Partial Superficial Parotidectomy With Retrograde Dissection of the Facial Nerve for Clinically "Benign" Parotid Tumors.

BACKGROUND: To review experience with partial superficial parotidectomy (PSP) and retrograde dissection of the facial nerve as a treatment for benign parotid tumors. METHODS: Retrospective cohort study of all patients presenting with a suspected benign primary parotid tumor undergoing parotid surgery. RESULTS: There were 214 cases retrieved. Postoperative facial nerve weakness occurred in 33% of patients; all were temporary. Increased extent of surgical resection (P < .001), deeper tumors (P = .05), and close tumor proximity to the facial nerve (P = .007) significantly correlated with postoperative facial weakness. The surgical margin was clear in 54%; 31% had capsule exposed in at least 1 point, and 13.5% had tumor at the margin. Cases with close proximity of tumor to facial nerve were more likely to have tumor at the margin (P = .034). CONCLUSION: Partial superficial parotidectomy with retrograde dissection is a suitable method for benign appearing parotid tumors.

Demographics of benign parotid tumours: Warthin's tumour versus other benign salivary tumours.

CONCLUSION: Some variation from the 'classical' clinical picture for Warthin's tumours is evident in these patients. A predilection for the parotid tail and a propensity for multiplicity has been confirmed. OBJECTIVES: This study sought to analyse demographic and clinical features of a Warthin's patient population. METHODS: Retrospective review of patients presenting with a benign parotid tumour. The group of Warthin's tumours was compared with the group of patients with other benign parotid tumours. RESULTS: Of 170 primary parotid tumours, 41 (24%) were Warthin's tumour. Mean age of Warthins patients was significantly older (60 years vs 48 years, p = 0.001) and male gender more prevalent (61% vs 33%, p = 0.015) than in other benign tumours. Most (86%) Warthin's tumours were found in the parotid tail, compared with 61% of other benign tumours (p = 0.002). There was no significant ethnic predilection for Warthin's tumours. Bilaterality (30%) and multiplicity (27%) were common. Significance of gender differences disappeared with logistic regression analysis.

Time to "refine" clinical ward assessments? Or time to retrain?

AIM: To investigate the reliability and intra-professional variation of senior and junior doctors in the assessment of a junior doctor's clinical skills via video simulation. METHODS: Simulation video was created showing 4 clinical scenarios. This video was shown to consultants, registrars and junior doctors in various forms at Auckland City Hospital. Participants evaluated each scenario against a modified version of the current assessment form used by the Medical Council of New Zealand. RESULTS: 103 Respondents completed the survey: 22 Senior Medical Officers, 17 registrars (PGY3+), 43 junior doctors (PGY1-2) and 21 undergraduates (medical students). Statistical significance between groups was reached only for Question 6 in which Senior Medical Officers rated communication skills and respect for patients lower than postgraduate students (p=0.005). Large variability was noted in ratings for 'presentation of history' and 'clinical knowledge'. CONCLUSION: There is marked variation between Senior Medical Officers in the assessment of a junior doctor's clinical practice as demonstrated by the use of a simulation video. This variation is of potential major concern. Quality training methods of assessors may need to be implemented for standardisation of assessment if a summative component exists.