Copyright
©The Author(s) 2015.
World J Clin Cases. Feb 16, 2015; 3(2): 180-185
Published online Feb 16, 2015. doi: 10.12998/wjcc.v3.i2.180
Published online Feb 16, 2015. doi: 10.12998/wjcc.v3.i2.180
Roh and Park[16] | |
Methods | Randomised controlled trial |
Participants | Patients undergoing parotidectomy (superficial, partial, total) ± neck dissection 44 patients Exclusion: 1 Direct FN invasion of FN requiring FN sacrifice and reconstruction 2 Incidental cutting of the facial nerve |
Interventions | Started day 1 or day 2 postoperatively Reducing dose of oral prednisolone (50 mg/d for 5 d, 30 mg/d for 3 d and 10 mg/d for 2 d) Placebo group received lactose with similarly formulated doses |
Outcomes | House Brackmann grading of FN by two blinded experts Assessed postoperatively: immediately, 1 wk, 1 mo, 3 mo and 6 mo |
Results | Overall recovery times from FNP: At 3 mo: 84% had fully recovery At 6 mo: 98% had full recovery Prednisolone vs placebo recovery at 1, 3 and 6 mo (minimal difference) (P > 0.10) |
Notes | One patient was lost to follow-up and excluded from the analysis (prednisolone group) |
Risk of Bias | |
Method of randomisation | Not specified |
Allocation concealment | Adequate |
Other confounding factors | Groups comparable demographically and extent of postoperatively FNP, however tumour size, type or type of parotid surgery not compared in between intervention and placebo groups |
Lee et al[14] | |
Methods | Randomised controlled trial |
Participants | Patients undergoing superficial or total parotidectomy 49 patients Exclusion criteria: Diabetes, age < 18, peptic ulcer disease, previous adverse reaction to steroids and any other contraindication to steroids Prior parotid surgery, anticipated section of FN and pre-existing FNP |
Interventions | Two doses of dexamethasone (0.51 or 1.41 mg/kg) depending on type of surgery (superficial or total parotidectomy respectively) at 8 and 16 h postoperatively Placebo group received saline at the same intervals |
Outcomes | Facial nerve function in the four major regions was assessed (frontal, orbital, midface, upper lip and lower lip) at a percentage 0-100 depending on extent of function Assessed postoperatively: immediately and every month for 12 mo (or until facial nerve function returned to normal) |
Results | Average early postoperative facial nerve function: All patients (n = 49): 75.4% Overall: Dexamethasone (69.5%) vs placebo (81.3%) (P = 0.239) Dose of dexamethasone: High (63.9%) vs low (74.7%) (P = 0.118) Type of surgery: Superficial (P = 0.637) and deep (P = 0.465) Time to full recovery of facial nerve (median): Placebo (60 d) vs Dexamethasone (150 d) (no P value stated) |
Notes | As intervention administered intravenously, total compliance can be ensured |
Risk of Bias | |
Method of randomisation | Not specified |
Allocation concealment | Adequate |
Other confounding factors | Initial power calculation required 120 patients, however a nationwide shortage of the intervention drug (dexamethasone) allowed only 52 patients to be enrolled in the trial No comparison of the type of parotid lesion excised within the trial groups (i.e., malignant or benign and tumour size) Operations were conducted by more than one surgeon (including junior residents) |
- Citation: Varadharajan K, Beegun I, Daly N. Use of steroids for facial nerve paralysis after parotidectomy: A systematic review. World J Clin Cases 2015; 3(2): 180-185
- URL: https://www.wjgnet.com/2307-8960/full/v3/i2/180.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v3.i2.180