title: Dissection with harmonic scalpel versus cold instruments in parotid surgery.
abstract: BACKGROUND
  The harmonic scalpel (HS) has been used successfully in several head and neck surgical procedures. Some authors highlighted its advantages in reducing operative time, blood loss, and damages to surrounding tissue. In our study, we compared the results obtained during parotidectomy using the HS with the traditional approach to determine the benefits of the HS.
  
  
  METHODS
  130 patients with benign parotid tumors were enrolled and randomized into two groups for this prospective study. 63 patients underwent HS parotidectomy, and 67 patients received a parotidectomy using cold instruments and bipolar electrocautery hemostatic control (CI). 20 HS and 2 CI patients did not meet the inclusion criteria requirements, and were excluded.
  
  
  RESULTS
  The admission time was significantly shorter in the HS group than the CI group (3.9 ± 1.2 days and 4.7 ± 1.4 days, respectively, p < 0.01). In the early post-operative period, 84% of HS patients and 60% of CI cases showed no facial nerve impairment (p = 0.01). Significantly more CI patients than HS patients showed the onset of Frey's syndrome (29% and 9%, respectively, p = 0.01). Multivariate stepwise regression analysis confirmed the reduction in admission length (Odds Ratio (OR): 0.62; p = 0.02) and the lower risk of Frey's syndrome (OR: 0.29; p = 0.04) in HS compared to CI parotidectomies.
  
  
  CONCLUSIONS
  In parotid surgery, the HS is useful in preventing Frey's syndrome and reducing early transitory facial nerve dysfunction and admission times, and results in decreased medical costs and increased quality of life.
authors: A
authors: A
authors: Deganello
authors: G
authors: G
authors: Meccariello
authors: M
authors: M
authors: Busoni
authors: G
authors: G
authors: Parrinello
authors: R
authors: R
authors: Bertolai
authors: O
authors: O
authors: Gallo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation; D010306:Parotid Gland / Q000601:surgery*; D010307:Parotid Neoplasms / Q000601:surgery; D011446:Prospective Studies; D013547:Sweating, Gustatory / Q000209:etiology; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*; D055815:Young Adult