Acta Oto-Laryngologica. 2014; 134: 413–415

LETTER TO THE EDITOR

Leriche operation for parotid gland pathology

YORIHISA ORITA 1, TOSHIAKI OGAWARA2, RYUTARO ENDO3, SAYAKA FUJI4, KENTARO MIKI4, MISATO HIRAI4, YOHEI NODA1, HIDENORI MARUNAKA5, TOMOYASU TACHIBANA6, YASUHARU SATO7 & KAZUNORI NISHIZAKI1 1

Departments of Otolaryngology, Head and Neck Surgery, Okayama, 2Ogawara ENT Clinic, Okayama, 3Eki-mae ENT Clinic, Department of Otolaryngology, Head and Neck Surgery, Okayama, 4Okayama Saiseikai General Hospital, Okayama, 5Okayama Medical Center, Okayama, 6Himeji Red Cross Hospital, Hyogo, Japan and 7Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama

Sir, Dr Leriche was a famous French neurosurgeon. The operation that bears his name is known in Japan from a surgical text book written by Dr Takeshi Kitamura, professor and chairman of the Department of Otolaryngology at Chiba University, Chiba, Japan, between 1951 and 1977 [1]. He introduced the Leriche operation as a simple and effective technique for the treatment of sialorrhea, salivary fistula, or salivation due to advanced esophageal carcinoma. However, we seldom see descriptions of this operation in the English literature. We have recently encountered cases with pathologies involving the parotid glands in which cure was achieved using this operation. Here we want to re-introduce this operation and describe its efficacy. We have performed the Leriche operation in three cases (Table I). Two patients showed intractable postoperative salivary fistula and the remaining patient suffered recurrent parotid abscess. In the case with parotid abscess, we confirmed that aspirate from abscess lesions contained amylase. Case 1 requested to undergo the operation under general anesthesia. The other two cases were operated on under local anesthesia with 1% lidocaine containing 0.1% epinephrine. Considering the cosmetic problems, the incision line was drawn along the preauricular wrinkle to the edge of the tragus. The length

of the incision was less than 3 cm (Figure 1a). In the cases performed after parotid surgeries, the previous incision lines were reused. After palpating the pulsations of the superficial temporal artery (STA), subcutaneous connective tissue was opened to expose the STA. During this process, the superficial temporal vein (STV), which is located slightly superficial to and behind the STA, and the auriculotemporal nerve (ATN), which is usually located superficial and/or posterior to the STA, were detected and exposed (Figure 1b). After cutting all the branches to the facial nerve at points parallel to the ATN, the ATN was exposed cranially and caudally (especially caudally) as widely as possible (Figure 1c). Resection of the ATN was performed as far as possible to the proximal side (Figure 1d). The wound was then closed. Drain insertion was not necessary. The effects of surgeries obviously appeared from the first day postoperatively, and symptoms of all three cases were completely resolved within 15 days postoperatively (Figure 2). No recurrence of symptoms has been observed for over 5 years in cases 1 and 2, and for 1 year in case 3. The ATN originates from the posterior trunk of the mandibular nerve (V3), runs through the deep lateral pterygoid muscle, and emerges onto the face behind the temporomandibular joint within the superior surface of the parotid gland [2]. This nerve carries

Correspondence: Yorihisa Orita MD PhD, Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama 700-8558, Japan. Tel: +81 86 235 7307. Fax: +81 86 235 7308. E-mail: [email protected]

(Received 22 October 2013; accepted 17 November 2013) ISSN 0001-6489 print/ISSN 1651-2251 online Ó 2014 Informa Healthcare DOI: 10.3109/00016489.2013.871749

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Letter to the Editor

Table I. Profiles of the three cases who underwent the Leriche operation. Age (years)

Period to operation* (days)

Period to cure† (days)

General

37

5

Postoperative salivary fistula‡

Local

22

12

Repetitive parotid abscess

Local

46

15

Case no.

Sex

Disease

1

F

50

Postoperative salivary fistula‡

2

F

42

3

F

78

Anesthesia

F, female. *Period from symptom appearance to performance of the Leriche operation. †Period from the Leriche operation to complete cure. ‡Both cases had undergone partial superficial parotidectomy for pleomorphic adenoma of the parotid gland.

a

b ATN EAM

STA STV

d

c ATN

Figure 1. (a) The incision line is less than 3 cm. (b) The auriculotemporal nerve (ATN) lies superficial to the superficial temporal artery (STA). In the preauricular area superior to the external auditory meatus (EAM), the superficial temporal vein (STV) is located behind the STA. (c) After cutting the branches to the facial nerve, the ATN is exposed vertically as widely as possible. (d) A section of ATN as long as possible should be resected. The left side of the picture shows the proximal side of the ATN.

a

b

Figure 2. (a) CT scan for case 3 before performance of the Leriche operation. Abscesses with cystic lesions in the left parotid gland are observed. (b) CT scan at 15 days postoperatively shows no abscess in the left parotid gland.

autonomic fibers to the parotid glands and the intent of the Leriche operation is thus to achieve permanent denervation of this communication. When performing the Leriche operation, the ATN is found superficial or posterior to the STA in most cases [3]. Since head and neck surgeons are familiar with intra-arterial infusion chemotherapy for maxillary sinus carcinoma administered via the STA, this technique is not difficult or unfamiliar. The operation can be performed under local anesthesia with an incision less than 3 cm. This surgery takes less than 1 h, and operation time should consistently be within 30 min with the accumulation of experience. Although tympanic neurectomy or completion parotidectomy have been suggested as surgical treatments for external fistula of the parotid gland [4], these options seem more invasive than the Leriche operation. Non-surgical methods for managing parotid fistula such as botulinum toxin injection have also been described [5]. However, we do not consider these conservative methods as necessarily less invasive than the Leriche operation. The majority of patients with postparotidectomy fistula will resolve spontaneously, but long-standing pressure dressings may cause discomfort for the patients and may require a lengthy hospitalization. Thus we will consider Leriche operation when a salivary fistula does not resolve within 2 weeks after the fistula formation. Although insensibility of the side of the head may occur after Leriche operations, in our experience, no complications or adverse events were noted, although the number of cases was small and complaints from patients might have been masked by the successful results of the operations. In conclusion, we have successfully treated two cases with postoperative salivary fistula and one case with recurrent abscesses of the parotid gland using the Leriche operation. We have re-recognized the utility of this technique and want to re-introduce this operation to the world.

Letter to the Editor Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content of the paper.

References [1] Kawada S, Kirikae I, Morimoto M. Parotid gland surgery. In The compendium of surgery for otolaryngology, vol III. Tokyo: Kanahara Co. 1975; in Japanese.

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[2] Gülekon N, Anil A, Poyraz A, Peker T, Turgut HB, Karaköse M. Variations in the anatomy of the auriculotemporal nerve. Clin Anat 2005;18:15–22. [3] Jeong SM, Park KJ, Kang SH, Shin HW, Kim H, Lee HK, et al. Anatomical consideration of the anterior and lateral cutaneous nerve in the scalp. J Korean Med Sci 2010;25:517–22. [4] Gordin EA, Daniero JJ, Krein H, Boon MS. Parotid gland trauma. Facial Plast Surg 2010;26:504–10. [5] Porta M, Gamba M, Bertacchi G, Vaj P. Treatment of sialorrhoea with ultrasound guided botulinum toxin type A injection in patients with neurological disorders. J Neurol Neurosurg Psychiatry 2001;70:538–40.

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Leriche operation for parotid gland pathology.

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