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PubMed1978

The surgical management of recurrent parotitis.

Twenty-eight parotidectomies were carried out upon 26 patients with chronic parotitis. The lesion considered is chronic inflammation of the parotid gland associated with such intraglandular defects as sialadenitis secondary to ductal obstruction by calculi, cellular debris, stenosis or infiltrating lesions, that is, Mikulicz's or Sjögren's syndromes and sialoangiectasis, either primary or secondary to obstruction of the duct. Seventeen near total parotidectomies were done without significant complications or a recurrence of symptoms. Eleven superficial parotidectomies were performed in which symptoms recurred on the 12th postoperative day in one patient. No permanent weakness of the facial nerve occurred in any of the 28 parotidectomies. Based upon this experience, near total parotidectomy with removal of the parotid duct can be performed safely and should be the procedure of choice in patients with chronic, relapsing parotid sialadenitis.

Chronic Disease↗

PubMed1991

Benign parotid tumors: a 24-year experience.

The medical records of 125 patients benign parotid neoplasms surgically treated over a 24-year period were retrospectively reviewed; 128 tumors were excised. These included 90 pleomorphic adenomas, 33 Warthin's tumors, 3 benign lymphoepitheliomas, and 2 oncocytomas. The surgical procedures consisted of 2 local excisions, 6 enucleations, 88 superficial parotidectomies, 13 subtotal parotidectomies, and 3 radical parotidectomies. The morbidity rate was 49%. There was one total permanent facial nerve paralysis (0.7%), four (3%) partial permanent facial nerve paralysis, five (5%) transient total facial nerve paralysis, and 32 (25%) partial transient facial nerve paralysis. After a median follow-up of 84 months, there was one recurrence (0.7%). A superficial parotidectomy is the minimum procedure that should be performed for the treatment of a benign parotid neoplasm.

Adolescent↗

PubMed1986

Facial nerve sacrifice and tumor recurrence in primary and recurrent benign parotid tumors.

Three hundred eight patients underwent parotidectomy for a benign parotid tumor between 1948 and 1979. Two hundred seventy-four had operation for primary tumor, and 34, for recurrent tumor. Ninety-eight percent of those with primary tumors had superficial or total parotidectomy, and 2 percent had local excision with a wide margin of normal tissue. In those with recurrent tumor, 91 percent had superficial or total parotidectomy and 9 percent had local excision with a wide margin of normal tissue. There were nine recurrences in the primary group (3.2 percent) and 10 in the recurrent group (29 percent), at an average follow-up of 10 and 13 years, respectively. The time to recurrence in the primary group was between 5 and 20 years, whereas, second recurrences in the recurrent group generally took place within 5 years. Seven patients in the primary group (2.5 percent) and 9 in the recurrent group (26 percent) had sacrifice of the facial nerve. Most facial nerve sacrifices in the primary group were minor, involving a branch of the nerve only. Facial nerve sacrifice in the recurrent group, however, usually involved division of the nerve or the nerve trunk. These findings demonstrate that the major morbidity associated with managing benign parotid tumors occurs in dealing with recurrent tumors. Recurrence is uncommon if superficial or total parotidectomy is performed for a primary tumor.

Adenolymphoma↗

PubMed1991

Patterns of regional lymph node metastases from cutaneous melanomas of the head and neck.

A consecutive series of 111 patients treated between 1964 and 1989 with primary cutaneous malignant melanoma of the head and neck and histologically proven regional metastases was reviewed to determine the patterns of nodal metastases. The primary sites were grouped in the following categories: face (34), anterior scalp (25), anterior neck (16), posterior scalp (15), ear (11), and posterior neck (10). All patients underwent radical neck dissection: 80 of the procedures were therapeutic and 31 elective. A total of 106 specimens were positive for metastases. Thirty-three of the 57 patients undergoing parotidectomy had positive results for metastases (14 of 20 in therapeutic parotidectomies and 19 of 37 in elective parotidectomies). Based on the incidence of involvement of the parotid gland and the patterns of lymph node metastases from levels I through V, three observations are made. Patients undergoing regional lymphadenectomy for primary melanomas on the ear, face, and anterior scalp should be considered for parotidectomy. The use of selective limited neck dissection for elective regional lymphadenectomy appears justified based on the location of the primary site. In patients undergoing therapeutic neck dissection, a complete neck dissection should be performed due to the unpredictable distribution of lymph node metastases to the cervical lymph nodes.

Female↗

PubMed1992

Acinic cell carcinoma of the salivary glands. A long term follow-up study of 15 cases.

Fifteen cases of acinic cell carcinoma of the salivary glands were evaluated retrospectively with respect to histological and clinical data. DNA content assessment was carried out in six cases by cytophotometry. The majority of tumors were located in the parotid gland and were Stage I at presentation. There was a female predominance and the mean age at primary diagnosis was 51.2 years for females and 41.0 for males. The solid-acinar cell pattern was the most frequently observed and the tumors were 'diploid' in all the six cases studied. Surgery was the therapeutic modality in all cases (enucleation in seven, superficial parotidectomy in three and total parotidectomy in five) and, in four of them, was complemented with radiotherapy. The clinical course was characterized by recurrence in 10 cases, metastases occurred in three patients and one patient died of the tumor. Of the seven recurrent cases, six were treated by enucleation and one by superficial parotidectomy. The histological pattern showed no correlation with the clinical course or DNA content. Acinic cell carcinoma has a significant morbidity with a high recurrence rate which seems to be largely influenced by the type of surgery employed. Wide surgical excision of the neoplasia, which includes total parotidectomy in the parotid cases, is recommended in order to reduce the frequency of recurrence of the tumor.

Adult↗

PubMed1992

Frey's syndrome: a preventable phenomenon.

Gustatory sweating, or Frey's syndrome, is a fairly common sequela of partial or radical parotidectomy, submaxillary gland surgery, or radical neck dissection. It is caused by an anastomotic communication with facial sweat glands by parasympathetic secretomotor nerve fibers intended for the excised parotid gland; treatments, whether surgical or topical, generally have been less than satisfactory. We present the first documented prophylactic approach to Frey's syndrome that is performed during and as part of parotidectomy. The surgery involves use of the superficial aponeurotic system (SMAS) as an interposing flap to interrupt the anastomotic nerve communication with the sweat glands. The SMAS is derived from the fascia in the periauricular cheek and neck area that is continuous with the platysma muscle. In a prospective study in 55 patients undergoing elective parotidectomy, the SMAS flap was elevated during the beginning of the operative procedure once it had been determined that fashioning of the flap would in no way compromise tumor excision. In all cases, at follow-up, there has been no clinical evidence of development of Frey's syndrome. We have shown that the development of the SMAS flap in parotid gland resections is an effective new approach both as a preventative measure against Frey's syndrome and as an aesthetic improvement over the usual defect typical of parotidectomies.

Humans↗

PubMed1991

[Surgery of the parotid gland. Indications. Review of the anatomy].

The surgical division of the parotid gland in three parts or "lobes" in relation to facial nerve is a practical custom. After revising the surgical anatomy, the indications and operative technique of total parotidectomy with preservation of the facial nerve (TPP) are described. The discussion is open for pleomorphic adenomas of the superficial lobe, between some authors in favour of a superficial parotidectomy and others who perform a systematic TPP. Other surgical operations are total parotidectomy (TP) without preservation of the facial nerve, TP associated with a neck dissection, at lastly extensive or partial parotidectomies. Trans-parotid surgery uses the parotid region as an approach to neighbouring structures or regions.

Humans↗

PubMedDate not supplied

Treatment of parotid gland tumors.

A clinical review has been made of 55 patients who underwent surgery for parotid tumors between 1972 and 1987. The incidence of pleomorphic adenomas was 61.8%. The F.N.A.B. permitted us to reach a correct preoperative diagnosis in 94% of the cases. The surgical procedures we used were: enucleation in eight cases, enucleoresection in five cases, superficial parotidectomy in seven cases, total conservative parotidectomy in 28 cases, total parotidectomy sacrificing the facial nerve in four cases, extended surgery in three cases. For these last three patients a cycle of postoperative radiotherapy for a total of 6000-6500 R. was carried out. As regards complications and sequelae, we must report: temporary lesions of the facial nerve (12.76%), permanent lesions (17%), Frey's syndrome in 10.61%, while a salivary fistula arose in 6.38% of the cases. The follow-up of 47 patients allowed us to observe three recurrences in cases of pleomorphic adenomas (two after enucleoresection and one after superficial parotidectomy), three recurrences in malignant tumors treated with surgery and one recurrence after combined treatment surgery and radiotherapy.

Adolescent↗

PubMed1984

The surgical approach to recurrent pleomorphic adenoma of the parotid gland.

This is a retrospective study of 19 patients who were referred to the Department of Otolaryngology, Edinburgh Royal Infirmary with recurrent pleomorphic adenoma of the parotid gland. In the majority of patients, a superficial parotidectomy was performed as primary treatment. Recurrence of the tumour was either due to tumour implantation or inadequate surgical excision. Permanent facial paralysis occurred in three patients after revision parotidectomy. Change from pleomorphic adenoma at first operation to carcinoma in pleomorphic adenoma (malignant mixed tumour) at the second was noted in three patients who are still alive and free of recurrent tumour. Eighteen out of the 19 patients did not have further recurrences after revision parotidectomy. The surgical principles in the prevention of tumour recurrence and revision parotidectomy are discussed.

Adenoma, Pleomorphic↗

PubMed1995

[Facial motor lesion after surgery of the parotid gland].

The authors report a retrospective study of 351 parotidectomies observed during a 28 years period. The average follow-up is 28 months. Preoperative and post-operative facial nerve function, type of parotidectomy, surgical management of facial nerve and histologic diagnosis according to the revised WHO classification (1990) are presented. Type of parotidectomy and degree of tumor malignancy are statistically analyzed. It seems that occurrence of post-operative facial nerve dysfunction depends on radical parotidectomy, whereas long term dysfunction is determined by tumor malignancy. Malignant epithelial tumors of the major salivary glands proved to be radiosensitive. Apart from preoperative dysfunction, clinical involvement and impossible facial nerve dissection, the authors insist upon sparing the facial nerve, event in the case of microscopic residual tumors, and prefer postoperative radiotherapy.

Adenoma↗

PubMed1994

[Facial nerve involvement after surgery of the parotid gland].

The authors report a retrospective study of 351 parotidectomies observed during a 28 years period. The average follow-up is 28 months. Preoperative and postoperative facial nerve function, type of parotidectomy, surgical management of facial nerve, and histologic diagnosis according to the revised WHO classification (1990) are presented. Type of parotidectomy and degree of tumor malignancy are statistically analyzed. It seems that occurrence of post-operative facial nerve dysfunction depends on radical parotidectomy, whereas long term dysfunction is determined by tumor malignancy. Malignant epithelial tumors of the major salivary glands proved to be radiosensitive. Apart from preoperative dysfunction, clinical involvement and impossible facial nerve dissection, the authors insist upon sparing the facial nerve, even in the case of microscopic residual tumors, and prefer postoperative radiotherapy.

Adolescent↗

PubMed1984

Recurrent pleomorphic adenomas of the parotid gland.

In this retrospective study of 19 cases of recurrent pleomorphic adenoma of the parotid gland, all 19 patients underwent primary surgery elsewhere, namely, lumpectomy in five cases and superficial parotidectomy in 14 cases. The age at which those patients with recurrence had originally been seen was significantly earlier than those seen in our series of cases of primary surgery for pleomorphic adenoma. If the primary operation had been a parotidectomy, the average time interval between the first and second operation was 7.7 years; however, if it had been a lumpectomy, it was ten months. Implantability of the tumor and inadequate surgery were reasons for tumor recurrence. The suggested treatment of recurrence is total parotidectomy with preservation of the facial nerve. Revision surgery has been successful in all cases with no further recurrences, except in two cases in which multiple operations had already been performed.

Adenoma, Pleomorphic↗

PubMed1993

Frey's syndrome analysis with biosensor. A preliminary study.

OBJECTIVE: Objective quantification of Frey's syndrome (gustatory sweating), following total parotidectomy. A biosensoring method of enzymatic electrodes enabling the detection of L-lactate on intact skin with the use of a skin extraction device and enzymatic electrodes is presented and analyzed. DESIGN: A criterion standard study. SETTING: This prospective trial was undertaken at our research laboratory (University of Paris [France]). Parotidectomy was performed in our department, which is a tertiary care center for parotid gland pathology. PATIENTS: Twenty-eight patients with gustatory sweating following total parotidectomy and nine control patients not operated on were asked to take part in this prospective study. MAIN OUTCOME AND MEASURES: Gustatory sweating was assessed in all patients using a clinical scale, the Minor starch iodine test, and the L-lactate biosensoring method. RESULTS: Instrumentation and assay procedure for the L-lactate biosensoring method are detailed. Statistical analysis of data was performed using the Kruskal-Wallis H Test and the Mann-Whitney U Test. Results demonstrate that this method enables objective measurement of the L-lactate on skin without the need for chemical reagents, continuous nondestructive analysis in real time, and physiological dynamic monitoring of the L-lactate rate of production after stimulus. Data achieved strongly suggested that the aberrant regeneration theory is the main clue to Frey's syndrome pathogenesis. CONCLUSION: This safe, reliable, noninvasive, objective, and highly sensitive method provides an investigative tool for clinicians as well as physiologists involved with patients presenting gustatory sweating following parotid gland surgery.

Adenoma, Pleomorphic↗

PubMed1996

Low grade salivary duct carcinoma. A distinctive variant with a low grade histology and a predominant intraductal growth pattern.

BACKGROUND: Salivary duct carcinoma (SDC) has been established as a morphologically distinct and highly aggressive (HG) malignancy of the major salivary glands. However, a low grade (LG) or intermediate grade salivary duct neoplasm has not been described. METHODS: We report the clinicopathologic findings of 10 cases believed to represent the (LG) counterpart of SDC. Immunoperoxidase stains were performed on five cases, and electron microscopy on three. RESULTS: All of the tumors occurred in adult patients with no sex predilection, and presented as slow growing parotid gland lesions. Four cases involved the superficial lobe, one the deep lobe, and one arose within an intraparotid lymph node. The exact location of the tumor within the parotid gland was not stated in four cases. The size of the tumors ranged from 0.7 to 4 cm in greatest dimension, with most measuring between 1 and 2 cm. The gross appearance was focally to predominantly cystic. Microscopically, the tumors were characterized by intraductal proliferative lesions exhibiting three main patterns: (1) cystic ducts with micropapillary, tufted, and plaque-like intraluminal projections; (2) ducts distended by a solid or pseudocribriform (fenestrated) cellular proliferation, with varied cystic dilatation; and (3) ducts exhibiting architectural atypia. The three patterns coexisted and merged in most tumors, in varying proportions. All tumors shared bland to LG cytologic features, with the exception of one that had focal high-grade cytologic ductal atypia. Despite gross circumscription, there was microscopic multifocality, and in one case, stromal invasion. By immunohistochemistry, the neoplastic cells expressed the conventional ductal and glandular epithelial cell markers in addition to strong positivity for S-100 with coexpression for CK-903. Electron microscopy confirmed the ductal phenotype of the tumors and supported an in situ process evidenced by the presence of native myoepithelial cells. Nine patients underwent total parotidectomy and one superficial parotidectomy. One patient received radiation therapy following total parotidectomy. Follow-up for 6 cases ranged from 2 to 12 years and revealed no evidence of disease. CONCLUSIONS: LG-SDC represents the LG end of the spectrum of salivary duct malignant neoplasms and exhibits differentiation towards an intercalated duct-like cell phenotype. Its relationship to HG-SDC should be further explored.

Adult↗

PubMedDate not supplied

Frey's syndrome: treatment with topical glycopyrrolate.

Gustatory sweating and flushing of the facial skin, or Frey's syndrome, is fairly common after parotidectomy. The most likely mechanism is aberrant reinnervation of the sweat glands of the face by the severed parotid parasympathetic nerve fibers. A survey of 61 patients having undergone parotidectomy yielded 29 (47.5%) with gustatory sweating. Twenty-three percent (14 patients) considered the symptoms severe. In a double-blind study, five of those 14 patients were alternately treated with topically applied placebo and with glycopyrrolate (an anticholinergic agent) as 0.5% lotion, 2% lotion, and 2% cream. All five patients showed some improvement with the test preparations, but had longer lasting and more effective lessening of symptoms with the 2% glycopyrrolate preparations. There were no adverse side effects. We therefore believe that the topical application of a 2% glycopyrrolate preparation is a safe and effective treatment for severe gustatory sweating following parotidectomy.

Administration, Topical↗

PubMedDate not supplied

Adenocarcinoma of the parotid.

All of the consultants considered needle biopsy an integral tool in management of a parotid neoplasm. If the tumor was limited to the superficial lobe of the parotid, they were split between ordering no further tests (Drs. Johnson and Glenn) and proceeding with a CT scan (Dr. Beckford). If frozen section revealed adenocarcinoma, the consultants agreed that a total parotidectomy with preservation of any uninvolved nerve would be in order. If the nerve had to be sacrificed, repair should be with a greater auricular or sural nerve graft. Two consultants (Drs. Beckford and Glenn) would search for a distant primary or metastasis. Controversy regarding management of an N0 neck divided the group into favoring neck dissection (Drs. Beckford and Johnson) and a modified radical neck dissection (Dr. Glenn). In the case of anaplastic carcinoma the consultants differed by suggesting an extended resection (Dr. Beckford), total parotidectomy with nerve preservation (Dr. Johnson), and total parotidectomy with modified radical neck dissection (Dr. Glenn). All the consultants recommended postoperative radiotherapy.

Adenocarcinoma↗

PubMedDate not supplied

Recurrent pleomorphic adenomas of the parotid gland.

Twenty-seven patients with recurrent pleomorphic adenomas of the parotid gland were seen. This study confirms that superficial parotidectomy with identification and dissection of the facial nerve greatly decreases the incidence of recurrent benign pleomorphic adenoma, and, in the small number that recur, are easier to cure. All lumps in the parotid area should be approached in the same manner, with the surgeon prepared to isolate the facial nerve and perform superficial parotidectomy. This technique is successful because it avoids dissection near the tumor capsule, which is the major cause of recurrence. The procedure recommended for treatment of patients to remove the first recurrent tumor is total parotidectomy and excision of the previous scar. This vigorous approach is dictated by the increasing difficulty of removing further recurrent tumors. Only 67% of patients with recurrent tumors ultimately achieve a tumor-free status. Experienced surgeons can preserve the facial nerve even after multiple operations.

Adenoma↗

PubMedDate not supplied

Surgical management of chronic parotitis.

A series of 17 consecutive parotidectomies for chronic sialoadenitis is presented. This comprises 10% of all parotidectomies performed by one surgeon over the 5-year period between 1987 and 1991. In 16 patients, symptoms were relieved by surgery. The extent of surgery was guided by the clinical findings. In this series, near total and superficial parotidectomy were equally efficacious and no patient suffered permanent facial nerve dysfunction. Surgery is a safe and effective treatment for parotitis.

Adult↗