Temporary facial nerve dysfunction after parotidectomy correlates with tumor location

Objective

To investigate the clinical factors associated with temporary facial nerve dysfunction (TFND) following surgery for benign parotid gland tumors.

Methods

We reviewed the records of 175 patients with benign parotid gland tumors who underwent partial parotidectomy at Yokohama City University Medical Center in Japan. TFND was found in 33 patients (18.9%). We used two hypothetical lines in magnetic resonance imaging (MRI) images to define the tumor location (upper/lower or anterior/posterior) in the parotid gland. We then studied the associations of TFND with the following clinical factors: patient age, tumor size, histopathological diagnosis, and the location of the tumor within the parotid gland (superficial lobe/deep lobe; upper part/lower part; and anterior part/posterior part).

Results

Tumors located in the upper parts, anterior parts or the deep lobes of the parotid gland had statistically higher incidences of TFND compared with tumors located in the lower parts, posterior parts or the superficial lobe (P < 0.001, <0.001, <0.01, respectively). The odds ratio for the risk of TFND was significantly high if tumors were located in the upper parts, the anterior parts or the deep lobes with stepwise multivariate regression analysis. The other factors, including patient's age, tumor size, histopathology of the tumor, and inadequate surgeon's experience, were not apparent risks for TFND.

Conclusions

Parotid gland tumors located in the upper parts, the anterior parts or the deep lobes had a higher risk of TFND. The two hypothetical lines we used were shown to be useful to define the tumor location, eventually the risk of TFND.     

The extent of surgery for benign parotid pathology and its influence on complications: A prospective cohort analysis

Background

The surgical management of benign parotid tumors is aimed at complete extirpation of the mass with preservation of facial nerve function. There is a relative paucity of literature pertaining to complications after benign parotid surgery and related risk factors. We aim to critically review the outcomes following treatment of benign parotid pathology when surgery entailed either complete superficial parotidectomy (CSP), partial superficial parotidectomy (PSP) or extracapsular dissection (ECD).

Comprehensive analysis of parotid mass: A retrospective study of 369 cases

Objective

To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic.

Partial Superficial Parotidectomy via Retroauricular Hairline Incision

Objectives

The purpose of this study was to evaluate the usefulness of retroauricular hair line incision (RAHI) in partial superficial parotidectomy by comparison with modified Blair incision or facelift incision.

Methods

Medical records of 73 patients with benign parotid tumor who underwent partial superficial parotidectomy were retrospectively reviewed. Size and location of tumors, operative time, occurrence of facial nerve paralysis and Frey''s syndrome, and cosmetic outcomes were compared among RAHI, facelift incision (FLI), modified Blair incision (MBI) groups.

Results

RAHI group showed better cosmetic results than FLI group or MBI group compared with other type of incisions (P<0.001, P<0.001, respectively). Among the 3 groups, there were no significant differences of operative time and location of tumor (P=0.377), size of tumor (P>0.999), occurrence of temporary or permanent facial nerve paralysis (P=0.745) and Frey''s syndrome (P=0.940).

Conclusion

Partial superficial parotidectomy can be done safely by RAHI in most cases of benign parotid tumor. Compared with MBI or FLI, RAHI has better cosmetic outcome with no increase of operative time or postoperative complications.     

Parotid gland tumors: a retrospective study of 154 patients

IntroductionBenign tumors of the parotid gland comprise the majority of salivary gland tumors.ObjectiveTo review the clinical characteristics of parotid gland tumors submitted to surgical treatment by the same surgeon.MethodsRetrospective study with 154 patients who had parotid gland tumors. Clinical and histological data, type of surgery, and complications were assessed and described.ResultsThe main manifestation was a mass with a median evolution of 12 months for benign tumors and five months for malignant tumors. Ultrasonography was the most frequent complementary exam. Pleomorphic adenoma was the most common of the benign tumors, and mucoepidermoid carcinoma was the most frequent malignant tumor. Superficial parotidectomy with preservation of the facial nerve was the most common surgical procedure and reversible paresis of branches of the facial nerve was the most common complication.ConclusionsPleomorphic adenoma is the most common parotid gland tumor and superficial parotidectomy with preservation of the facial nerve is the most common and appropriate treatment for most low-morbidity tumors.     

Parotidectomy under local anesthesia—report of 7 cases

Objective

Parotidectomy is usually carried out under general anesthesia. We reported our early experience of performing parotidectomy under local anesthesia.

Study design

Case series reviewed.

Setting

Head and neck services of a regional hospital.

Patients, intervention, and results

Seven patients underwent parotidectomy under local anesthesia. The indications were high risk for general anesthesia due to co-morbidity in 2 patients and personal preference for the rest. The operations were performed by retrograde facial nerve dissection after superficial cervical plexus block and incision wound infiltration with local anesthetics. There was no conversion to general anesthesia. Six operations were carried out in the setting of ambulatory procedure and were discharged on the same day. Transient mild facial paresis occurred in 2 patients.

Conclusion

Parotidectomy under local anesthesia can be conducted successfully and avoid the adverse effect of general anesthesia.     

Prudent Management of the Mid‐Cheek Mass: Revisiting the Accessory Parotid Gland Tumor

Objectives/Hypothesis The head and neck surgeon's fascination with parotid surgery arises from the gland's spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid‐cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided. Study Design This is a retrospective review of our experience with four accessory parotid gland neoplasms and five other masses mimicking this lesion. Methods A literature review and retrospective chart review. Results Over a 6‐year period, we have encountered four true accessory lobe tumors, all pleomorphic adenomas. These presented very similarly to four other more commonly encountered masses not of salivary origin and one normal but hyperplastic accessory parotid gland. All were removed through a wide parotidectomy‐style approach modified by extending incisions anterosuperiorly and inferoanteriorly. The only complication was a minor salivary fistula in one patient. There were no permanent facial paralyses. Conclusions Accessory parotid gland neoplasms are rare and may present as innocuous extraparotid mid‐cheek masses. A high index of suspicion, prudent diagnostic skills (including fine‐needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and meticulous surgical approach (extended parotidectomy‐style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions.     

Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance

Background

Complete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor tissue and allows to identify residual tumor tissue could be Fluorescein Sodium.

Methods

Retrospective chart analysis on 7 patients with benign parotid gland lesions that were operated using Fluorescein Sodium intravenously and the application of the YELLOW 560 nm filter of the operating microscope. Safety and feasibility were evaluated.

Results

All tumors showed fluorescence and the rating ´contrast-enhancing´ was assigned in all cases. In 2 patients, satellite nodules were identified and resected meaning that the fluorescence staining of the tumor margins was significantly better than under white light.

Conclusion

The use of Fluorescein Sodium in parotidectomy is promising. In two cases residual tumor was detected that would have been left behind under white light. Further research in parotid gland surgery and other head and neck tumor procedures is warranted.

     

Balloon catheter assisted excision of benign cervical cyst

Objectives

Benign cystic masses that develop in the neck are easily excised with a wide skin incision. However, if the cyst is perforated and the contour of the cyst is not maintained during surgery, complete excision may be difficult. We developed a surgical method that can maintain the contour of a cyst and decrease the wound size with a balloon catheter.

Methods

Two cases with a branchial cleft cyst (BCC) were removed using this method without recurrence. The surgical technique includes a skin incision above the cyst, and fine dissection to expose the cyst wall. Then a small tap incision was created on the cyst using a #11 blade and a #14 Fr. Foley catheter was inserted through the incision site and the balloon was inflated up to 4 cm³ using normal saline. The fluid inner content was carefully removed keeping the intracystic balloon inflated. By pulling and releasing the catheter, the cyst was dissected carefully and excised.

Results

Complete excision of the cyst was performed with the balloon catheter successfully. The final pathological diagnosis was BCC in the two cases.

Conclusions

The balloon-assisted technique was easy to perform and could be used for the excision of a benign cystic neck mass.     

Partial parotidectomy under local anesthesia for benign parotid tumors - An experience of 50 cases

Purpose

Benign parotid tumors are adequately treated with partial parotidectomy, which is often performed under general anesthesia (GA). We have reported our preliminary results on the feasibility to perform parotidectomy under local anesthesia (LA). We hereby present our accumulated experience of partial parotidectomy under LA to further consolidate its feasibility, efficacy and safety in a larger series.

腮腺良性肿瘤的手术方式与术后复发和并发症

目的;研究腮腺良性肿瘤手术方式与复发和术后并发症的关系。方法 在１９８７～１９９７年手术治疗腮腺良性肿瘤５５例（单纯肿瘤除２０例,腮腺浅地切除２８例,全腮腺切除７例）的临床随访资料进行分析。结果 单纯肿瘤切除中肿瘤复发６例,并发持续性面瘫１例,腮腺浅叶切除中复发１０例,并发暂时性面瘫４例腮腺瘘２例,Ｆｒｅｙ综合征２例,腮腺全切除中复发１例,并发暂时性面瘫２例,持续性面瘫１例,腮腺瘘２例,Ｆｒｅｙ综     

显微镜下功能性腮腺切除术治疗腮腺良性肿瘤42例

目的 评价显微镜下功能性腮腺切除术治疗腮腺良性肿瘤的临床疗效。方法 采用显微镜下功能性腮腺切除术,治疗腮腺浅叶良性肿瘤患者42例。该术式较传统术式改良之处主要有：全程显微镜下手术直观准确;切口改良、美容;腮腺嚼肌筋膜下翻瓣;解剖保留耳大神经后支和腮腺导管;只解剖暴露面神经的部分分支;包括肿瘤在内的腮腺浅叶部分切除;胸锁乳突肌肌瓣填塞术腔等。结果 42例术后出现面神经损伤3例(7.1%),损伤均为暂时性;出现Frey综合征者1例(2.4%);发生涎瘘者0例;5例(11.9%)患者术后出现不同程度的耳垂和耳郭背部皮肤感觉减弱;术后局部凹陷不明显,患者对颜面部外观满意。术后随访1～5年,未见肿瘤复发。结论 显微镜下功能性腮腺切除术治疗腮腺良性肿瘤,既降低手术并发症发生率,又可取得良好美容效果。     

Effects of benign parotid tumors on unstimulated saliva secretion from the parotid gland

Objective

Salivary tumors can manifest as abnormalities of the gland itself and/or changes in salivary flow. However, effects of salivary tumors on saliva secretion have not been studied in much detail. The aim of the present study was to evaluate effects of benign parotid tumors on unstimulated saliva secretion from the affected gland.

Methods

Unstimulated parotid saliva was collected bilaterally using the swab method in patients with unilateral pleomorphic adenoma (n = 14) or Warthin's tumor (n = 6). Pre-weighted cotton rolls were placed at the opening of each parotid duct for 15 min.

Results

The range of salivary flow was similar to that found in studies on unstimulated parotid saliva. Salivary flow did not differ between the involved and non-involved side. No difference was found between the involved and non-involved side when the patients with pleomorphic adenoma or Warthin's tumor were separately analyzed.

Conclusion

The present results suggest that the most common benign parotid tumors do not alter unstimulated salivary flow from the affected gland.     

Clinical History,Prognostic Factors,and Management of Facial Nerve in Malignant Tumors of the Parotid Gland

Objectives

We analyzed the outcomes following clinical management of parotid masses that were determined to be malignant tumors after parotidectomy.

Methods

We evaluated data from 70 patients with parotid malignancies between November 1994 and December 2005.

Results

Among salivary histotypes (n=49), the most significant prognostic parameter was cT4 stage at diagnosis (P=0.0055, log-rank) both for clinical involvement of the facial nerve and for invasion of other structures. The main cause of cancer-related death was a distant metastasis.

Conclusion

The present series confirms that the main prognostic parameter in salivary parotid malignancies was cT4 classification at diagnosis, often due to clinical involvement of the facial nerve. The oncological outcome of salivary malignancies was influenced by distant metastasis more than most other head and neck sites. We recommend dissecting and preserving the functioning VIIth cranial nerve during surgery for parotid malignancies.     

腮腺肿瘤的治疗经验及远期疗效观察

目的手术治疗腮腺肿瘤的多种方法及其远期疗效评定。方法回顾性分析我科自1997～2004年所收治的腮腺肿瘤手术患者病历资料86例,男性53例,女性33例,年龄23～84岁,中间年龄57岁。所有患者都作腮腺浅叶切除术或浅叶扩大切除术或腮腺全切除术,必要时作颈清扫术。常规术中快速冰冻和术后病理检查。术后面神经功能评定。恶性肿瘤患者辅助性根治放疗(50 Gy～70 Gy)。有效随访期36～120个月不等。结果86例腮腺肿瘤患者中良性肿瘤73例(85%),恶性肿瘤13例(15%)。8例腮腺深叶肿瘤中5例为恶性肿瘤。随访中良性肿瘤1例局部复发,局部控制率为98.6%(72/73);恶性肿瘤3年生存率为69.2% (9/13),3年原发灶局部控制率为84.6%(11/13),术后颈淋巴结转移率为23.1%(3/13)。术中快速冰冻与术后常规病理符合率为86%,腮腺良性肿瘤的面神经完好保存率为97.3%(71/73),恶性肿瘤面神经完好保存率为69.2%(9/13),总体面神经完好保存率为93%。结论腮腺浅叶切除术是常规基本术式,根据肿瘤具体情况可改变为腮腺浅叶扩大切除术或全腮腺切除术。术中应尽可能保存面神经主干及各分支,特别是颞面干。快速冰冻是腮腺手术中的有效诊断方法。腮腺深叶肿瘤恶变率高。     

Oval window atresia: A novel surgical approach and pathognomonic radiological finding

Objectives

The facial nerve usually occupies the oval window area in patients with oval window atresia. During exploration, if the facial nerve is discovered to lie in the oval window area, this is usually regarded as a contraindication for further surgical intervention. The aim of the present paper is to demonstrate the preoperative pathognomonic radiological sign and describe a new surgical approach for this difficult situation.

Methods

3 patients and 4 ears were operated due to conductive hearing loss by the same surgeon in a tertiary referral center. Their clinical presentation, radiological findings, surgical findings and final outcomes were evaluated and correlated.

Results

Surgical findings were identical in all 4 ears: facial nerve was running over the oval window and tympanic portion was completely dehiscent. Incus long arm was medially displaced due to abnormal development of the stapes suprastructure. In each ear a successful vestibulotomy and teflon piston placement was achieved. Preoperative mean air-bone gap of 47.5 dB was improved to 21.5 dB. There were no complications.

Conclusion

Oval window atresia is a rare middle ear anomaly usually regarded as a contraindication for surgical intervention. In this study we present a novel surgical approach with succesful results. However the best approach is to inform the family by showing the nerve on tomography, showing the operation video, informing the family about the sensorineural hearing loss and letting the family choose the treatment option.     

A rare primary leiomyosarcoma of the parotid gland: A case report and literature review

Background

Leiomyosarcoma of the head and neck region is very rare. Primary parotid leiomyosarcoma has only been reported nine times in the medical literature.

Facial nerve in recurrent benign pleomorphic adenoma.

Improvements in the treatment of benign and malignant tumors in the parotid gland have substantially reduced the incidence of recurrence. This has come about primarily be the abandonment of the enucleation techniques and the development of lateral lobectomy operation. The recurrence rate for benign mixed tumor in the parotid gland is variously reported in the ranges of 0.5% to 10%. Because the benign mixed tumor comprises approximately 65% of the tumors in this gland, this complication assumes an important and specific role. A review of this problem establishes the principles of management, extending from simple reexcision through total parotidectomy with preservation of the facial nerve, and radical parotidectomy with resection of the facial nerve and immediate nerve grafting.     

Minimally invasive surgery of sialolithiasis using sialendoscopy

Objective

The introduction of minimally invasive surgical procedures using sialendoscopy has significantly reduced the rate of major salivary gland removal due to sialolithiasis. The present study assessed the utility of sialendoscopy and identified potential factors influencing successful sialendoscopic salivary stone retrieval.

Methods

Medical records of sialendoscopic procedures performed at the Department of Otolaryngology of the National Defense Medical College in Japan from November 2007 to January 2014 were retrospectively reviewed. We identified 78 patients diagnosed with sialolithiasis and treated with sialendoscopy (SE). Factors analyzed included stone location, size, symptom duration, surgical methods, and complications.

Results

The mean age at presentation was 41 years (range, 11–76 years) with a male-to-female gender ratio of 1:1.89. In total, 73 submandibular and 5 parotid endoscopies were performed. Stone size ranged from 2 to 20 mm in diameter. Submandibular stones were removed either by SE alone (9.6%), by transoral stone removal (19.2%), or a combined approach (57.5%). Only 13.7% (10/73) of the cases required submandibular gland removal. Stone size and shape were significant predictors for successful endoscopic stone removal, and stone size and location were significant predictors for submandibular gland removal.

Conclusion

Sialendoscopy is a reasonable, minimally invasive treatment option for sialolithiasis that avoids salivary gland removal. The present results indicate that sialendoscopy is the first treatment of choice for submandibular gland sialolithiasis. Complete surgical excision is becoming uncommon as a first-line treatment, but it remains indispensable in certain cases.     

Incidence and predictors of malignancy in children with persistent cervical lymphadenopathy

Objective

The aim of this study was to analyze the clinical and histopathologic aspects of persistent cervical lymphadenopathies in children.

Methods

This retrospective study included 98 children who underwent surgical excision for persistently swollen cervical lymph nodes between 2001 and 2013. Lymph nodes greater than 1.5 cm that persisted for more than 4 weeks and were unresponsive to an initial antibiotic treatment were considered “persistent”. The largest lymph node with an abnormal ultrasonographic appearance was selected for surgical biopsy. The patients were divided into 2 groups according to the histopathologic outcome: benign or malignant.

Results

No significant differences were found between the groups regarding the mean size and mean duration of the swollen cervical lymph nodes (p = 0.147 and p = 0.446, respectively). The area under the ROC curve was 0.567 (95% confidence interval = 0.463–0.667, p = 0.259) for lymph node size and 0.507 (95% confidence interval = 0.404–0.609, p = 0.909) for the duration of the cervical lymphadenopathy. There was no significant difference in the presence of B symptoms between the two groups (p = 0.519). No significant difference was found between benign and malignant groups regarding bilaterality (p = 0.913).

Conclusions

The findings of our study demonstrated that the size and duration of cervical lymphadenopathy, bilateral or unilateral involvement and the presence or absence of B symptoms are not indicators of malignancy. We found a high incidence of malignancy in pediatric cervical lymphadenopathy cases in contrast to other current studies.