Int J Stomatol

Int J Stomatol ›› 2025, Vol. 52 ›› Issue (2): 217-230.doi: 10.7518/gjkq.2025020

• Original Articles • Previous Articles     Next Articles

Applying ABC-partition concept-based operation approaches to endoscopic surgery of parotid gland tumor

Chang Cao1(),Zhiyan Zhang1,Jialu He1,Su Chen1,Fan Yang1,Shasha Meng2,Daiwei Li3,Yongtao Dong4,Jie Yan4,Yan Sun4,Guiquan Zhu1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.Dept. of Dentistry, the First People’s Hospital of Pingdingshan City, Pingdingshan 467000, China
    3.Dept of Oral and Maxillofacial Surgery, the People’s Hospital of Yuxi City, Yuxi 653100, China
    4.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Operating Room, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-03-26 Revised:2024-09-03 Online:2025-03-01 Published:2025-03-01
  • Contact: Guiquan Zhu E-mail:cao_oncology@163.com;zhugq@scu.edu.cn
  • Supported by:
    Special Funds for Guiding Local Scientific and Technological Development of Sichuan Province under the Central Government(2023ZYD0106)

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Abstract:

Objective This study aimed to evaluate the feasibility, safety, and cosmetic outcomes of operation approaches based on the ABC-partition concept for parotid tumors. Methods A total of 95 patients who underwent gasless endoscopic parotidectomy at the Dept. of Head and Neck Oncology in West China Hospital of Stomatology from January 1, 2022, to January 1, 2024 were retrospectively included. Patients were divided into two groups based on whether the ABC-partition concept-based operation approaches were used. Perioperative and follow-up data were retrieved and analyzed. Results The ABC group showed significantly better outcomes compared to the non-ABC group (P<0.05) in several areas, including average operation time, intraoperative blood loss, postoperative drainage, incidence of salivary fistula, and length of hospital stay. Both groups reported satisfaction with their cosmetic results, with a visual analogue scale score of 1.63±0.88 for the non-ABC group and 1.35±0.82 for the ABC group (P>0.05). Conclusion This study demonstrated that the ABC-partition approach enhances the efficiency and minimally invasive nature of endoscopic surgery for parotid gland tumors, promotes better recovery after surgery, and provides satisfactory safety and cosmetic results.

Key words: partition concept, endoscopic parotidectomy, endoscopic surgery approaches

CLC Number: 

  • R739.87

TrendMD: 

Fig 1

ABC-partition concept of parotid gland"

Tab 1

ABC-partition concept of the parotoid gland and operation approaches"

肿瘤最大径/cm部位入路腮腺术式
<2A区颞-耳屏入路部分切除
<2B区颅耳沟入路部分切除
<2C区耳后发际入路部分切除
2~4A/B/C区耳后发际入路部分切除/浅叶切除

Fig 2

Preoperative preparation and incision design"

Fig 3

Operative procedures for temporal-tragus approach"

Fig 4

Operative procedures for cephaloauricular furrow approach"

Fig 5

Operative procedures for retroauricular hairline approach"

Tab 2

Patient characteristics of different groups"

分类特征非ABC分区法组（n=49）ABC分区法组（n=46）P值
年龄/岁37.10±9.18（20~59）38.67±10.35（17~59）0.435
颞-耳屏入路36.13±9.78（20~51）34.73±10.90（17~51）0.714
颅耳沟入路40.00±10.49（22~59）40.54±8.70（30~59）0.885
耳后发际入路35.80±7.65（26~53）40.61±10.58（25~57）0.156*
性别/（男/女）12/3711/351
颞-耳屏入路5/104/110.5?
颅耳沟入路2/123/100.462?
耳后发际入路5/154/141?
肿瘤最大径/cm1.84±0.63（0.8~3.0）1.79±0.59（1.0~3.5）0.707
颞-耳屏入路1.84±0.71（0.8~3.0）1.65±0.28（1.2~2.1）0.571*
颅耳沟入路1.39±0.48（0.8~2.3）1.36±0.48（1.0~2.5）0.867
耳后发际入路2.15±0.49（1.5~3.0）2.22±0.58（1.5~3.5）0.681
病理类型0.206?
多形性腺瘤2731
Warthin瘤02
基底细胞腺瘤64
其他169

Tab 3

Operative data of different groups"

术中检测指标非ABC分区法组（n=49）ABC分区法组（n=46）P值
手术时间/min134.06±48.05（38~245）104.07±25.44（55~147）<0.001*△△
颞-耳屏入路123.27±49.03（38~238）118.00±27.16（55~147）0.604*
颅耳沟入路98.29±34.99（40~160）88.25±22.62（55~125）0.327
耳后发际入路167.2±32.14（120~245）109.22±20.55（60~135）<0.001△△
切口长度/cm5.05±1.24（3~9）5.22±0.89（3~7）0.458
颞-耳屏入路4.87±1.73（3~9）5.40±1.12（4~7）0.324
颅耳沟入路4.71±1.27（3~8）4.54±0.66（3~5）0.659
耳后发际入路5.43±0.59（4~6）5.56±0.51（5~6）0.474
术中失血量/mL36.16±26.41（2~100）22.93±14.01（5~70）0.011*△
颞-耳屏入路43.70±27.55（10~100）27.33±13.35（10~50）0.093*
颅耳沟入路25.86±17.20（2~50）18.08±16.53（5~70）0.243
耳后发际入路37.75±29.58（5~100）22.78±12.27（10~50）0.104*
肿瘤位于面神经浅面/深面36/1335/110.954
颞-耳屏入路11/412/30.5?
颅耳沟入路12/212/10.529?
耳后发际入路13/711/71
中转开放手术/（是/否）1/480/461?
颞-耳屏入路1/140/151?
颅耳沟入路0/140/13
耳后发际入路0/200/18

Tab 4

Postoperative data of different groups"

术后检测指标非ABC分区法组（n=49）ABC分区法组（n=46）P值
术后引流量/mL59.74±42.87（14~180）35.30±16.29（7~87）0.002*△△
颞-耳屏入路33.40±22.24（14~102）27.00±11.95（7~54）0.292*
颅耳沟入路58.14±41.76（30~175）32.46±15.84（10.5~72）0.018*△
耳后发际入路80.60±45.58（21~180）44.28±15.97（25~87）0.003*△△
引流时间/d2.84±1.46（1~7）2.26±0.61（1~5）0.112*
颞-耳屏入路2.00±0.54（1~3）2.33±0.90（1~5）0.335
颅耳沟入路3.21±1.67（2~7）2.23±0.44（2~3）0.085*
耳后发际入路3.20±1.53（1~6）2.22±0.43（2~3）0.058*
暂时性面神经功能降碍/（有/无）8/416/400.872
颞-耳屏入路2/134/110.326?
颅耳沟入路2/120/130.259?
耳后发际入路4/162/160.663?
涎瘘/（有/无）6/430/460.027?△
颞-耳屏入路0/150/15
颅耳沟入路3/110/130.124?
耳后发际入路3/170/180.232?
住院时间/d6.22±2.15（4~13）5.00±0.87（4~7）0.004*△△
颞-耳屏入路5.60±1.45（4~8）5.13±0.83（4~7）0.439*
颅耳沟入路6.21±2.61（4~13）4.92±0.76（4~6）0.277*
耳后发际入路6.70±2.23（4~12）4.94±0.99（4~7）0.005*△△

Fig 6

Frontal and lateral images of patients with different incisions at 3 months postoperatively"

Tab 5

Follow-up data of different groups"

随访指标非ABC分区法组（n=49）

ABC分区法组

（n=46）

P值
随访时间/月5.24±1.90（3~12）5.85±2.29（3~12）0.165
颞-耳屏入路5.47±2.07（4~12）5.80±1.15（4~8）0.589
颅耳沟入路6.00±2.18（4~10）5.08±2.10（3~10）0.274
耳后发际入路4.80±1.36（3~9）6.44±2.98（3~12）0.076?
Frey’s综合征（有/无）0/490/46
耳垂麻木（有/无）8/413/430.241
颞-耳屏入路4/111/140.330*
颅耳沟入路2/121/121*
耳后发际入路2/181/171*
伤口感染（有/无）3/462/441*
颞-耳屏入路2/130/150.483*
颅耳沟入路0/140/13
耳后发际入路1/192/160.595*
瘢痕增生（有/无）2/471/451*
颞-耳屏入路0/150/15
颅耳沟入路1/130/131*
耳后发际入路1/191/171*
复发（有/无）0/490/46
VAS评分1.63±0.88（0~4）1.35±0.82（0~3）0.108
颞-耳屏入路1.20±0.68（0~2）1.40±0.83（0~3）0.475
颅耳沟入路1.50±1.02（0~4）1.23±0.83（0~3）0.461
耳后发际入路1.85±0.99（0~4）1.39±0.85（0~3）0.134

Tab 6

Clinical data of different operation approaches"

检测指标颞-耳屏（n=30）颅耳沟（n=27）耳后发际（n=38）P值
年龄/岁35.43±10.20（17~51）40.26±9.49（22~59）38.08±9.35（25~57）0.173
性别（男/女）9/215/229/290.597
肿瘤最大径/cm1.74±0.54（0.8~3.0）1.38±0.47（0.8~2.5）2.18±0.53（1.5~3.5）<0.001△△△
手术时间/min118.03±39.31（38~238）92.78±29.70（40~160）139.74±39.81（60~245）<0.001△△△
切口长度/cm5.13±1.46（3~9）4.63±1.00（3~8）5.49±0.55（4~6）0.001*△△
术中失血量/mL35.50±22.83（10~100）22.11±17.02（2~70）30.66±24.00（5~100）0.071
肿瘤位于面神经浅面/深面23/724/324/140.06
中转开放手术（是/否）1/290/270/380.6?
术后引流量/mL30.20±17.84（7~102）45.78±34.04（10.5~175）63.40±39.01（21~180）<0.001*△△△
引流时间/d2.17±0.75（1~5）2.74±1.32（2~7）2.74±1.27（1~6）0.085*
暂时性面神经功能障碍（有/无）6/242/256/320.385?
涎瘘（有/无）0/303/243/350.175?
住院时间/d5.37±1.19（4~8）5.59±2.02（4~13）5.87±1.95（4~12）0.507
随访时间/月5.63±1.65（4~12）5.56±2.15（3~10）5.45±2.42（3~12）0.937
耳垂麻木（有/无）5/253/243/350.52?
伤口感染（有/无）2/280/273/350.44?
瘢痕增生（有/无）0/301/262/360.625?
VAS评分1.30±0.75（0~3）1.37±0.93（0~4）1.74±0.88（0~4）0.077
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