Subtotal parotidectomy for a parotid gland tumour in two players of wind instruments, with preservation of facial nerve function

Two professional musicians, a 55-year-old clarinet player and a 58-year-old trumpet player, presented to the surgical outpatient clinic with a Warthin's tumour and a pleomorphic adenoma in the deep lobe of the parotid gland, respectively. The several branches of the facial nerve form the virtual plane between the superficial and deep lobes of the parotid gland. Due to the localisation of this nerve, parotid surgery entails a significant risk of neurapraxia of the facial nerve branches. Before the operation, both patients were informed carefully about both the necessity and the risks of surgical excision of parotid tumours. Even slight damage to the facial nerve during parotidectomy could have severe implications for their careers. Both underwent subtotal parotidectomy. Postoperatively, there was clinically a temporary minor marginal branch dysfunction in one patient. Pre- and postoperative electromyography did not indicate asymmetrical function of the facial muscles. A few weeks after the operations, both musicians could resume playing; subtotal parotidectomy can apparently be safely performed in players of wind instruments.     

Parotid gland Warthin's tumor combined with actinomycosis

The authors describe the diagnostic problems and difficulties of treatment of Warthin's tumor combined with actinomycosis. A 48-year-old woman was presented with a mass in the left parotid region and paresis of the lower left palpebra. The CT, echography, parotid X-ray findings supposed a neoplasm of the left parotid gland which was proved by intraoperative freezing histology. The ramus of the mandible was involved in the process. Total parotidectomy and partial mandiblectomy were performed, with sacrifice of the facial nerve, followed by nerve reconstruction. The final histological evaluation was Warthin's tumor with actinomycosis. Eight years after treatment the patient is free of disease.     

Surgical Treatment of Parotid Tumors

Treatment of parotid tumors, whether benign or malignant, is always early, total parotidectomy; aspiration biopsy permits definitive differentiation. If the tumor proves benign, as in the case illustrated, the surgeon is prepared for the detailed dissection that makes it possible to preserve all or almost all of the facial nerve and its branches. In malignancy, sacrifice of the nerve may become obligatory.     

Stimulation electromyography as a method of intraoperative localization and identification of the facial nerve during parotidectomy: review of 15 consecutive parotid surgeries

INTRODUCTION: It has been widely recognized that one of the major hazards during operation of the parotid gland, mainly in tumor resection, is the injury of the facial nerve. Facial nerve monitoring has achieved wide application in otologic and neurotologic procedures to help localization and protection of the facal nerve in the temporal bone. MATERIAL AND METHODS: The authors analyze localization and identification of 15 nerves in 15 patients who underwent parotid gland surgery in the Department of Ear Nose and Throat Diseases of the Medical University in Plovdiv from September 15, 2000 to December 15, 2000. Nerve integrity monitor Neurosign 100 and specially designed electromyographic electrodes were used. RESULTS: In all patients stimulation electromyography of the facial nerve was successfully used to locate, identify and evaluate the integrity of the facial nerve during and at the end of the operation. No postoperative facial nerve injury was detected clinically. In two patients with parotid gland cancer the inferior division of the facial nerve was found infiltrated by the cancer growth. CONCLUSION: The results indicate that identification of the facial nerve by electromyography is a safe, effective and simple method of electrophysiologic monitoring during parotid gland surgery. This method allows assessment of the nerve integrity at the end of the operation.     

解剖游离保留面神经应用于腮腺肿瘤手术的临床体会

目的：探讨解剖游离保留面神经在腮腺肿瘤切除术中的临床应用。方法：对本科2008年1月-2013年12月进行解剖游离保留面神经加全腮腺及肿瘤切除术的20例患者的临床资料进行分析研究。结果：面神经主干平均直径约1 mm,有5分支如丝线。术后3 d面神经轻度不全麻痹18例,术后7 d恢复8例,术后2个月内恢复8例。随访3个月-2年,其中1例因切断面神经下颌缘支行吻合术的患者,半年后恢复;1例损伤面神经颧支,左眼睑闭合无力;味觉出汗综合征1例;耳垂麻痹18例,1年后恢复;无腮腺漏,无肿瘤复发。结论：复发性、多发性以及深叶腮腺肿物行解剖游离保留面神经的全腮腺及肿瘤切除术,并发症少,临床治疗效果满意。     

腮腺切除术中沿面神经总干顺行解剖面神经的效果及安全性

目的探讨腮腺切除术中应用沿面神经总干顺行解剖面神经的治疗效果及安全性。方法选取我院2016年2月至2019年3月收治的60例择期行腮腺切除术的患者,随机分为观察组与对照组各30例。对照组沿面神经总干逆行解剖面神经,观察组沿面神经总干顺行解剖面神经,观察两组患者术后1个月面神经功能及术后并发症发生情况。结果术后1个月,两组患者的面神经功能分级比较无统计学差异(P>0.05);观察组的术后并发症发生率为10.00%,明显低于对照组的33.33%(P <0.05)。结论临床行腮腺切除术中,沿面神经总干顺行解剖面神经可降低术后并发症发生率,值得推广。     

改良型腮腺切除术在腮腺肿瘤治疗中的临床价值

目的探讨改良型腮腺切除术在腮腺肿瘤切除治疗中的临床价值。方法选择我院2008年至2011年收治的择期行腮腺肿瘤切除术患者127例,按照入院日期,分为2组,单日为观察组62例,双日为对照组65例。观察组患者采取改良型腮腺切除术,对照组患者采取传统腮腺切除术,并进行随访,比较2组患者手术时间、术中出血量和并发症情况。结果共102例患者接受随访,随访率为80.3%,随访时间为2～46个月,观察组在术中出血量和手术时间和肿瘤复发率方面与对照组无差别（P〉0.05）,但在面部瘫痪、凹陷畸形、Frey综合征等并发症发生率显著低于对照组（P〈0.05）。结论改良型腮腺切除术有效的切除肿瘤,且切口隐蔽、手术创伤小、不良反应发生率低,值得临床推广。     

区域性切除术在腮腺浅叶良性肿瘤治疗中的临床应用

目的：探讨区域性切除术在腮腺浅叶良性肿瘤治疗中的临床应用价值。方法：选取2011年5月-2013年3月入住本院的70例腮腺浅叶良性肿瘤首发患者（肿瘤直径均≤3 cm）,按照随机数字表法将其分为观察组和对照组各35例,观察组采用区域性切除术,对照组采用传统腮腺浅叶切除术,术后所有患者随访6个月~2年,观察记录两组患者手术时间、切口长度、术中出血量及解剖面神经分支数,并发症的发生率及肿瘤的复发情况。结果：观察组患者的平均手术时间、平均切口长度、平均术中出血量、解剖面神经分支数均明显优于对照组,比较差异均有统计学意义（P〈0.05）。观察组患者术后暂时性面瘫、面部畸形、涎液潴留、耳垂麻木、Frey综合征和口干等并发症的发生率均明显低于对照组,比较差异均有统计学意义（P〈0.05）。而两组患者的肿瘤复发率相比较差异无统计学意义（P〈0.05）。结论：区域性切除术用于治疗腮腺浅叶良性肿瘤,创伤小、术后并发症少、肿瘤复发率低,值得在临床推广应用。     

腮腺Warthin瘤67例临床分析

目的探讨腮腺Warthin瘤的临床特点。方法对唐山市人民医院收治的67例腮腺Warthin瘤病例进行回顾性分析。结果腮腺Warthin瘤发病年龄主要分布在50～70岁。治疗Warthin瘤的手术方式包括：单纯摘除肿瘤;腮腺区域性切除术;腮腺浅叶或腮腺大部分切除术。结论腮腺Warthin瘤多发于老年男性,位于腮腺后下级的宜采用腮腺区域性切除术。     

Pleomorphic adenoma of the parotid gland, rules for resection

The importance of complete excision of a benign pleomorphic adenoma is illustrated by two patients' histories. A 28-year-old man underwent a local excision of a nodule under the left ear without histological confirmation. Ten years later he returned to our institute with a large multilocular process and subcutaneous nodules. Cytology showed pleomorphic adenoma. Patient was treated with total facial nerve preserving parotidectomy and radiotherapy. An 81-year-old male underwent a surgical removal of a swelling under his left ear eight years before admission for a large diffusely infiltrating tumor in the neck. Repeated cytology showed carcinoma ex pleomorphic adenoma. This tumor was inoperable and he was treated by palliative irradiation. In case of incomplete resection, pleomorphic adenoma cells are spilled with an increasing chance of local recurrence. Also degeneration into carcinoma ex pleomorphic adenoma is possible after incomplete resection, with impact on survival. These risks of residual disease determine the need of centralization of diagnosis and treatment of this benign parotid tumor.     

腮腺浅叶良性肿瘤功能性切除术与全切术治疗比较分析

目的比较腮腺浅叶良性肿瘤功能性切除术与全切术两种手术治疗方式的临床效果。方法 60例腮腺浅叶良性肿瘤患者,32例行腮腺浅叶良性肿瘤的功能性切除术,28例行肿瘤及全部浅叶切除面神经解剖术。观察手术伤口愈合情况、术后涎瘘发生率、术后1周面瘫率、术后两年内肿瘤复发率。结果手术伤口均为甲级愈合,两组患者术后均无涎瘘、面瘫并发症;所有病例随访2年,行肿瘤功能性切除术患者的复发率为6.25%（2/32）,行肿瘤及全部浅叶切除面神经解剖术者的复发率为7.14%（2/28）,两组肿瘤的复发率无明显差异（P〉0.05）。结论腮腺浅叶良性肿瘤功能性切除术在不增加肿瘤术后复发率基础上,保留了腮腺分泌唾液的功能,减少了术后面部味觉性出汗综合征的发生,不会造成大块切除后的面部畸形。     

Assessment for facial nerve paralysis based on facial asymmetry

Facial nerve paralysis (FNP) is a loss of facial movement due to facial nerve damage, which will lead to significant physical pain and abnormal function in patients. Traditional FNP grading methods are solely based on clinician’s judgment and are time-consuming and subjective. Hence, an accurate, quantitative and objective method of evaluating FNP is proposed for constructing a standard system, which will be an invaluable tool for clinicians who treat the patient with FNP. In this paper, we introduce a novel method for quantitative assessment of FNP which combines an effective facial landmark estimation (FLE) algorithm and facial asymmetrical feature (FAF) by processing facial movement image. The facial landmarks can be detected automatically and accurately using FLE. The FAF is based on the angle of key facial landmark connection and mirror degree of multiple regions on human face. Our method provides significant contribution as it describes the displacement of facial organ and the changes of facial organ exposure during performing facial movements. Experiments show that our method is effective, accurate and convenient in practice, which is beneficial to FNP diagnosis and personalized rehabilitation therapy for each patient.     

咽旁间隙肿瘤手术并发症分析及防治措施

目的 探究咽旁间隙肿瘤手术并发症分析及防治措施.方法 收集在某院就诊的咽旁间隙肿瘤患者的临床资料,统计患者在术后出现各类并发症的情况,并分析各类并发症产生的原因、提出相应的预防措施.结果 200例患者中术后出现术腔感染3例、神经损伤15例、血管损伤12例、腮腺漏2例;其中,颈颌入路和颞骨加腮腺入路两种手术方式对血管和神经的创伤更大,所引起的并发症也较多.结论 经颈侧切开入路适用于绝大多数的咽旁间隙良性肿瘤,但是为了有效的控制和减少术后并发症的发生,仍需要根据患者具体的病情选择合理的手术入路.     

Is there a role for radiotherapy in the treatment of patients with pleomorphic adenoma of the parotid gland?

A group of 79 patients primarily operated (n = 63) or operated for local recurrence after previous surgery (n = 16) and irradiated post-operatively was studied retrospectively. Indications for radiation treatment were: enucleation and spill after pseudo-penetration of the capsule or remnants of tumour after partial or total parotidectomy respectively. During follow-up (4-16 years) only one of the patients, irradiated because of recurrence, had a second recurrence. No major complications or malignant degenerations took place. Partial or total parotidectomy with saving of the facial nerve is the treatment of choice rather than a combination of enucleation with radiotherapy. However, in case of remnants after radical surgery or re-excision for recurrent tumour postoperative irradiation appears to be indicated and effective.     

MSCT对茎突综合征的诊断价值

目的：探讨多层螺旋CT（MSCT）对茎突综合征（SPS）的诊断价值。方法：选择本院临床拟诊断SPS的患者32例,行MSCT扫描,三维重建技术测量双侧茎突的长度和茎咽距。结果：32例患者64侧茎突全部显示,其中16侧茎突长度〈30 mm;48侧茎突长度为30～68 mm,平均（32.0±5.6）mm。13侧茎咽距〈20 mm,平均（23.0±2.2）mm。结论：多层螺旋CT能多平面、多角度清晰地显示茎突的立体解剖及其与临近组织的关系,并可直接精确地测量茎突的长度和咽侧壁之间的最短距离,为临床诊断SPS提供可靠依据,并能为手术方案的制定和手术路径的选择提供可靠的信息。     

超声定位与解剖标志法行颈内静脉穿刺置管的比较研究

目的将超声定位技术与解剖标志法行颈内静脉穿刺置管进行对比研究,旨在阐明超声引导定位穿刺是一种非常有价值而且很有必要开展的创新技术与手段。方法择期消化道肿瘤切除病人100例,ASAⅡ-Ⅲ级,随机分为超声组(B组)和解剖标志组(T组),每组均为50例,麻醉诱导气管插管后需行颈内静脉穿刺置管。超声组在B超定位后穿刺,解剖标志组采用体表标志定位穿刺,分别记录首次穿刺成功率,穿刺次数及操作时间。结果超声组首次穿刺的成功率,穿刺的次数,操作的时间均明显优于传统组(P<0.05)。结论采用超声引导行颈内静脉穿刺定位准确,成功率高,操作省时简便而且安全,是一种有必要开展的创新技术与手段。     

Pleomorphic Adenoma of the Parotid Gland: Report of a Case With Review of Literature

Background

Pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. The tumor has a female predilection between 30–50 years of age. Slowly progressing asymptomatic swelling is the usual presentation of the tumor. Surgical excision of the tumor mass forms the mainstay of treatment, with utmost care taken to preserve the facial nerve.

Case Details

This case report aims to throw light on an interesting case of pleomorphic adenoma of the parotid gland in a 50 years old female patient. The patient presented with a slowly progressing asymptomatic swelling on the left side of the face. There is also a special emphasis to a detailed review of literature.

Conclusion

Salivary gland neoplasms can occur at any site where salivary tissue is present. Pleomorphic adenoma is the commonest salivary gland tumor characterized by diverse histomorphological features. Early diagnosis and treatment plan entails thorough history taking, clinical examination, coupled with radiographic and histopathological findings.     

双层螺旋CT改进扫描技术在茎突综合征中的临床应用

目的研究双层螺旋cT改进扫描技术后对人体茎突的显示、观察及测量,为茎突综合征的诊断与治疗提供最可靠的依据。方法采用双层螺旋CT并改进扫描技术对48例临床疑似茎突综合征的患者扫描,后重建原始数据,再多层面重建及三维重建,观察、测量茎突的形态、长度、粗细、倾斜角度及发育变异等内容。结果48例患者的双侧茎突均得到完整、清晰的显示,茎突长度2．7～6．8cm,其中〉3cm者42例,双侧茎突均过长者30例,左侧茎突过长者8例,右侧茎突过长者10例,向内向前倾斜角度〉40°者17例（侧）,向内向前倾斜角度〈20°者9例（侧）。结论经过改进后的双层螺旋cT扫描技术在人体茎突的显示及测量方面具有很好的应用价值,能为临床诊断与治疗茎突综合征提供最可靠的影像学依据。     

Anatomo-topographic landmarks on the lateral wall of nasal cavity used in endonasal surgery.

INTRODUCTION: A dissection of the lateral wall of nasal cavity that imitates a true endonasal operation was the design of the present study. The object of the study was by measuring the distance between a pivot landmark and important anatomical structures revealed successively during an endonasal operation to create additional highlights that will minimise the hazard of injuring vital structures. METHODS: Twenty anatomical preparations of sagittally sectioned heads from cadavers (elderly males of Bulgarian origin) were dissected to study the topographic relationships between the great paranasal cavities (maxillary, frontal, and sphenoidal sinus) and the ethmoidal labyrinth. Using punctum subnasale as a pivot landmark, the distances to crucial microendoscopic landmarks (i.e., nasolacrimal duct, uncinate process, ethmoidal bulla, base of the skull, anterior wall of the sphenoid sinus, orifice of the maxillary sinus) were measured at different angles to the horizontal plane. RESULTS: The mean distances from punctum subnasale to the natural ostium of the maxillary sinus and anterior wall of the sphenoidal sinus, measured at an angle of 30 degrees to the floor of the nasal cavity, were 48.25 +/- 0.75 and 67.105 +/- 0.794 mm, respectively. At an angle of 45 degrees, the mean distance to the nasolacrimal duct was 38.056 +/- 0.591 mm; to the uncinate process 45.25 +/- 0.57 mm; to the ethmoidal bulla 50.25 +/- 0.57 mm; and to the base of the skull 66.053 +/- 0.818 mm. Mean distance of 43.158 +/- 0.568 mm to the lacrimal sac and 60.25 +/- 0.68 mm to the base of the skull were measured at an angle of 60 degrees. CONCLUSION: The analysis of the results imply that the selected distances will contribute to a more precise application of this contemporary surgical method.     

颈外径路与口内径路治疗茎突综合征的对比分析

目的分析比较颈外径路和口内径路手术治疗茎突综合征的疗效及其优缺点。,方法140例茎突综合征患者,颈外径路手术治疗104例,口内径路切除扁桃体后截短茎突36例,并对其进行手术前后的临床观察。结果行颈外径路茎突截短截除茎突平均长度为2．0cm,术后78．85％的病人症状消失;口内径路切除扁桃体后行茎突截短截除茎突平均长度为1．9cm。经手术治疗后55．56％的病人症状消失;两种术式在治愈率、手术时间及术中出血量方面差异有统计学意义,在住院时间方面差异无统计学意义。结论茎突异常并不全部引起咽部异常感觉,对于茎突异常和咽部异常感觉的病人应该仔细检查,综合分析,明确诊断。对于口内未触及茎突的茎突综合征患者应尽量行颈外径路茎突截短术,尽量避免口内径路切除扁桃体后截短茎突,减少咽部的瘢痕,注意防止并发症.