Surgical procedure
All surgeries were performed by the same high-volume head and neck
surgeon (A.K.). An individualized modified mini-Blair incision
[11] was used in all patients. The relevant facial
nerve branches or trunk were identified according to the location of the
tumor and the surgical needs. The tumor was excised with clean borders
and non-involved parotid tissue was preserved. The FS group received 2
cc of Evicel, prepared according to the manufacture’s specifications.
After meticulous hemostasis, Evicel was sprayed on the surgical bed
using a designated jet syringe system (Figure 1). When a substantial
mass of parotid gland was removed and a significant post-operative
cosmetic deficit was expected, the sternocleidomastoid muscle was
detached from its insertion to the mastoid and sutured to the parotid
gland prior to the placement of the Evicel glue, in order to decrease
potential dead space and cosmetic deficit at the surgical bed.