Parotid function after selective deep lobe parotidectomy

Selective deep lobe parotidectomy is a demanding technique, but it preserves healthy glandular tissue, improves cosmetic results and minimises the incidence of Frey's syndrome. We have evaluated postoperative function of the superficial lobe of the parotid after selective resection of the deep lobe. Fourteen patients who each had a mass involving the deep lobe of the parotid were selected from 127 patients with tumours of the parotid gland who were seen and treated between January 2001 and March 2004. Of the 14, 12 matched the study criteria. The preoperative diagnosis was made using both computed tomography (CT) and ultrasound or fine needle aspiration cytology, and the diagnosis was confirmed by histological analysis. All cases were treated by the same surgeon. At 6 months follow-up all patients had a House-Brackmann test, iodine starch test, and scintigraphy of both parotid glands. After scintigraphy the maximum uptake value and function of the gland were evaluated with the concentration index (CI) and the CI percentage ratio. The concentration function of the gland in the resected side of the study group had a mean (S.D.) CI index of 5.5 (3.6) and a CI percentage ratio of 84%. Selective deep lobe parotidectomy has the following advantages: it minimises the impact of treatment on the facial contour, it does not increase postoperative morbidity and it preserves the function of the gland.     

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。     

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.     

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。     

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.     

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 %.     

Face-lift approach combined with a superficial musculoaponeurotic system advancement flap in parotidectomy

A standard bayonet-shaped incision with no reconstruction of the parotid bed is usually used for removal of parotid tumours. Its disadvantages are often an obvious cervical scar, a conspicuous shallow contour around the angle of the mandible, and gustatory sweating. We have studied 17 patients with benign parotid tumours, who were treated by superficial parotidectomy with a combination of a face-lift approach and a superficial musculoaponeurotic system (SMAS) advancement flap. The patients were followed up every 6 months for 3 years. All patients were satisfied with the cosmetic outcome, and the depression deformity was considerably less. This approach prevented gustatory sweating. We think that this approach is simple and a useful tool in parotidectomy.     

Synchronous unilateral pleomorphic adenomas in the parotid gland: report of a case

A 45 year old man presented with a swelling on the right side of his face of 12 months duration. Subsequent magnetic resonance imaging (MRI) scans revealed he did in fact have two discrete tumours of his right parotid gland. Following a superficial parotidectomy and dissection of the deep lobe, histopathology revealed both tumours to be pleomorphic adenomas. We discuss the clinicopathological findings and implications in contemporary surgical management of parotid neoplasms.     

Frey syndrome--delayed clinical onset: a case report

Frey syndrome is a disorder characterized by unilateral sweating and flushing of the facial skin in the area of the parotid gland occurring during meals. The syndrome is a sequela of parotidectomy and may follow other surgical, traumatic, and inflammatory injuries of the parotid and submandibular glands and the cervical and upper thoracic portions of the sympathetic trunk. Pathogenesis is based on regeneration of sectioned parasympathetic fibers with inappropriate innervation of cutaneous sweat glands. Various studies have reported the clinical incidence of Frey syndrome after parotidectomy to be as high as 53%. The reported incidence of Frey syndrome in patients not undergoing intraoperative preventive measures is 96% in patients evaluated by means of an iodine-starch test 12 months postoperatively. We present a case in which a patient developed symptoms of Frey syndrome 8(1/2) years after superficial parotidectomy. Although most patients with Frey syndrome have only mild-to-moderate symptoms (only 6% of patients experience severe symptoms), the potential for appearance of Frey syndrome years after the parotidectomy must be discussed with the patient before surgery in the parotid region.     

Surgical management of chronic parotid disease

This is a retrospective review of a single surgeon's experience over a 20-year period, and covers the presentation, investigation, histology, management and complications of the surgical treatment of chronic parotid disease. There were 46 superficial parotidectomies (23 with ductal ligation); 3 required removal of calculi and there was one ductoplasty and one total parotidectomy. There were 28 cases of temporary palsy of the VIIth cranial nerve (55%, mean duration 4 months) and this was predominantly panfacial (79%). There were no cases of permanent palsy. Five patients who initially had a superficial parotidectomy required subsequent total parotidectomy for recurrent disease (11%). We have now adopted a policy of near total parotidectomy for the surgical treatment of chronic parotid disease.     

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%.     

腮腺浅叶良性肿瘤包膜外切除术与浅叶切除术的比较研究

目的:比较腮腺浅叶良性肿瘤包膜外切除术与浅叶切除术2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1994～2011年间收治的腮腺浅叶良性肿瘤506例,其中404例采用腮腺肿瘤包膜外切除术,102例行腮腺浅叶切除术,随访1～17年。结果:采用腮腺肿瘤包膜外切除术的病例术后面瘫、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:腮腺肿瘤包膜外切除术治疗腮腺浅叶良性肿瘤手术创伤小,并发症少,还可以保存腮腺大部分功能,值得在临床推广。     

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目的    探讨胸锁乳突肌肌瓣即刻修复腮腺肿瘤术后面部凹陷畸形和减少术后味觉出汗综合征（Frey综合征）发生的临床效果。方法    选择2006年1月至2009年1月蚌埠医学院第一附属医院口腔科腮腺肿瘤住院手术患者68例,分为试验组48例、对照组20例。试验组患者按常规“S”切口施行腮腺肿瘤加腮腺浅叶或全叶切除术,同期行胸锁乳突肌肌瓣转移修复术;对照组则不行同期肌瓣修复,经随访对比观察6月至3年。结果    对照组局部凹陷畸形发生率为90%（18／20）,Frey综合征发生率为 55%（11／20）;试验组局部凹陷畸形发生率为16.67%（8／48）,Frey综合征发生率为8.33 %（4／48）,两组间差异有统计学意义（P < 0. 01）。结论    胸锁乳突肌肌瓣转移修复术是一种即刻修复腮腺肿瘤术后面部凹陷畸形和降低Frey综合征发生率的较好方法。     

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.     

Postoperative complications after removal of pleomorphic adenoma from the parotid gland: A long-term follow up of 297 patients from 2002 to 2016 and a review of publications

Pleomorphic adenomas are rounded, lumpy, capsulated lesions that are more common in women. They are typically benign, but can be associated with malignancy in a minority of cases (such as carcinoma ex pleomorphic adenoma), between 3% - 12% of the time, according to available data. The purpose of our study was to evaluate clinical outcomes in patients with benign parotid gland tumours after extracapsular dissection (ECD) or superficial parotidectomy (SP). We made a retrospective study of 297 patients who had had benign tumours of the parotid gland, and had been referred to our department from 2002 – 2016 to have either procedure. We measured the statistical differences between the two techniques (evaluated recurrence rate and complications) with the chi squared test. The chosen level of statistical significance was p < 0.05. Median (range) follow-up time was 43 months (25–168) months. Haematoma and hypoaesthesia were significantly more common after SP than after ECD (8.9% compared with 7.7%, and 16.8% compared with 5.6%, respectively). Transient facial nerve injury, Frey syndrome, and facial paralysis were significantly more common after SP than after ECD (23.6% compared with 1.5%, 6.7% compared with 1% and 6,7% compared with 0%, respectively). ECD had the advantage of reduced operating time, lower morbidity and lower recurrence rate, and could be considered the treatment of choice for pleomorphic adenoma of the parotid gland up (to 3 cm) which are mobile and sited in the superficial lobe of the parotid gland.     

Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients

The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. The mean ( ± standard deviation) surgical time did not differ significantly between the groups: 64 ± 22.4 min for PSP and 59 ± 19.8 min for ECD-TFND (P = 0.302). There was a significant difference in sialocele: 18 (36.7%) patients in the PSP group and four (10%) in the ECD-TFND group (P = 0.002). There was also a significant difference in facial nerve injuries: temporary paralysis was observed in 13 (26.5%) patients in the PSP group and two (5%) in the ECD-TFND group (P = 0.007). It appears that TFND is a viable and safe approach when performing ECD for benign tumours in the tail of the parotid gland. ECD-TFND should be preferred over PSP for benign tumours in the tail of the parotid gland.     

Omega incision face-lift approach and SMAS rotation advancement flap in parotidectomy for prevention of contour deficiency and conspicuous scars affecting the neck

To overcome the disadvantages after the surgical removal of tumours of the parotid gland, especially the depressed facial deformity and conspicuous cervical scar formation subsequent to parotid surgery, we have concentrated on omega face-lift incision in combination with an SMAS rotation advancement flap for the last several years using a lazy omega incision. Nine patients (3 male and 6 female) ranging in age from 43 to 68 years (mean age: 56.3 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine needle cytology result. Parotidectomy was performed using the modified omega face-lift incision in conjunction with the rotation advancement SMAS flap. All patients underwent follow-up every 3 months in the first year. During the follow-up, the patients were specifically asked about their satisfaction with the post-operative appearance and whether they would consent to the operation again. The vascularized SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy. There are no drawbacks in the use of modified face-lift incision to remove tumours of the parotid gland.     

保留腮腺主导管腮腺浅叶切除术的临床应用

目的　探讨保留腮腺主导管腮腺浅叶切除的临床应用。方法　对 110例临床诊断为腮腺良性肿瘤或多形性腺瘤的病例作保留腮腺主导管腮腺浅叶加肿瘤切除手术。结果　 10 6例病例得到 1～ 4年的随访。随访率96.3 %。无一例病例发生肿瘤复发。结论　腮腺肿瘤的复发和深叶腮腺组织剩留无内在联系。手术关键是保存有足够的安全切缘 ,严格掌握适应证和术中的准确操作。适合于位于腮腺浅叶、峡部和下极的良性肿瘤和临界瘤     

Pleomorphic adenoma of the parotid in childhood.

INTRODUCTION: Pleomorphic adenoma is a benign growth that most often appears in the parotid gland where it is the most frequent type of tumour. Its appearance in childhood is rare and there are no large series available in this age group for comparison with its presentation in adults. Surgical treatment is similar in children and in adults; whilst the prognosis is good, they may become malignant and metastasize. MATERIAL AND METHOD: In this study, we present seven parotid pleomorphic adenomas in childhood treated in our Department and a review of the literature. The following data were evaluated: sex, age, affected side, clinical symptoms and period of evolution of the symptoms, surgical technique applied and complications observed. RESULTS: The mean age at presentation was 12.4 years. All patients were males with the right side affected in five patients. The treatment was conservative superficial parotidectomy in five patients, conservative total parotidectomy in one, and an enucleation including a wide safety margin in the last case. None of the patients exhibited any permanent postoperative complication. The mean follow-up was 41.3 months (26-58 months).