Function-preserving intracapsular versus superficial parotidectomy for benign parotid tumors: A randomized controlled trial.

Abstract

Background: Superficial parotidectomy is the traditional treatment for benign parotid tumors but may be associated with facial nerve dysfunction and other morbidities. Intracapsular parotidectomy has emerged as a function-preserving alternative; however, concerns regarding oncologic safety remain. Randomized evidence comparing both techniques is limited. Therefore, this study aimed to compare their functional and oncologic outcomes.

Objective: This study aimed to compare intracapsular parotidectomy and superficial parotidectomy in terms of operative efficiency, complications, facial nerve preservation, and tumor recurrence for benign parotid tumors.

Methodology: This multicenter randomized controlled trial included patients with benign parotid tumors who were randomly assigned to undergo either intracapsular or superficial parotidectomy between May 2019 and May 2023, in Cairo, Egypt. Functional outcomes, postoperative complications, and recurrence rates were evaluated.

Results: The mean age was 46.3 ± 9.5 years, with a range of 25-65 years. Most patients (84, 70%) were male, while 36 (30%) were female. The intracapsular parotidectomy (ICP) group demonstrated significantly reduced operative time (68.5 ± 12.3 vs. 88.3 ± 14.5 minutes; p = 0.01) and blood loss (120 ± 55.3 vs. 170 ± 50.5 ml; p = 0.001) compared to the superficial parotidectomy (SP) group. Facial nerve injury occurred exclusively in the SP group 9 (15%), including 3 (5%) cases of permanent palsy. Recurrence was observed in 1 (1.7%) ICP case and 3 (5%) SP cases, with no statistically significant difference (P > 0.05). Other complications, including seroma formation and postoperative bleeding, were similarly distributed between the two groups.

Conclusion: Intracapsular parotidectomy is a safe, effective, and less invasive alternative to superficial parotidectomy for benign parotid tumors. It offers shorter operative time, reduced bleeding, and improved facial nerve preservation without compromising oncological outcomes. Careful patient selection is essential for optimal results.