Author's response to the letter of the editor regarding the "Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors"
Abstract
We would like to thank Tretiakow and Skorek for their interesting comments. As we stated in our article, extracapsular dissection (ECD) is a surgical technique that has advantages and limitations and is only one of many options in benign parotid surgery.
We agree that main indications are parotid tumors located at the caudal part or the tail of the parotid gland (PG). Experienced surgeons can expand the indications to tumors of the cranial part of the PG as shown in Figures 2 and 5 of our manuscript.
Furthermore, we agree that pleomorphic adenoma (PLA) should be treated with extra caution. If PLA is preoperatively suspected, ECD can be applied, but surgeons have to make sure not to injure the capsule of the tumor and if possible, preserve some millimeters of healthy tissue around the tumor.
We disagree with Tretiakow and Skorek that MRI (including diffusion-weighted sequences) is superior to ultrasound in the diagnosis of parotid tumors. As we could show in previous studies, multimodal ultrasound with elastography is a very promising method to help differentiate between benign and malignant PG tumors and cervical lymph nodes.
Finally, we agree that all parotid surgeons offering extracapsular dissection should be highly experienced in all surgical techniques of PG surgery (especially superficial and total parotidectomy) and be able to safely identify the main trunk of the facial nerve, otherwise wrong indications and increased complications are inevitable.