Periauricular incision vs. Modified blair incision in parotidectomy: A systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose

To compare safety, functional outcomes, and cosmetic results of periauricular incision (PI) versus modified Blair incision (MBI) in superficial benign parotidectomy.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing parotidectomy with PI versus MBI. PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang, and VIP databases were searched through April 20, 2025 (PROSPERO: CRD42024620827). Outcomes included transient facial palsy, Frey’s syndrome, earlobe numbness, facial deformity, patient satisfaction, salivary fistula, operative time, intraoperative blood loss, postoperative drainage, hospital stay, and incision length. The risk of bias was assessed with RoB 2 and evidence certainty was graded by GRADE.

Results

Eleven RCTs encompassing 804 patients (PI 401; MBI 403) met the inclusion criteria. Pooled analysis demonstrated that PI significantly reduced transient facial palsy (RR = 0.60, 95 % CI: 0.39–0.93; moderate certainty), Frey’s syndrome (RR = 0.27, 95 % CI: 0.13–0.55; high certainty), earlobe numbness (RR = 0.53, 95 % CI: 0.34–0.84; moderate certainty), and facial deformity (RR = 0.19, 95 % CI: 0.08–0.46; high certainty), as well as higher patient satisfaction (RR = 1.24, 95 % CI: 1.16–1.33; moderate certainty). No significant difference was observed in salivary fistula incidence (RR=0.70; 95 % CI, 0.31–1.59; low certainty) and operative time (SMD=-0.29; 95 % CI, –1.30–0.71; very low certainty). Intraoperative bleeding, postoperative drainage, hospitalization length, and incision length favored PI, but evidence quality was downgraded to low/very low due to high heterogeneity (I² = 72–97 %).

Conclusion

PI appears to be a safe, cosmetically superior alternative to MBI for small-to-medium benign, superficial parotid tumors. Further multicenter, high-quality RCTs with long-term follow-up are warranted to confirm these findings.