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

Summary

Across 11 RCTs (n=804), periauricular incision reduced transient facial palsy, Frey’s syndrome, earlobe numbness, and facial deformity versus modified Blair incision, with higher patient satisfaction. No differences were found in salivary fistula or operative time; some perioperative metrics favored PI but with high heterogeneity.

Key Findings

• Periauricular incision reduced transient facial palsy (RR 0.60, 95% CI 0.39–0.93).
• Frey’s syndrome risk was substantially lower with PI (RR 0.27, 95% CI 0.13–0.55).
• Earlobe numbness (RR 0.53) and facial deformity (RR 0.19) were reduced, and patient satisfaction was higher (RR 1.24).
• No significant differences in salivary fistula (RR 0.70) or operative time; some perioperative parameters favored PI but with high heterogeneity.

Clinical Implications

For small-to-medium benign superficial parotid tumors, consider adopting periauricular incision to reduce facial nerve-related morbidity and improve aesthetic satisfaction. Surgeons should be trained in PI planning to minimize facial contour deformity without increasing fistula risk or operative time.

Limitations

• High heterogeneity for several perioperative outcomes (I² 72–97%).
• Applicability limited to small-to-medium benign superficial tumors; long-term outcomes variably reported.

Future Directions

Conduct multicenter RCTs with standardized PI techniques, longer follow-up, and patient-reported scar assessments; evaluate applicability to larger tumors and different pathology.