery at 3 months. Other complications were comparable. RD was associated with shorter operative time, less blood loss, and smaller resected tissue volume. Subgroup analysis indicated reduced transient palsy mainly in superficial parotidectomy.
Conclusion:
RD offers advantages over AD, particularly in superficial parotidectomy, though further randomized trials are warranted.
