Methylene blue staining in the parotid surgery: Randomized trial, 144 patients ★

ObjectiveTo investigate usefulness of the methylene blue staining for parotid gland surgery.Study designRandomized, prospective controlled trial.MethodsThe study analyzed 144 surgical operations (2000–2014) for parotidectomy. The cases were randomly divided into two groups: Group 1 (n = 70) for surgeries with methylene blue staining, and Group 2 (n = 74) for surgeries without staining. Surgical complications like temporary facial weakness, permanent facial nerve injury, and Frey's syndrome were taken for comparison between groups as well as rate of tumor recurrence.ResultsTemporary facial weakness and Frey's syndrome occurred almost evenly in both groups (p = 0.34, p = 0.68 respectively). Permanent facial nerve injury was significantly lower in the group with staining (p = 0.032) and the decline of rate of tumor recurrence was even more significant (p = 0.007).ConclusionIntravital staining with methylene blue in parotidectomies simplifies the operation and could assist in better visualization that leads to (1) rapid and precise localization of the tumor, (2) preservation of the facial nerve, and (3) complete removal of the gland tissue in cases with malignancy. This technique reduces the rate of recurrence in cases with malignant tumors.Level of evidence: 1.