Clinical and radiological evidence to support superficial parotidectomy as the treatment of choice for chronic parotid sialadenitis: a retrospective study

We present a retrospective series of 23 consecutive parotidectomies, over a 10-year period (1989-1999) for 22 patients with chronic sialadenitis unresponsive to conservative measures. There were 10 male and 12 female patients. Mean age was 52 years (range 12-72), and mean duration of symptoms 4.5 years (range 8 months-30 years). All patients had preoperative sialography and 2 had computed tomography to exclude a neoplasm. A complete superficial parotidectomy with preservation of the main duct was done in all cases. Fifteen patients developed temporary facial nerve weakness postoperatively and 7 developed Frey's syndrome. There were no cases of permanent facial nerve palsy. Nineteen patients reported complete resolution of their symptoms and 3 patients had mild persisting symptoms that did not necessitate any further treatment. Histologically there was evidence of sialadenosis in one case and benign lymphoepithelial lesion in another; the others showed evidence of chronic sialadenitis of varying degrees of severity. Fifteen patients had postoperative sialograms, of which 11 showed evidence of some filling of residual parotid gland parenchyma and in 8 patients there was filling of a normal-looking accessory lobe. In this series, superficial parotidectomy with preservation of the main duct was safe and effective, with minimal long-term complications, for most patients with chronic parotid sialadenitis that was unresponsive to conservative measures and, in some patients, it allowed some preservation of function. The potential damage to the facial nerve and the cosmetic problems associated with a total or near-total parotidectomy were avoided.     

Accessory parotid gland tumours: 24 years of clinical experience

The accessory parotid gland (APG) is salivary tissue anterior to and anatomically separate from the parotid gland. APG is a common anatomical variation, but APG tumours are extremely rare. The authors report 6 patients with APG tumours emphasizing the diagnosis, clinical features, indications and rationales for different treatment approaches. Patients with primary tumours of the parotid gland or APG tumours who underwent surgical treatment were included. APG tumours comprised 1.23% of overall parotid tumours (6/488) and had a malignancy rate of 33.3% (2/6). There were three male and three female patients with a mean age of 39 years (range 14–70 years). 5 of 6 parotidectomies entailed superficial lobectomy, while one was a total parotidectomy with composite resection of masseter muscle. Concomitant selective lymphadenectomy was carried out in 3 of 6 patients. At 5 years disease-free survival was 83.3%. Mean follow-up was 161 months (range 14–253 months). Although nonsalivary diagnoses frequently occur in the buccal area, APG tumours should be considered in every differential diagnosis in patients presenting with a mid-cheek mass. From oncosurgical, cosmetic and functional standpoints, treatment by facelift parotidectomy or ‘S-incision’ with concomitant superficial lobectomy is the recommended surgical approach; high-grade malignancies require total parotidectomy with regional lymphadenectomy.     

Treatment of parotid gland tumors in Latvian Oncological Center

A total of 268 patients were treated for parotid gland lesions at department of Head and Neck Surgery of Latvian Oncological Center between 1996 and 2000, and the results were analyzed retrospectively. The objective was to analyze the incidence and factors associated with facial nerve dysfunction after different types of parotidectomies with facial nerve dissection and to compare the changing attitudes towards the pathology and surgical treatment in order to better define prevention and management of pleomorphic adenoma recurrences. Limited superficial parotidectomy was the commonest operation performed in 143 patients. Other procedures were complete superficial parotidectomy in 11%, total radical surgery in 10 patients and enucleation in 20 patients. Neck node dissection was done in 9 patients. In 4 patients (6%) paresis was observed after limited superficial parotidectomy, in 10 patients (16%) after complete superficial parotidectomy, in 18 cases (28%) after near - total (subtotal) parotidectomy and in 32 patients (50%) after total parotidectomy. Recurences after the surgical treatment of benign diseases were observed in 12 patients (5.2%). Overall 5-year survival for all stages and histologic types was 58 %.     

Prevention of Frey syndrome with superficial temporal fascia interpositioning: a retrospective study

Frey syndrome (FS) is a commonly documented postoperative complication following parotidectomy. The aim of this study was to clinically evaluate the efficacy of superficial temporal fascia (STF) as interpositioning barrier between the overlying skin flap and the parotid bed for the prevention of FS following superficial parotidectomy. A retrospective study was designed involving a population of patients from a single institution who underwent superficial parotidectomy for parotid tumours and refractory chronic sialadenitis from 2008 to 2011. Forty-eight cases were identified and divided into two groups: group I (n = 25) had undergone STF interpositioning between the skin flap and the parotid bed after extending the modified Blair's incision in the temporal region, and group II (n = 23) had undergone a superficial parotidectomy using the modified Blair's incision without any interpositioning. In group I, one of 25 cases (4%) developed mild FS; in group II, nine of 23 cases (39.1%) developed FS of varying severity. There were no cases of permanent facial palsy in either group. Alopecia along the temporal extension of the incision line was imperceptible in all group I cases. The use of an STF interpositioning barrier between the overlying skin flap and the parotid bed is a safe and effective procedure for the prevention of FS following superficial parotidectomy.     

腮腺复发性多形性腺瘤的临床分析--附22例报告

目的：探讨腮腺多形性腺瘤复发、恶变的原因及临床治疗方法。方法：对22例腮腺多形性腺瘤复发患者进行回顾性分析和追踪调查。结果：多数腮腺多形性腺瘤复发病例肿块呈多灶性（18／22），手术越简单其复发率越高，复发间期越短（P＜0．05）。22人中有7例发生恶变，占31．8％，恶变与初发年龄较大有关（P＜0．05），与手术次数关系不大。末次手术分别采用浅叶切除术，腮腺全切术、扩大切除术，对7例有恶变者于术后辅以放射治疗。术后平均追踪54月，除1例多形性腺瘤恶变者于术后30月时肿瘤复发外，其余均未见复发。结论：不恰当的手术方式是导致腮腺性多形性腺瘤复发的直接原因。     

Superficial parotidectomy: technical modifications based on tumour characteristics

AIM: The purpose of this study was to evaluate the adequacy of partial superficial parotidectomy and tumour enucleation in the surgical management of patients with pleomorphic adenoma of the parotid. MATERIAL AND METHODS: A total of 62 patients were treated for pleomorphic adenoma of the parotid during the years 1995-1999; 17 patients were treated with conventional superficial parotidectomy, whereas 42 patients were subjected to partial superficial parotidectomy. In three patients, tumour size and facial nerve proximity essentially resulted in enucleation of the parotid mass. In partial superficial parotidectomy, only the tumour-bearing area of the gland parenchyma was excised with identification of the main trunk and preservation of the facial nerve division that was adjacent to the tumour site with no need for more extensive facial nerve dissection. RESULTS: There was no incidence of recurrence or facial nerve injury in our group of patients. The incidence of Frey's syndrome was 4.8%.     

腮腺区域性切除术在治疗腮腺浅叶多形性腺瘤中的体会

目的探讨腮腺多形性腺瘤两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据。方法总结1999年1月至2007年1月间汕头市第二人民医院收治的腮腺多形性腺瘤90例,其中44例采用腮腺区域性切除术,46例行腮腺浅叶切除术,随访时间2～9年。结果采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而采用两种术式肿瘤的复发率差异无统计学意义。结论区域性切除术手术创伤小．并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式。     

Partial superficial parotidectomy as the method of choice for treating pleomorphic adenomas of the parotid gland

We present our experience of 156 patients with parotid pleomorphic adenomas who were treated from 1995 to 2009 by partial superficial parotidectomy. In each case the main trunk of the facial nerve was identified and dissected. Only the division of the nerve adjacent to the tumour was dissected, and only the parotid tissue surrounding the tumour was excised. The results were satisfactory, as no patient developed permanent partial or total facial nerve paralysis, and transient paresis was noticed in only 23 patients (15%). Only one tumour recurred, and Frey syndrome developed in only 6 patients (4%). Enucleation was required in 55 patients (35%) because the tumour was so close to the branches of the facial nerve. Partial superficial parotidectomy is a safe treatment for parotid pleomorphic adenomas with relatively few postoperative complications. When it is done by experienced surgeons no permanent deficits are likely, it has low rates of recurrence, and gives excellent aesthetic results.     

腮腺多形性腺瘤区域性切除术与浅叶切除术的比较研究

目的 比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据.方法 总结1998年1月～2004年6月间收治的腮腺多形性腺瘤61例,其中24例采用腮腺区域性切除术,37例行腮腺浅叶切除术,随访时间3～9年.结果 采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异.结论 区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式.     

Wide excision of accessory parotid gland with anterior approach

Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.     

Surgical approach to parotid pleomorphic adenoma: a 15-year retrospective cohort study

Our aim was to investigate the clinical outcomes (recurrences, duration of follow-up, and effectiveness) after extracapsular dissection and superficial parotidectomy for pleomorphic adenoma of the parotid gland. We retrospectively studied 261 patients whose adenomas were treated at the Maxillofacial Unit of Magna Graecia University of Catanzaro between January 2003 and December 2015 and had been followed up for at least three years after either extracapsular dissection or superficial parotidectomy. The difference in recurrences and complications between the two techniques were measured by univariate analysis (Fisher’s exact test). The level of significance was set at p ≤ 0.05. Of the 261 patients 125 were male (48%) and 136 female (52%), mean (range) age 47 (14-78) years. A total of 210 of the 261 patients had an extracapsular dissection (80%, 101 male and 109 female), and 51 had a superficial parotidectomy (24 male and 27 female). Postoperative complications were recorded in 48 of the 261 patients; complication rate was 10% in the extracapsular dissection group, and a third after superficial parotidectomy. There were more complications in the parotidectomy group (p=0.042). For pleomorphic adenomas located in the superficial portion of the parotid gland, extracapsular dissection is a viable alternative to traditional superficial parotidectomy in the hands of experienced parotid surgeons with regard to clinical outcomes, and it may be superior with regard to cost.     

腮腺切除术的手术径路改良

目的 设计一种改良的腮腺切除术的手术径路,旨在改善术后的外形与功能。方法 10例患者采用了该改良手术径路,切口上端起自发际内沿耳屏前,沿纵向皮纹切开,绕过耳垂向后沿耳背后延至乳突根部的发际内。行腮腺全切术3例,腮腺浅叶切除术7例。结果 改良术手术切口,术野暴露清楚,所有病例均将肿瘤完整切除。经1－12个月随访,疗效满意。术后手术切口区基本见不到疤痕。无1例出现永久性面瘫。手术时间和采用“S”切口的手术时间无统计学意义（P＞0．1）。结论 该手术径路,能充分暴露并完整切除腮腺及肿瘤,术后有较满意的面部外形,提高了患者的生存质量。     

功能性腮腺切除术治疗腮腺深叶良性肿瘤

目的：探讨保存功能性外科在腮腺深叶肿瘤切除术中的应用及疗效。方法：17例腮腺深叶良性肿瘤患者,其中位于深叶者12例,累及浅深2叶者5例,直径均≤3 cm。采用制备筋膜腺体瓣并预留出将要切除的肿瘤及周围腺体的方法,完整切除腮腺深叶及肿瘤同时保存腮腺浅叶功能。结果：全部患者的手术均顺利完成,创口均Ⅰ期愈合,无涎瘘,外形满意;暂时性面瘫发生2例（11．76％）。17例均获随访,随访时间6～24个月,平均11个月。未见肿瘤复发;面瘫基本消失。结论：应用功能性腮腺切除术治疗腮腺深叶良性肿瘤能有效保存腺体功能,减少面部凹陷畸形及味觉出汗综合征等并发症。     

Lipomatous lesions of the parotid gland.

PURPOSE: Lipomatous lesions of the parotid gland are rare and seldom considered in the initial diagnosis of a parotid mass. We report our experience in the management of patients with lipomatous lesions affecting the parotid gland. PATIENTS AND METHODS: Retrospective analysis of all parotidectomies performed for neoplastic lesions in the maxillofacial unit between 1975 and 2003 and patients with lipomatous lesions involving the parotid gland were identified; 638 parotidectomies were performed in this period on 629 patients in which 660 neoplasms were identified. Eight patients were found to have lipomatous lesions and form the basis of this study. RESULTS: Lipomatous lesions accounted for only 1.3% of parotid tumors and occurred more frequently in males, at a ratio of 3 to 1. The most common presentation was that of a slowly enlarging, painless mass. Computed tomography scan was the most frequent imaging modality undertaken, and in 3 patients a diagnosis of a lipoma was made preoperatively. Seven patients underwent a superficial parotidectomy and 1 patient had a total conservative parotidectomy because of the deep lobe location of the mass. Five patients were found to have a focal lipoma and 3 patients had diffuse lipomatosis. There were no recurrences. Temporary facial nerve palsy and Frey's syndrome were the most frequent complications. CONCLUSION: Lipomatous lesions accounted for only 1.3% of all parotid tumors. There were no specific distinguishing clinical features in our patients, and an accurate preoperative diagnosis was made in 3 patients based on imaging investigations. A well-circumscribed lipoma was more common than diffuse lipomatosis. Superficial parotidectomy was the treatment of choice and there were no recurrences in our series.     

A multicentre retrospective clinico-histopathological review of 250 patients after parotidectomy

A clinicopathological review of parotid tumours treated surgically in two oral and maxillofacial surgery departments was conducted. The performance of fine needle aspiration cytology (FNAC) was also assessed. This retrospective study included 250 consecutive patients treated surgically for parotid gland-related tumours. Benign tumours (n = 211, 84.4%) were more prevalent than malignancies (n = 39, 15.6%). A predominance of pleomorphic adenoma (48.8%) was identified, and epithelial-myoepithelial carcinoma (3.6%) was the most common malignant tumour. Overall, the sensitivity and specificity of FNAC were 64% and 99%, respectively. Subgrouping resulted in sensitivity and specificity of 50% and 100% for clinically assisted FNAC versus, 72% and 99% for ultrasound guidance. Surgically, 31.6% underwent complete superficial parotidectomy and 28.4% underwent extracapsular dissection. Overall, facial nerve palsy was the most prevalent postoperative complication, affecting 29.2% (70/240); loss of function was transient in 21.2% (51/240) and permanent in 7.9% (19/240). Extracapsular dissection and superficial parotidectomy with facial nerve preservation were the treatments of choice when a benign tumour was suspected. Facial nerve palsy was quite frequent; treatment options however are scarce. Preoperative diagnostic workup using imaging and ultrasound-guided FNAC was essential in identifying malignancy so that surgical planning could be adapted.     

Parotid benign tumors: comments on surgical treatment of 263 cases

263 patients with benign parotid gland tumors have been operated upon, from 1970 through 1980. Of this total number of tumors, according to their histopathologic examination, 185 corresponded to pleomorphic adenoma, 24 to Warthin's tumor, 10 to recurrent pleomorphic adenomas (at first operated on elsewhere) and 44 to miscellaneous tumors or tumor-like lesions (simple cyst, lymphoepithelial lesion, branchial cleft cysts, lymph node hyperplasia etc.). 25 cases of pleomorphic adenoma, operated on during the past 24 months, were not evaluated as far as recurrence is concerned, because their follow-up was insufficiently long. The operative procedures used by us for pleomorphic adenoma surgery were: (a) pericapsular (extracapsular) excision, with a margin of normal parotid gland tissue without preparation of the fascial nerve, for 98 small size and superficially sited pleomorphic adenomas (52.6%); (b) subtotal parotidectomy (superficial lobectomy) with preparation of the facial nerve for 78 tumors (42.5%); (c) total parotidectomy with preservation of the nerve for 9 tumors located on the deep lobe of the gland (4.9%). We did not see any permanent facial palsy, and not one case of recurrence.     

Surgical techniques in the treatment of pleomorphic adenoma of the parotid gland: our experience and review of literature.

This paper presents a retrospective study carried out on a sample of 100 patients affected by pleomorphic adenoma of the parotid gland and treated at the Department of Maxillofacial Surgery at the University of Rome "La Sapienza" between January 1, 1989 and December 31, 1997. For the diagnosis of this neoformation, cytological tests were performed on material taken from the neoformation using fine needle aspiration and ultrasound scan. In some selected cases, a CT examination of the head and neck with medium contrast or Nuclear Magnetic Resonance (NMR) was carried out. This study sets out to examine the most suitable treatment to be followed for the removal of the pleomorphic adenoma of the parotid gland. In 56 cases the patients underwent a superficial, conservative parotidectomy. Forty one patients had a total parotidectomy with the facial nerve left intact and one patient had a total parotidectomy where the marginal mandibular nerve of the facial nerve was damaged. The remaining two patients involved in the study were suffering from a recurrent pleomorphic adenoma and in these two cases a total parotidectomy was performed where the facial nerve was killed. The removal of the cranial nerve VII in these patients proved necessary because the nerve fibers had adhered to the surrounding scar tissue of the tumor, either after previous surgery or due to repeated chronic phlogosis of the gland.     

Tumour recurrence after surgical removal of parotid pleomorphic salivary adenoma using a retrograde facial nerve dissection technique

Recurrence after surgical removal of parotid pleomorphic salivary adenoma using retrograde facial nerve dissection is not well researched. We adopted retrograde nerve dissection for parotid surgery for benign disease as a standard procedure in 1995. The objective of this study was to establish the rate of recurrence of primary tumours associated with the technique after removal of parotid pleomorphic salivary adenoma. We recruited 59 patients over a 16-year (1995-2011) period and collected the data prospectively. Eight patients were excluded as they had died or had been lost to follow up. Male:female ratio was 16:35 and age range was 15-69 years. The mean tumour size as measured on magnetic resonance imaging (MRI) was 27.4mm. Thirty-eight patients had superficial parotidectomy, 8 had total parotidectomy, and 5 had partial superficial parotidectomy. Mean follow up from the date of operation was 104 months (median 98, range 17-171). All patients were reviewed and examined in 2011 to establish whether the tumour had recurred. One patient had developed a solitary nodular recurrence 8 years after the initial procedure. Recurrence was 2%. The rate of clinically apparent recurrence after parotidectomy for pleomorphic salivary adenoma in this study is low and is comparable with others reported.     

腮腺区良性肿瘤术后并发症发生的相关因素分析

目的： 探讨腮腺良性肿瘤术后各类并发症发生的相关因素。方法：搜集并整理我院2010—2015年手术治疗的215例腮腺良性肿瘤患者的病例资料,回顾分析一般资料、手术治疗中不同因素及术后并发症的发生情况。采用SPSS17.0软件包对资料进行χ2检验。结果：术后积涎或涎瘘、面神经功能障碍及Frey综合征的发生与手术治疗中不同因素（手术切口、术中是否缝扎腺体残端、面神经解剖方式、手术切除范围及是否行胸锁乳突肌瓣转移修复等）之间具有显著相关性（P＜0.05）。结论：“N”形切口在解剖形态上不利于术后常规引流渗出液,需配合负压引流管,以减少术后积涎的发生。缝扎腺体残端能有效避免术后积涎及涎瘘的发生。顺行法解剖面神经及腮腺肿瘤区域性切除能加快手术速度,减少面神经的解剖量及暴露时间,从而减轻术后面神经功能障碍的发生。胸锁乳突肌瓣的转移修复能很好避免术后Frey综合征的发生。