Incidence, Risk Factors and Management of Salivary Fistula and Sialocele After Parotidectomy: Two-centers Study

Incidence, Risk Factors and Management of Salivary Fistula and Sialocele After Parotidectomy: Two-centers Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidence, Risk Factors and Management of Salivary Fistula and Sialocele After Parotidectomy: Two-centers Study Mostafa M Farag, Ibrahim Fathi, Khaled E Barakat, Reda F Ali This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7873836/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Salivary fistula and sialocele are recognized as common postoperative complications following parotidectomy, contributing to patient morbidity and decreasing quality of life. Studies that focus on the incidence, risk factors, and effective management remain limited. Methods This is a retrospective cohort study conducted in two academic referral centers and included 95 patients who underwent different kinds of parotidectomy procedures from January 2022 to December 2024. The incidence, risk factors and management of salivary fistula and sialocele were studied using patients' file reports and follow-up data. Correlations with demographics, tumor information and surgery-related factors were analyzed. Results The incidence of salivary fistula or sialocele was 10.5%. Significant risk factors identified included smoking (80% in affected vs 17.6% in unaffected patients, p < 0.001), larger tumor size (mean 3.46 cm vs 2.82 cm, p = 0.038), tumor location in the parotid tail (90% vs 44.7%, p = 0.034 ), longer operative time (mean 96.0 min vs 81.35 min, p = 0.035), and the presence of concurrent postoperative complications (90.0% vs 31.8%, p = 0.001). Conservative management—such as pressure dressings, aspiration, and dietary modifications—was effective in 80% of cases, while only 2 patients (20%) required tympanic neurectomy. Age, sex, BMI, comorbidity, type of the tumour, type of surgery and surgical side were not statistically associated with fistula or sialocele formation. Conclusion Salivary fistula & sialocele occur in approximately one in ten cases of parotidectomy. Key risk factors are smoking, tumor size, operative duration, tumor location at the gland tail, and other concurrent complications. Conservative management is highly effective as initial therapy, and tympanic neurectomy is reserved for refractory cases. Parotidectomy Salivary fistula Sialocele Postoperative complications Risk factors Figures Figure 1 Figure 2 INTRODUCTION The parotid gland is the largest of the major salivary glands, located between the sternocleidomastoid Parotidectomy is the surgical removal (partial or total) of the parotid gland and represents one of the basic interventions in head and neck surgery with various clinical indications [ 1 ]. Parotidectomy for neoplasms represents 75% to 80% of parotidectomy cases; the majority of parotid neoplasms are benign in nature [ 1 – 3 ]. Pleomorphic adenoma is the most common benign parotid tumor, accounting for 60% to 66.5% of parotid neoplasms, followed by Warthin tumor at10% to 25% [ 1 , 3 ]. Mucoepidermoid carcinoma and adenoid cystic carcinoma are the most-common primary malignant neoplasms in the parotid gland [ 1 – 3 ]. Salivary gland tumors account for approximately 3% of all head and neck malignancies and occur at annual incidence rate of 1 person in 100,000 per year [ 3 ]. Salivary fistula and sialocele are serious yet common postoperative complications following parotidectomy, which due to their high incidence can influence postoperative morbidity and even the quality of life of the patient [ 4 , 5 ]. Surgical manipulation of salivary glands disrupts normal salivary and duct architecture, which leads to aberrant saliva flow and stagnation, resulting in these complications [ 6 , 7 ]. Salivary fistula is abnormal, epithelialized communications between salivary gland or (ductal system), and another anatomical structure including skin surface through which saliva is continuously expelled from the gland [ 7 , 8 ]. This pathological duct permits salivary extravasation out of the regular physiological tract and leads to external drainage that typically increases at mealtimes and mastication when salivary stimulation is greatest [ 5 , 7 ]. Salivary leakage from the fistula tract may cause maceration of the skin, bacterial contamination, and considerable patient discomfort due to constant drainage [ 7 ]. In contrast, sialoceles are formed by pooling of extravasated saliva in the surrounding soft tissues without a defined epithelial lining [ 6 , 9 ]. In this retrospective study, we aimed to identify the incidence, risk factors, and treatment outcomes of salivary fistula and sialocele at two University tertiary centres in Egypt. METHODS Study Design and Setting This retrospective study was conducted at Alexandria Main University Hospital and Kafr Elsheikh University Hospital, two major tertiary referral centers in Egypt. Both hospitals have specialized head and neck surgery units with high procedural volumes for parotid gland diseases. Patient Population The analysis included all patients who underwent different types of parotidectomy surgeries, namely, enucleation, extracapsular dissection, superficial parotidectomy, partial superficial parotidectomy, and total conservative parotidectomy, for benign or malignant parotid pathology between January 2022 and December 2024. Cases were identified from surgical and pathology records, and only those with complete operative notes and at least six months of postoperative follow-up were included. Patients were excluded if records were incomplete, follow-up was insufficient, surgery was performed for trauma, prior radiation therapy was given, or if previous parotidectomy was done. Preoperative Assessment Preoperative review of all the patients comprised a thorough clinical history and physical examination, concentrating on the head and neck region, and with special emphasis on the parotid gland and facial nerve function. Tumor size, site and relationships with surrounding structures were evaluated using routine magnetic resonance imaging (MRI) with or without ultrasonography. Fine needle aspiration cytology (FNAC) was not routinely performed and was kept only for inconclusive MRI findings to reach a preoperative diagnosis. Additional preoperative laboratory tests and anesthetic assessments were done based on institutional protocols. Data Collection Patient data were extracted and included age, gender, BMI, comorbidities, surgical approach, lesion characteristics, duration of surgery, wound care, incidence and management of complications, and follow-up outcomes. Diagnostic Criteria Salivary fistula was defined as persistent, clear parotid drainage that increased with eating, while sialocele was identified as a ballotable, painless parotid swelling within two weeks of surgery with aspirated fluid showing salivary fluid characteristics. Statistical Analysis IBM SPSS software version 20.0 (Armonk, NY: IBM Corp, released 2011) was used to perform the statistical analysis of the data. The categorical data were presented as numbers and percentages. Chi-square test was used for comparison between two groups and when > 20% of cells have expected count < 5, Fisher Exact correction & Monte Carlo correction test was used instead. Quantitative data were summarized as range (minimum and maximum), mean, and standard deviation. Student t-test was used to compare groups of normally distributed quantitative variables While Mann-Whitney test was applied for comparisons of two groups for not normally distributed quantitative variables. Results obtained were considered significant at 5% level of significance. Ethical Approval and Consent to Participate The study protocol received ethical approval from the ethics committees of Faculty of Medicine, Alexandria University and Faculty of Medicine, Kafrelsheikh University. As it was a retrospective chart review, informed consent was waived by both ethics committees, and all patient data were anonymized to maintain confidentiality. This study was performed in compliance with the ethical standards described in the World Medical Association Declaration of Helsinki. RESULTS Among the 95 analyzed cases, sialocele or salivary fistula occurred in 10 patients (10.5%), while no such complication was seen postoperatively in the remaining 85 patients (89.5%). (Fig. 1,2) A large proportion of patients (8 out of 10) who experienced fistula or sialocele were treated successfully with conservative management only (8.4% total). Only in 2 patients (2.1%) tympanic neurectomy was needed. (Fig. 1,2) The results of this study show several key findings regarding the occurrence of salivary fistula or sialocele following parotidectomy procedure. (table 1) A significant association was observed with smoking . Eight out of 10 patients (80.0%) who developed fistula or sialocele were smokers, compared to 15 out of 85 patients (17.6%) in the uncomplicated group (p < 0.001), indicating smoking is a significant risk factor for postoperative fistula or sialocele. Maximum lesion size was significantly larger among patients who developed fistula or sialocele (mean: 3.46 ± 1.00 cm, median: 3.60 cm) versus those without fistula or sialocele (mean: 2.82 ± 0.73 cm, median: 2.80 cm; p = 0.038). This suggests increased lesion size is correlated with the development of postoperative fistula or sialocele. The tail of the parotid gland was significantly the most common tumor site among patients who developed fistula or sialocele (90.0%), compared to a lower rate (44.7%) in the uncomplicated group (p = 0.034). (table 1) There were no statistically significant differences in terms of age, sex ratio, marital status, co-morbidities or body mass index (BMI) between the groups. The average age was 43.39 ± 14.88 years overall, and patients who developed fistula or sialocele were relatively older (mean 47.20 ± 6.53 years), although this difference was not statistically significant (p = 0.123). (table 1) Additionally, our results highlight significant associations between fistula or sialocele and different tumor and procedural parameters among patients undergoing parotidectomy. (table 2) Patients who developed salivary fistula or sialocele had longer mean operative times (mean: 96.0 ± 13.22 minutes, median: 95.50 minutes) compared to those without fistula or sialocele (mean: 81.35 ± 21.13 minutes, median: 81.0 minutes; p = 0.035), identifying extended operative duration as a possible risk factor. (table 3) The incidence of postoperative complications was significantly higher in the group with fistula or sialocele. Ninety percent of patients with fistula or sialocele experienced additional complications, including seroma (40.0%, p = 0.021), hematoma (30.0%, p = 0.015), and distal flap ischemia (20.0%, p = 0.054). Marginal mandibular branch injuries, Frey’s syndrome, and facial nerve neuropraxia were not significantly different between groups. (table 2) Regarding the type of Surgery , although 50.0% of patients who developed fistula or sialocele had undergone partial superficial parotidectomy (vs. 12.9% in the other group), the association did not reach statistical significance (p = 0.096). Also, there was no statistically significant difference in postoperative diagnosis between groups, though pleomorphic adenoma remained the most frequent diagnosis in those who developed complications (90.0%) versus those without (62.4%). (table 2) DISCUSSION The management of salivary fistula or sialocele after parotidectomy is still an important clinical problem, incidence rates mentioned in the literature are very variable. The overall incidence rate in our study is 10.5%, consistent with the current data and appears to be an intermediate value when compared with reports in the literature [ 10 , 11 , 12 ]. It’s also comparable with the up-to-date literature reporting rate of 10.4% in sialocele formation after superficial parotidectomy [ 12 , 13 ]. The heterogeneity in the published literature, with reported incidence ranging from 2% to 65% is probably related to institutional differences in surgical technique, patient selection and follow-up [ 10 , 14 ]. (Fig. 2) Our results have shown that smoking status, tumor size, tumor location, other postoperative complications and operative time significantly play an important role in the development of salivary fistula or sialocele. The significant association of smoking with salivary fistula or sialocele formation is consistent with evidence in the literature suggesting that smoking is a significant risk factor for postoperative surgical complications in patients undergoing parotidectomy [ 11 ]. Kim et al. reported comparable results, active smoking was found to correlate with higher postoperative complication rates (p = 0.025) [ 11 ]. The pathogenesis of the association may be explained by a smoking-induced delay in wound healing, poor tissue perfusion and disrupted immune system responses that can lead to sialocele formation and subsequent poor resolution [ 15 ]. Our cohort showed that bigger tumor size (mean 3.46 ± 1.00 cm vs.2.82 ± 0.73 cm, p = 0.038) and longer operative time (mean 96.0 ± 13.22 min vs..81.35 ± 21.13 min, p = 0.035) were significant predictors for salivary fistula or sialocele occurrence. These results confirm other studies showing that tumor size over 3 cm is a risk factor for postoperative complications [ 12 , 16 , 17 ]. The relationship of tumor size and salivary fistula or sialocele may represent the higher operative difficulty, increased handling and more dissection needed in larger lesions, which are liable to disrupt normal salivary parenchyma resulting in leakage [ 18 ]. The higher incidence of salivary fistula or sialocele in tail lesions (90.0% vs 44.7%, p = 0.034) is a new finding with clinical significance. This anatomic predisposition is different to what has been reported in some other studies that suggested anterior tumor location as a risk factor for sialocele formation [ 19 , 20 ]. In addition, salivary fistula or sialocele were frequently observed in conjunction with other postoperative complications , such as seroma (40.0%, p = 0.021) and hematoma (30.0%, p = 0.015), which might reflect common predisposing factors [ 10 , 21 ]. In the presented cohort, our management outcomes demonstrate excellent results with 80% of patients responding successfully to conservative treatment alone, which aligns with published success rates of 70–85% reported in literature [ 4 ]. Conservative treatments generally involve pressure dressings, repeated aspiration, dietary alteration and medication using an anticholinergic agent to decrease salivary secretion [ 14 ]. Only 20% (2/10) underwent tympanic neurectomy for alleviation of symptoms. Tympanic neurectomy is a more definitive treatment for the occasional refractory patient, and successful response has been reported in nearly 100% of properly selected patients. The operation acts to cut off parasympathetic innervation of the parotid gland by sectioning the tympanic nerve (Jacobson's Nerve) and produce a decrease in salivary flow which promotes healing of the fistula [ 22 , 23 ]. While we did not utilize botulinum toxin A, recent systematic reviews report 70–100% success rates for this intermediate treatment option, which could potentially reduce the need for surgical intervention [ 24 ]. There are a few limitations that need to be mentioned when interpreting our findings. The design of the study was retrospective in nature. The low patient’s number potentially limit the statistical power to identify other risk factors. Additionally, the study was performed at only two centers and thus the results may not be generalizable to other practice settings. In conclusion , salivary fistulae and sialocele formation after parotidectomy are still a relevant and common clinical problem with a frequency of 10.5% in our study. Taking in consideration the limited number of patients with sialocele/salivary fistula in this study, smoking, large tumor size, long operative time, concurrent other postoperative complications, and tail site of tumors were identified as significant risk factors. Conservative management was successful in most cases, with more complex intervention such as tympanic neurectomy reserved for only refractory instances. Declarations Conflict of interest Authors declare no conflict of interest. Clinical trial number not applicable. Funding No funding was used for this study. Author Contribution All authors contributed to the study conception and design. M.M.F. and R.F.A. contributed to data collection, and interpretation. K.E.B. wrote the manuscript draft and performed statistical analysis. I.F. participated in critical manuscript revision and literature review. All authors reviewed and approved the submitted version, agree to be personally accountable for their contributions and the accuracy or integrity of the work, and meet the authorship criteria as described. Data Availability The data are available upon reasonable request from the corresponding author. References Ahmad, Y. E. S., & Winters, R. (2024, March 10). Parotidectomy . StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557651/ Ghannam, M. G., & Singh, P. (2023, May 29). Anatomy, head and neck, salivary glands . StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK538325/ Takahama, A., De Almeida, O. P., & Kowalski, L. 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Total (n = 95) Fistula or scialocele Test of Sig. p Absent (n = 85) Present (n = 10) Sex Male 58 (61.1%) 50 (58.8%) 8 (80.0%) χ 2 = 1.687 FE p= 0.307 Female 37 (38.9%) 35 (41.2%) 2 (20.0%) Age (years) Min. – Max. 13.0 – 84.0 13.0 – 84.0 35.0 – 55.0 t= 1.598 0.123 Mean ± SD. 43.39 ± 14.88 42.94 ± 15.53 47.20 ± 6.53 Median (IQR) 45.0 (31.50 – 54.0) 45.0 (30.0 – 55.0) 49.50 (42.0 – 52.0) Marital status Sexually Inactive 33 (34.7%) 29 (34.1%) 4 (40.0%) χ 2 = 0.137 0.734 Sexually Active 62 (65.3%) 56 (65.9%) 6 (60.0%) Comorbidity No 70 (73.7%) 62 (72.9%) 8 (80.0%) χ 2 = 0.921 MC p= 0.934 DM 8 (8.4%) 7 (8.2%) 1 (10.0%) HTN 8 (8.4%) 8 (9.4%) 0 (0.0%) HTN+DM 9 (9.5%) 8 (9.4%) 1 (10.0%) BMI (kg/m 2 ) Min. – Max. 21.10 – 36.10 21.10 – 36.10 22.30 – 34.10 t= 0.282 0.778 Mean ± SD. 28.03 ± 3.59 28.0 ± 3.67 28.34 ± 3.08 Median (IQR) 27.90(25.55 – 31.15) 27.90(25.40 – 31.20) 28.20(27.20 – 29.40) Smoking 23 (24.2%) 15 (17.6%) 8 (80.0%) χ 2 =18.958 FE p=<0.001 * Side Left 46 (48.4%) 38 (44.7%) 6 (60.0%) χ 2 = 0.842 FE p=0.506 Right 49 (51.6%) 47 (55.3%) 4 (40.0%) Size (cm) (Max.) Min. – Max. 1.20 – 4.90 1.20 – 4.30 1.50 – 4.90 U= 254.000 * 0.038 * Mean ± SD. 2.89 ± 0.79 2.82 ± 0.73 3.46 ± 1.00 Median (IQR) 2.90 (2.40 – 3.20) 2.80 (2.30 – 3.20) 3.60 (2.90 – 4.10) Site of the tumor Deep 13 (13.7%) 13 (15.3%) 0 (0.0%) 6.345 * MC p= 0.034 * Tail 46 (48.4%) 38 (44.7%) 9 (90.0%) Upper superficial 36 (37.9%) 34 (40.0%) 1 (10.0%) Hospital stay (1day) 95 (100.0%) 85 (100.0%) 10 (100.0%) – – IQR: Inter quartile range SD: Standard deviation t: Student t-test U: Mann Whitney test c 2 : Chi square test FET: Fisher Exact test MC: Monte Carlo test p: p value for comparing between the two studied groups *: Statistically significant at p ≤ 0.05 Table (2): Comparison between the two studied groups according to operative and postoperative parameters Total (n = 95) Fistula or scialocele χ 2 p Absent (n = 85) Present (n = 10) Operative time (min) Min. – Max. 37.0 – 131.0 37.0 – 131.0 74.0 – 113.0 t= 2.137 * 0.035 * Mean ± SD. 82.89 ± 20.89 81.35 ± 21.13 96.0 ± 13.22 Median (IQR) 81.0 (68.0 – 92.50) 81.0 (68.0 – 90.0) 95.50 (89.0 – 108.0) Type of surgery Enucleation 3 (3.2%) 3 (3.5%) 0 (0.0%) 7.944 MC p= 0.096 Extracapsular dissection 22 (23.2%) 19 (22.4%) 3 (30.0%) Superficial parotidectomy 41 (43.2%) 39 (45.9%) 2 (20.0%) Partial superficial parotidectomy 16 (16.8%) 11 (12.9%) 5 (50.0%) Total conservative parotidectomy 9 (9.5%) 9 (10.6%) 0 (0.0%) Total conservative parotidectomy + Ipsilateral MRND 4 (4.2%) 4 (4.7%) 0 (0.0%) Postoperative diagnosis Warthin's tumor 19 (20.0%) 18 (21.2%) 1 (10.0%) 4.915 MC p= 0.729 Pleomorphic adenoma 62 (65.3%) 53 (62.4%) 9 (90.0%) Mucoepidermoid tumor 8 (8.4%) 8 (9.4%) 0 (0.0%) Metastatic nodal lesion vs neoplastic parotid lesion 1 (1.1%) 1 (1.2%) 0 (0.0%) Recurrent pleomorphic adenoma 1 (1.1%) 1 (1.2%) 0 (0.0%) Cystic lesion 2 (2.1%) 2 (2.4%) 0 (0.0%) High grade carcinoma 1 (1.1%) 1 (1.2%) 0 (0.0%) Squamous cell carcinoma 1 (1.0%) 1 (1.0%) 0 (0.0%) Complications No 59 (62.1%) 58 (68.2%) 1 (10.0%) 12.893 * FE p=0.001 * Yes 36 (37.9%) 27 (31.8%) 9 (90.0%) Seroma 12 (12.6%) 8 (9.4%) 4 (40.0%) 7.586 * FE p=0.021 * Marginal mandibular injury 5 (5.3%) 5 (5.9%) 0 (0.0%) 0.621 FE p=1.000 Hematoma 6 (6.3%) 3 (3.5%) 3 (30.0%) 10.596 * FE p=0.015 * Frey’s Syndrome 6 (6.3%) 5 (5.9%) 1 (10.0%) 0.256 FE p=0.497 Facial nerve neuropraxia 7 (7.4%) 6 (6.3%) 1 (10.0%) 0.256 FE p=0.497 Distal flap ischemia 4 (4.2%) 2 (2.4%) 2 (20.0%) 6.909 * 0.054 * Fistula or scialocele 10 (10.5%) 0 (0.0%) 10 (100.0%) 95.000 FE p=<0.001 * c 2 : Chi square test FET: Fisher Exact test MC: Monte Carlo test p: p value for comparing between the two studied groups *: Statistically significant at p ≤ 0.05 Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Fathi","suffix":""},{"id":539323292,"identity":"b2d1f404-914c-470e-bccd-f5620571a3af","order_by":2,"name":"Khaled E Barakat","email":"data:image/png;base64,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","orcid":"","institution":"Alexandria 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05:33:46","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112556,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7873836/v1/862b79a9ee351f3c8bd524b7.html"},{"id":95529431,"identity":"044ccc38-14d7-49da-a31e-f9b9ad4ac2df","added_by":"auto","created_at":"2025-11-10 10:17:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1428549,"visible":true,"origin":"","legend":"\u003cp\u003eIllustrates two representative cases demonstrating parotid fistula development following parotidectomy. Each patient presented with persistent, clear salivary drainage from the surgical site, which increased noticeably during eating and mastication.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7873836/v1/f394e2cf4be8105ab4fd13a0.png"},{"id":95528103,"identity":"740223ab-e1ad-43ce-8942-085b70716c8e","added_by":"auto","created_at":"2025-11-10 10:15:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":110889,"visible":true,"origin":"","legend":"\u003cp\u003eA summary of the 95 patients showing the incidence, identified risk factors, and management.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7873836/v1/296afce880f8593deb9b989c.png"},{"id":97367784,"identity":"9d758605-faa4-4164-b29b-0e0f94786c1f","added_by":"auto","created_at":"2025-12-03 16:20:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2491937,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7873836/v1/c5c02622-d877-4789-9d2f-9791a3da18b1.pdf"},{"id":95501963,"identity":"284d64ea-9d4e-4fbf-a828-91af9e06b18e","added_by":"auto","created_at":"2025-11-10 05:33:46","extension":"jpg","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":674958,"visible":true,"origin":"","legend":"","description":"","filename":"VisualAbstract.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7873836/v1/5a082cacf33baaf303242e8e.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eIncidence, Risk Factors and Management of Salivary Fistula and Sialocele After Parotidectomy: Two-centers Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe parotid gland is the largest of the major salivary glands, located between the sternocleidomastoid Parotidectomy is the surgical removal (partial or total) of the parotid gland and represents one of the basic interventions in head and neck surgery with various clinical indications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Parotidectomy for neoplasms represents 75% to 80% of parotidectomy cases; the majority of parotid neoplasms are benign in nature [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Pleomorphic adenoma is the most common benign parotid tumor, accounting for 60% to 66.5% of parotid neoplasms, followed by Warthin tumor at10% to 25% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Mucoepidermoid carcinoma and adenoid cystic carcinoma are the most-common primary malignant neoplasms in the parotid gland [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Salivary gland tumors account for approximately 3% of all head and neck malignancies and occur at annual incidence rate of 1 person in 100,000 per year [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSalivary fistula and sialocele are serious yet common postoperative complications following parotidectomy, which due to their high incidence can influence postoperative morbidity and even the quality of life of the patient [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Surgical manipulation of salivary glands disrupts normal salivary and duct architecture, which leads to aberrant saliva flow and stagnation, resulting in these complications [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSalivary fistula is abnormal, epithelialized communications between salivary gland or (ductal system), and another anatomical structure including skin surface through which saliva is continuously expelled from the gland [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This pathological duct permits salivary extravasation out of the regular physiological tract and leads to external drainage that typically increases at mealtimes and mastication when salivary stimulation is greatest [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Salivary leakage from the fistula tract may cause maceration of the skin, bacterial contamination, and considerable patient discomfort due to constant drainage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In contrast, sialoceles are formed by pooling of extravasated saliva in the surrounding soft tissues without a defined epithelial lining [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this retrospective study, we aimed to identify the incidence, risk factors, and treatment outcomes of salivary fistula and sialocele at two University tertiary centres in Egypt.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis retrospective study was conducted at Alexandria Main University Hospital and Kafr Elsheikh University Hospital, two major tertiary referral centers in Egypt. Both hospitals have specialized head and neck surgery units with high procedural volumes for parotid gland diseases.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePatient Population\u003c/h3\u003e\n\u003cp\u003eThe analysis included all patients who underwent different types of parotidectomy surgeries, namely, enucleation, extracapsular dissection, superficial parotidectomy, partial superficial parotidectomy, and total conservative parotidectomy, for benign or malignant parotid pathology between January 2022 and December 2024. Cases were identified from surgical and pathology records, and only those with complete operative notes and at least six months of postoperative follow-up were included. Patients were excluded if records were incomplete, follow-up was insufficient, surgery was performed for trauma, prior radiation therapy was given, or if previous parotidectomy was done.\u003c/p\u003e\n\u003ch3\u003ePreoperative Assessment\u003c/h3\u003e\n\u003cp\u003ePreoperative review of all the patients comprised a thorough clinical history and physical examination, concentrating on the head and neck region, and with special emphasis on the parotid gland and facial nerve function. Tumor size, site and relationships with surrounding structures were evaluated using routine magnetic resonance imaging (MRI) with or without ultrasonography. Fine needle aspiration cytology (FNAC) was not routinely performed and was kept only for inconclusive MRI findings to reach a preoperative diagnosis. Additional preoperative laboratory tests and anesthetic assessments were done based on institutional protocols.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003ePatient data were extracted and included age, gender, BMI, comorbidities, surgical approach, lesion characteristics, duration of surgery, wound care, incidence and management of complications, and follow-up outcomes.\u003c/p\u003e\n\u003ch3\u003eDiagnostic Criteria\u003c/h3\u003e\n\u003cp\u003eSalivary fistula was defined as persistent, clear parotid drainage that increased with eating, while sialocele was identified as a ballotable, painless parotid swelling within two weeks of surgery with aspirated fluid showing salivary fluid characteristics.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eIBM SPSS software version 20.0 (Armonk, NY: IBM Corp, released 2011) was used to perform the statistical analysis of the data. The categorical data were presented as numbers and percentages. Chi-square test was used for comparison between two groups and when \u0026gt;\u0026thinsp;20% of cells have expected count\u0026thinsp;\u0026lt;\u0026thinsp;5, Fisher Exact correction \u0026amp; Monte Carlo correction test was used instead. Quantitative data were summarized as range (minimum and maximum), mean, and standard deviation. Student t-test was used to compare groups of normally distributed quantitative variables While Mann-Whitney test was applied for comparisons of two groups for not normally distributed quantitative variables. Results obtained were considered significant at 5% level of significance.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003cp\u003e The study protocol received ethical approval from the ethics committees of Faculty of Medicine, Alexandria University and Faculty of Medicine, Kafrelsheikh University. As it was a retrospective chart review, informed consent was waived by both ethics committees, and all patient data were anonymized to maintain confidentiality.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e This study was performed in compliance with the ethical standards described in the World Medical Association Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAmong the 95 analyzed cases, sialocele or salivary fistula occurred in 10 patients (10.5%), while no such complication was seen postoperatively in the remaining 85 patients (89.5%). (Fig.\u0026nbsp;1,2) A large proportion of patients (8 out of 10) who experienced fistula or sialocele were treated successfully with conservative management only (8.4% total). Only in 2 patients (2.1%) tympanic neurectomy was needed. (Fig.\u0026nbsp;1,2)\u003c/p\u003e\u003cp\u003eThe results of this study show several key findings regarding the occurrence of salivary fistula or sialocele following parotidectomy procedure. (table 1)\u003c/p\u003e\u003cp\u003eA significant association was observed with \u003cb\u003esmoking\u003c/b\u003e. Eight out of 10 patients (80.0%) who developed fistula or sialocele were smokers, compared to 15 out of 85 patients (17.6%) in the uncomplicated group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating smoking is a significant risk factor for postoperative fistula or sialocele. Maximum \u003cb\u003elesion size\u003c/b\u003e was significantly larger among patients who developed fistula or sialocele (mean: 3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 cm, median: 3.60 cm) versus those without fistula or sialocele (mean: 2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 cm, median: 2.80 cm; p\u0026thinsp;=\u0026thinsp;0.038). This suggests increased lesion size is correlated with the development of postoperative fistula or sialocele. The tail of the parotid gland was significantly the most common \u003cb\u003etumor site\u003c/b\u003e among patients who developed fistula or sialocele (90.0%), compared to a lower rate (44.7%) in the uncomplicated group (p\u0026thinsp;=\u0026thinsp;0.034). (table 1)\u003c/p\u003e\u003cp\u003eThere were no statistically significant differences in terms of age, sex ratio, marital status, co-morbidities or body mass index (BMI) between the groups. The average age was 43.39\u0026thinsp;\u0026plusmn;\u0026thinsp;14.88 years overall, and patients who developed fistula or sialocele were relatively older (mean 47.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53 years), although this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.123). (table 1)\u003c/p\u003e\u003cp\u003eAdditionally, our results highlight significant associations between fistula or sialocele and different tumor and procedural parameters among patients undergoing parotidectomy. (table 2)\u003c/p\u003e\u003cp\u003ePatients who developed salivary fistula or sialocele had longer mean \u003cb\u003eoperative times\u003c/b\u003e (mean: 96.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.22 minutes, median: 95.50 minutes) compared to those without fistula or sialocele (mean: 81.35\u0026thinsp;\u0026plusmn;\u0026thinsp;21.13 minutes, median: 81.0 minutes; p\u0026thinsp;=\u0026thinsp;0.035), identifying extended operative duration as a possible risk factor. (table 3) The incidence of \u003cb\u003epostoperative complications\u003c/b\u003e was significantly higher in the group with fistula or sialocele. Ninety percent of patients with fistula or sialocele experienced additional complications, including seroma (40.0%, p\u0026thinsp;=\u0026thinsp;0.021), hematoma (30.0%, p\u0026thinsp;=\u0026thinsp;0.015), and distal flap ischemia (20.0%, p\u0026thinsp;=\u0026thinsp;0.054). Marginal mandibular branch injuries, Frey\u0026rsquo;s syndrome, and facial nerve neuropraxia were not significantly different between groups. (table 2)\u003c/p\u003e\u003cp\u003eRegarding the \u003cb\u003etype of Surgery\u003c/b\u003e, although 50.0% of patients who developed fistula or sialocele had undergone partial superficial parotidectomy (vs. 12.9% in the other group), the association did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.096). Also, there was no statistically significant difference in \u003cb\u003epostoperative diagnosis\u003c/b\u003e between groups, though pleomorphic adenoma remained the most frequent diagnosis in those who developed complications (90.0%) versus those without (62.4%). (table 2)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe management of salivary fistula or sialocele after parotidectomy is still an important clinical problem, incidence rates mentioned in the literature are very variable. The overall incidence rate in our study is 10.5%, consistent with the current data and appears to be an intermediate value when compared with reports in the literature [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It\u0026rsquo;s also comparable with the up-to-date literature reporting rate of 10.4% in sialocele formation after superficial parotidectomy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The heterogeneity in the published literature, with reported incidence ranging from 2% to 65% is probably related to institutional differences in surgical technique, patient selection and follow-up [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. (Fig.\u0026nbsp;2)\u003c/p\u003e\u003cp\u003eOur results have shown that smoking status, tumor size, tumor location, other postoperative complications and operative time significantly play an important role in the development of salivary fistula or sialocele. The significant association of \u003cb\u003esmoking\u003c/b\u003e with salivary fistula or sialocele formation is consistent with evidence in the literature suggesting that smoking is a significant risk factor for postoperative surgical complications in patients undergoing parotidectomy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Kim et al. reported comparable results, active smoking was found to correlate with higher postoperative complication rates (p\u0026thinsp;=\u0026thinsp;0.025) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The pathogenesis of the association may be explained by a smoking-induced delay in wound healing, poor tissue perfusion and disrupted immune system responses that can lead to sialocele formation and subsequent poor resolution [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur cohort showed that bigger \u003cb\u003etumor size\u003c/b\u003e (mean 3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 cm vs.2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 cm, p\u0026thinsp;=\u0026thinsp;0.038) and longer \u003cb\u003eoperative time\u003c/b\u003e (mean 96.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.22 min vs..81.35\u0026thinsp;\u0026plusmn;\u0026thinsp;21.13 min, p\u0026thinsp;=\u0026thinsp;0.035) were significant predictors for salivary fistula or sialocele occurrence. These results confirm other studies showing that tumor size over 3 cm is a risk factor for postoperative complications [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The relationship of tumor size and salivary fistula or sialocele may represent the higher operative difficulty, increased handling and more dissection needed in larger lesions, which are liable to disrupt normal salivary parenchyma resulting in leakage [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe higher incidence of salivary fistula or sialocele in \u003cb\u003etail lesions\u003c/b\u003e (90.0% vs 44.7%, p\u0026thinsp;=\u0026thinsp;0.034) is a new finding with clinical significance. This anatomic predisposition is different to what has been reported in some other studies that suggested anterior tumor location as a risk factor for sialocele formation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition, salivary fistula or sialocele were frequently observed in conjunction with \u003cb\u003eother postoperative complications\u003c/b\u003e, such as seroma (40.0%, p\u0026thinsp;=\u0026thinsp;0.021) and hematoma (30.0%, p\u0026thinsp;=\u0026thinsp;0.015), which might reflect common predisposing factors [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the presented cohort, our management outcomes demonstrate excellent results with 80% of patients responding successfully to conservative treatment alone, which aligns with published success rates of 70\u0026ndash;85% reported in literature [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Conservative treatments generally involve pressure dressings, repeated aspiration, dietary alteration and medication using an anticholinergic agent to decrease salivary secretion [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Only 20% (2/10) underwent tympanic neurectomy for alleviation of symptoms. Tympanic neurectomy is a more definitive treatment for the occasional refractory patient, and successful response has been reported in nearly 100% of properly selected patients. The operation acts to cut off parasympathetic innervation of the parotid gland by sectioning the tympanic nerve (Jacobson's Nerve) and produce a decrease in salivary flow which promotes healing of the fistula [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. While we did not utilize botulinum toxin A, recent systematic reviews report 70\u0026ndash;100% success rates for this intermediate treatment option, which could potentially reduce the need for surgical intervention [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere are a few limitations that need to be mentioned when interpreting our findings. The design of the study was retrospective in nature. The low patient\u0026rsquo;s number potentially limit the statistical power to identify other risk factors. Additionally, the study was performed at only two centers and thus the results may not be generalizable to other practice settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn conclusion\u003c/b\u003e, salivary fistulae and sialocele formation after parotidectomy are still a relevant and common clinical problem with a frequency of 10.5% in our study. Taking in consideration the limited number of patients with sialocele/salivary fistula in this study, smoking, large tumor size, long operative time, concurrent other postoperative complications, and tail site of tumors were identified as significant risk factors. Conservative management was successful in most cases, with more complex intervention such as tympanic neurectomy reserved for only refractory instances.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eAuthors declare no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo funding was used for this study.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. M.M.F. and R.F.A. contributed to data collection, and interpretation. K.E.B. wrote the manuscript draft and performed statistical analysis. I.F. participated in critical manuscript revision and literature review. All authors reviewed and approved the submitted version, agree to be personally accountable for their contributions and the accuracy or integrity of the work, and meet the authorship criteria as described.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data are available upon reasonable request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAhmad, Y. E. S., \u0026amp; Winters, R. (2024, March 10). \u003cem\u003eParotidectomy\u003c/em\u003e. StatPearls \u0026ndash; NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557651/\u003c/li\u003e\n\u003cli\u003eGhannam, M. G., \u0026amp; Singh, P. (2023, May 29). \u003cem\u003eAnatomy, head and neck, salivary glands\u003c/em\u003e. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK538325/\u003c/li\u003e\n\u003cli\u003eTakahama, A., De Almeida, O. P., \u0026amp; Kowalski, L. P. (2009). Parotid neoplasms: analysis of 600 patients attended at a single institution. \u003cem\u003eBrazilian Journal of Otorhinolaryngology\u003c/em\u003e, \u003cem\u003e75\u003c/em\u003e(4), 497\u0026ndash;501. https://doi.org/10.1016/s1808-8694(15)30486-9\u003c/li\u003e\n\u003cli\u003eBelcastro, A., Reed, W., \u0026amp; Puscas, L. (2022). The management of salivary fistulas. \u003cem\u003eSeminars in Plastic Surgery\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(01), 004\u0026ndash;008. https://doi.org/10.1055/s-0042-1759561\u003c/li\u003e\n\u003cli\u003eMarchese-Ragona, R., De Filippis, C., Marioni, G., \u0026amp; Staffieri, A. (2005, June 1). \u003cem\u003eTreatment of complications of parotid gland surgery\u003c/em\u003e. https://pmc.ncbi.nlm.nih.gov/articles/PMC2639867/\u003c/li\u003e\n\u003cli\u003eParotid Tumor Surgery, Salivary Gland Surgery Los Angeles CA. (2020, May 18). \u003cem\u003eSialocele / Salivary gland cysts - Parotid Tumor surgery | Salivary Gland Surgery Los Angeles CA\u003c/em\u003e. Parotid Tumor Surgery | Salivary Gland Surgery Los Angeles CA - Parotidectomy \u0026amp; Sialendoscopy Experts. https://parotid.net/sialocele-salivary-gland-cysts/\u003c/li\u003e\n\u003cli\u003eManagutti, A., Tiwari, S., Prakasam, M., \u0026amp; Puthanakar, N. (2015, January 1). \u003cem\u003eFistulectomy of the parotid fistula secondary to suppurative parotitis: a case report\u003c/em\u003e. https://pmc.ncbi.nlm.nih.gov/articles/PMC4336664/\u003c/li\u003e\n\u003cli\u003eWikipedia contributors. (2023, November 5). \u003cem\u003eSalivary gland fistula\u003c/em\u003e. Wikipedia. https://en.wikipedia.org/wiki/Salivary_gland_fistula\u003c/li\u003e\n\u003cli\u003eJ\u0026uacute;nior, R. M., Da Rocha Neto, A. M., Queiroz, I. V., De Figueiredo Cauby, A., Gueiros, L. a. M., \u0026amp; Le\u0026atilde;o, J. C. (2012). Giant sialocele following facial trauma. \u003cem\u003eBrazilian Dental Journal\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 82\u0026ndash;86. https://doi.org/10.1590/s0103-64402012000100015\u003c/li\u003e\n\u003cli\u003eLambiel, S., Dulguerov, N., Courvoisier, D. S., \u0026amp; Dulguerov, P. (2020). Minor Parotidectomy Complications: A Systematic Review. The Laryngoscope, 131(3), 571\u0026ndash;579. https://doi.org/10.1002/lary.28912\u003c/li\u003e\n\u003cli\u003eKim, B. D., Lim, S., Wood, J., Samant, S., Halen, J. P. V., \u0026amp; Kim, J. Y. S. (2014). Predictors of adverse events after parotidectomy. Annals of Otology Rhinology \u0026amp; Laryngology, 124(1), 35\u0026ndash;44. https://doi.org/10.1177/0003489414542089\u003c/li\u003e\n\u003cli\u003eInfante-Cossio, P., Gonzalez-Cardero, E., Garcia-Perla-Garcia, A., Montes-Latorre, E., Gutierrez-Perez, J., \u0026amp; Prats-Golczer, E. (2018). Complications after superficial parotidectomy for pleomorphic adenoma. Medicina Oral, Patolog\u0026iacute;a Oral Y Cirug\u0026iacute;a Bucal, 0. https://doi.org/10.4317/medoral.22386\u003c/li\u003e\n\u003cli\u003eLiu, Y., Yuan, W., Sun, H., Su, M., Kong, X., \u0026amp; Huang, X. (2021). Predictors of sialocele or salivary fistula after partial superficial parotidectomy for benign parotid tumor: a Retrospective study. Journal of Oral and Maxillofacial Surgery, 80(2), 327\u0026ndash;332. https://doi.org/10.1016/j.joms.2021.09.013\u003c/li\u003e\n\u003cli\u003eBelcastro, A., Reed, W., \u0026amp; Puscas, L. (2022). The management of salivary fistulas. Seminars in Plastic Surgery, 37(01), 004\u0026ndash;008. https://doi.org/10.1055/s-0042-1759561\u003c/li\u003e\n\u003cli\u003eSadetzki, S., Oberman, B., Mandelzweig, L., Chetrit, A., Ben‐Tal, T., Jarus‐Hakak, A., Duvdevani, S., Cardis, E., \u0026amp; Wolf, M. (2008). Smoking and risk of parotid gland tumors. Cancer, 112(9), 1974\u0026ndash;1982. https://doi.org/10.1002/cncr.23393\u003c/li\u003e\n\u003cli\u003eMoussa, H. R., Mlees, M. A., \u0026amp; Abdelhamid, A. F. (2022). Incidence and risk factors of facial nerve palsy after parotidectomy for benign parotid diseases. ejsur.journals.ekb.eg. https://doi.org/10.4103/ejs.ejs_138_21\u003c/li\u003e\n\u003cli\u003eInfante-Cossio, P., Gonzalez-Cardero, E., Garcia-Perla-Garcia, A., Montes-Latorre, E., Gutierrez-Perez, J., \u0026amp; Prats-Golczer, E. (2018b). Complications after superficial parotidectomy for pleomorphic adenoma. Medicina Oral, Patolog\u0026iacute;a Oral Y Cirug\u0026iacute;a Bucal, 0. https://doi.org/10.4317/medoral.22386\u003c/li\u003e\n\u003cli\u003eGłuszkiewicz, E., Sowa, P., Zieliński, M., Adamczyk-Sowa, M., Misiołek, M., \u0026amp; Ścierski, W. (2022). Prospective Assessment of Risk Factors Influencing Facial Nerve Paresis in Patients after Surgery for Parotid Gland Tumors. Medicina, 58(12), 1726. https://doi.org/10.3390/medicina58121726\u003c/li\u003e\n\u003cli\u003eLee, Y. C., Park, G. C., Lee, J., Eun, Y. G., \u0026amp; Kim, S. W. (2015). Prevalence and risk factors of sialocele formation after partial superficial parotidectomy: A multi‐institutional analysis of 357 consecutive patients. Head \u0026amp; Neck, 38(S1). https://doi.org/10.1002/hed.24130\u003c/li\u003e\n\u003cli\u003eBritt, C. J., Stein, A. P., Gessert, T., Pflum, Z., Saha, S., \u0026amp; Hartig, G. K. (2016). Factors influencing sialocele or salivary fistula formation postparotidectomy. Head \u0026amp; Neck, 39(2), 387\u0026ndash;391. https://doi.org/10.1002/hed.24564\u003c/li\u003e\n\u003cli\u003eAlqaryan, S., Aldokhayel, F., Alotaibi, M., Alnasser, A., Alabdulqader, A., Alessa, M., Aldhahri, S., \u0026amp; Alqahtani, K. (2024). Factors associated with postoperative complications in patients who underwent parotidectomy: a retrospective study. Ear Nose \u0026amp; Throat Journal. https://doi.org/10.1177/01455613241244656\u003c/li\u003e\n\u003cli\u003eSinha, P. (2008). Successful treatment of parotid fistula with tympanic neurectomy. Indian Journal of Otolaryngology and Head \u0026amp; Neck Surgery, 60(3), 227\u0026ndash;230. https://doi.org/10.1007/s12070-008-0083-0\u003c/li\u003e\n\u003cli\u003eMarfatia, H., Madhavi, A., Kp, A., Goyal, P., Kaku, D. R., \u0026amp; Sharma, A. (2020). Endoscopic tympanic neurectomy in the management of persistent parotid fistulae. Brazilian Journal of Otorhinolaryngology, 87(1), 114\u0026ndash;117. https://doi.org/10.1016/j.bjorl.2020.09.016\u003c/li\u003e\n\u003cli\u003eMaharaj, S., Mungul, S., \u0026amp; Laher, A. (2020). Botulinum toxin A is an effective therapeutic tool for the management of parotid sialocele and fistula: A systematic review. Laryngoscope Investigative Otolaryngology, 5(1), 37\u0026ndash;45. https://doi.org/10.1002/lio2.350\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable (1): Comparison between the two studied groups according to demographics and tumor characteristics.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"701\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003cbr\u003e\u0026nbsp;(n = 95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 249px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFistula or scialocele\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of Sig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbsent\u003cbr\u003e\u0026nbsp;(n = 85)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresent\u003cbr\u003e\u0026nbsp;(n = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e58 (61.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e50 (58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e\u0026nbsp;1.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=\u003cbr\u003e\u0026nbsp;0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e37 (38.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e35 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e13.0 \u0026ndash; 84.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e13.0 \u0026ndash; 84.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e35.0 \u0026ndash; 55.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 77px;\"\u003e\n \u003cp\u003et=\u003cbr\u003e\u0026nbsp;1.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e43.39 \u0026plusmn; 14.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e42.94 \u0026plusmn; 15.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e47.20 \u0026plusmn; 6.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e45.0 (31.50 \u0026ndash; 54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e45.0 (30.0 \u0026ndash; 55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e49.50 (42.0 \u0026ndash; 52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSexually Inactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e33 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e29 (34.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e4 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e\u0026nbsp;0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSexually Active\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e62 (65.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e56 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e6 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e70 (73.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e62 (72.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e\u0026nbsp;0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003csup\u003eMC\u003c/sup\u003ep=\u003cbr\u003e\u0026nbsp;0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e7 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHTN+DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e9 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e21.10 \u0026ndash; 36.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e21.10 \u0026ndash; 36.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e22.30 \u0026ndash; 34.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 77px;\"\u003e\n \u003cp\u003et=\u003cbr\u003e\u0026nbsp;0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e28.03 \u0026plusmn; 3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e28.0 \u0026plusmn; 3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e28.34 \u0026plusmn; 3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e27.90(25.55 \u0026ndash; 31.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e27.90(25.40 \u0026ndash; 31.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e28.20(27.20 \u0026ndash; 29.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e23 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e15 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=18.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e46 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e38 (44.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e6 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e\u0026nbsp;0.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e49 (51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e47 (55.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e4 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSize (cm) (Max.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.20 \u0026ndash; 4.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.20 \u0026ndash; 4.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.50 \u0026ndash; 4.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 77px;\"\u003e\n \u003cp\u003eU=\u003cbr\u003e254.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.038\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.89 \u0026plusmn; 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.82 \u0026plusmn; 0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3.46 \u0026plusmn; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.90 (2.40 \u0026ndash; 3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.80 (2.30 \u0026ndash; 3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3.60 (2.90 \u0026ndash; 4.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSite of the tumor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 197px;\"\u003e\n \u003cp\u003eDeep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e13 (13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e13 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e6.345\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eMC\u003c/sup\u003ep=\u003cbr\u003e0.034\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 197px;\"\u003e\n \u003cp\u003eTail\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e46 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e38 (44.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9 (90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 197px;\"\u003e\n \u003cp\u003eUpper superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e36 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e34 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay (1day)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e95 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e85 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIQR: Inter quartile range\u0026nbsp; \u0026nbsp;\u0026nbsp;SD: Standard deviation\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;t: Student t-test\u0026nbsp; \u0026nbsp; \u0026nbsp;U: Mann Whitney test\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e: Chi square test \u003csup\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/sup\u003eFET: Fisher Exact test\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;MC: Monte Carlo\u003csup\u003e\u0026nbsp;\u003c/sup\u003etest\u003c/p\u003e\n\u003cp\u003ep: p value for comparing between the two studied groups\u003c/p\u003e\n\u003cp\u003e*: Statistically significant at p \u0026le; 0.05 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2): \u0026nbsp; \u0026nbsp; \u0026nbsp; Comparison between the two studied groups according to operative and postoperative parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"701\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003cbr\u003e\u0026nbsp;(n = 95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFistula or scialocele\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbsent\u003cbr\u003e\u0026nbsp;(n = 85)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresent\u003cbr\u003e\u0026nbsp;(n = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e37.0 \u0026ndash; 131.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e37.0 \u0026ndash; 131.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e74.0 \u0026ndash; 113.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 76px;\"\u003e\n \u003cp\u003et=\u003cbr\u003e2.137\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.035\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e82.89 \u0026plusmn; 20.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e81.35 \u0026plusmn; 21.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e96.0 \u0026plusmn; 13.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e81.0 (68.0 \u0026ndash; 92.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e81.0 (68.0 \u0026ndash; 90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e95.50 (89.0 \u0026ndash; 108.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eEnucleation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e3 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"6\" style=\"width: 74px;\"\u003e\n \u003cp\u003e7.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"6\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eMC\u003c/sup\u003ep=\u003cbr\u003e\u0026nbsp;0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eExtracapsular dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e22 (23.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e19 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eSuperficial parotidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e41 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e39 (45.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePartial superficial parotidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e16 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e11 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eTotal conservative parotidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e9 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eTotal conservative parotidectomy + Ipsilateral MRND\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e4 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e4 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eWarthin\u0026apos;s tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e19 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e18 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"8\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"8\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eMC\u003c/sup\u003ep=\u003cbr\u003e\u0026nbsp;0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePleomorphic adenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e62 (65.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e53 (62.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e9 (90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eMucoepidermoid tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e8 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eMetastatic nodal lesion vs neoplastic parotid lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eRecurrent pleomorphic adenoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eCystic lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e2 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eHigh grade carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e59 (62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e58 (68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e12.893\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36 (37.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27 (31.8%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9 (90.0%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eSeroma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e12 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e8 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e4 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e7.586\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=0.021\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eMarginal mandibular injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e5 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eHematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e6 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e10.596\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFrey\u0026rsquo;s Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e6 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFacial nerve neuropraxia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e6 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eDistal flap ischemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e4 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e6.909\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.054\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFistula or scialocele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e10 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e95.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003csup\u003eFE\u003c/sup\u003ep=\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e: Chi square test \u003csup\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/sup\u003eFET: Fisher Exact test \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;MC: Monte Carlo\u003csup\u003e\u0026nbsp;\u003c/sup\u003etest\u003c/p\u003e\n\u003cp\u003ep: p value for comparing between the two studied groups\u003c/p\u003e\n\u003cp\u003e*: Statistically significant at p \u0026le; 0.05\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Parotidectomy, Salivary fistula, Sialocele, Postoperative complications, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-7873836/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7873836/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSalivary fistula and sialocele are recognized as common postoperative complications following parotidectomy, contributing to patient morbidity and decreasing quality of life. Studies that focus on the incidence, risk factors, and effective management remain limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis is a retrospective cohort study conducted in two academic referral centers and included 95 patients who underwent different kinds of parotidectomy procedures from January 2022 to December 2024. The incidence, risk factors and management of salivary fistula and sialocele were studied using patients' file reports and follow-up data. Correlations with demographics, tumor information and surgery-related factors were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe incidence of salivary fistula or sialocele was 10.5%. Significant risk factors identified included smoking (80% in affected vs 17.6% in unaffected patients, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), larger tumor size (mean 3.46 cm vs 2.82 cm, p\u0026thinsp;=\u0026thinsp;0.038), tumor location in the parotid tail (90% vs 44.7%, p\u0026thinsp;=\u0026thinsp;0.034 ), longer operative time (mean 96.0 min vs 81.35 min, p\u0026thinsp;=\u0026thinsp;0.035), and the presence of concurrent postoperative complications (90.0% vs 31.8%, p\u0026thinsp;=\u0026thinsp;0.001). Conservative management\u0026mdash;such as pressure dressings, aspiration, and dietary modifications\u0026mdash;was effective in 80% of cases, while only 2 patients (20%) required tympanic neurectomy. Age, sex, BMI, comorbidity, type of the tumour, type of surgery and surgical side were not statistically associated with fistula or sialocele formation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSalivary fistula \u0026amp; sialocele occur in approximately one in ten cases of parotidectomy. Key risk factors are smoking, tumor size, operative duration, tumor location at the gland tail, and other concurrent complications. Conservative management is highly effective as initial therapy, and tympanic neurectomy is reserved for refractory cases.\u003c/p\u003e","manuscriptTitle":"Incidence, Risk Factors and Management of Salivary Fistula and Sialocele After Parotidectomy: Two-centers Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 05:33:41","doi":"10.21203/rs.3.rs-7873836/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d217c631-4a98-4b21-920b-20c705f5d1c0","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-02T10:08:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 05:33:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7873836","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7873836","identity":"rs-7873836","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}