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PubMed1997

Results of the surgical management and histopathological evaluation of 88 parotid gland Warthin's tumours.

With the introduction of parotidectomy after identification of the facial nerve the recurrence rates for benign tumours has declined rapidly. Subsequently, attention was focused on other sequelae of parotid surgery. To reduce the specific surgical morbidity, several modifications of parotidectomy have been implemented. This study compares the results of the different surgical techniques with regard to the histopathological findings and recurrence rate for Warthin's tumour of the parotid gland. Eighty-eight primary surgical parotid procedures were performed on 85 patients for a Warthin's tumour. The surgical procedures included 52 'partial' superficial parotidectomies, 22 'standard' superficial parotidectomies, 12 partial superficial/deep lobe parotidectomies, and two 'selective' deep lobe parotidectomies. No patient developed a recurrence or experienced permanent facial nerve paresis/paralysis, the median follow-up being 93 months. Histopathological examination revealed a multifocal origin in 23% (20/88) of the surgical specimens. Partial parotidectomy is an effective treatment for Warthin's tumour. There is no need for extended follow-up.

Adenolymphoma↗

PubMed1998

[Surgery in benign parotid tumors: individually adapted or standardized radical interventions?].

BACKGROUND: Several authors demand emphatically that the minimal operative procedure in benign parotid gland tumors has to be a superficial parotidectomy. MATERIAL: Of a consecutive series of 372 patients with benign parotid tumors treated in our department between 1973-1996 81% of the patients could be followed up 1-24 years. in 10.9% a total parotidectomy was performed, in 16% a lateral parotidectomy and in 73.1% a simple extirpation of the tumor (often taking away a small margin of surrounding parotid parenchyma). The operating microscope and microsurgical techniques were used in all of these operations. RESULTS: Of all the followed-up patients 2.3% developed a recurrence. There were no recurrences of cystadenolymphomas or of rare types of adenomas. Recurrences of primary treated pleomorphic adenomas occurred in 3.0%. In recurrent pleomorphic adenomas a further recurrence could be seen in 7.4% of the cases. The over-all incidence of permanent facial nerve weakness was 2.1%: 0.7% after extirpation, 3.3% after lateral parotidectomy and 9.7% after total parotidectomy. we observed in 6.3% a gustatory sweating. CONCLUSION: Our data prove that with simple extirpation similar results compared to lateral parotidectomy can be achieved concerning recurrence, function of the facial nerve and the Frey's syndrome. We suggest a surgical management adapted to the extent, the size and the location of the parotid gland tumors. In our opinion lateral or total parotidectomy should be reserved for tumors of larger amount or deep located tumors.

Adolescent↗

PubMed1994

[Pleomorphic parotid adenomas and their recurrence].

Even today, a wide variety of techniques are performed in parotid pleomorphic adenoma surgery, ranging from enucleation to total parotidectomy. This study reports the results of our experiences. Among a total of 587 surgically treated parotid lesions at the Homburg/Saar University ENT Department from 1968 through 1991, 205 were parotid pleomorphic adenomas. Among these, 166 patients received primary surgery at our department. Twenty-one enucleations led to 3 recurrent tumors (14%), while 108 superficial parotidectomies had 3 recurrences (2.8%). Fifteen extended superficial parotidectomies also produced 3 recurrences (20%) and 22 total parotidectomies had one recurrent case (4.5%). The overall recurrence rate was 6%, but increased to 8.3% in 5 years, 9.5% in 10 years and 12.5% in 15 years follow-up. The "true" overall recurrence rate after 10 years was estimated to be between 9.5 and 20% and that for lateral parotidectomies between 4.4 and 13%. Patients younger than 30 years of age at the time of primary surgery developed a tumor recurrence in 17% of all cases. The overall recurrence rate following secondary surgery was 13%. Clinical findings and surgical techniques for resections of pleomorphic adenomas and their recurrences are discussed. Segmental parotidectomy is the preferred treatment, but may have to be changed locally to enucleation in some cases in order to preserve the facial nerve.

Adenoma, Pleomorphic↗

PubMed1996

Surgical management of pleomorphic adenomas of the parotid gland: a follow-up study of three methods.

PURPOSE: This retrospective study evaluated data pertaining to history, symptoms, diagnosis, and mode of therapy of patients treated for pleomorphic adenoma of the parotid gland. PATIENTS AND METHODS: The records of 475 patients were reviewed. Follow-up was done by questionnaires sent to the referring doctor. RESULTS: The total rate of recurrence was 0.9% after 475 operations for pleomorphic adenoma of the parotid gland. One recurrence (0.7%) was reported for the group with superficial parotidectomy and none for the group with total parotidectomy. The rate of postoperative side effects was also low. The facial nerve was affected in 1.4% after superficial parotidectomy, and in 3.3% after total parotidectomy. CONCLUSION: The results of this follow-up study show that superficial parotidectomy for pleomorphic adenoma located in the superficial lobe of the parotid gland provides adequate therapy and generally avoids recurrence and side effects.

Adenoma, Pleomorphic↗

PubMed1992

Surgical management of adenoid cystic carcinoma in the parotid gland.

Although adenoid cystic carcinoma may be found in multiple sites in the head and neck as well as other glandular sites throughout the body, nowhere is management of the disease more controversial than in the parotid gland. Here the facial nerve is at risk from both the disease and the treatment. Seventy-five cases of adenoid cystic carcinoma of the parotid were analyzed. Patients were placed in four groups, depending on the type of parotid surgery received as definitive therapy: (1) lateral lobectomy, (2) total parotidectomy, (3) radical parotidectomy without preoperative facial weakness, and (4) radical parotidectomy with preoperative facial weakness. Patients were assessed with regard to staging of the initial lesion, the status of surgical margins, and the use of postoperative radiotherapy. The incidence of local recurrence and distant metastases were also recorded. Survival statistics are presented for each group. Though associated with facial nerve sacrifice, radical parotidectomy appears to offer clear advantages in terms of long-term disease-free survival in patients with T2 and T3 lesions. The residual facial paralysis may be rehabilitated primarily or secondarily to reduce patient morbidity. Four of 16 patients (25%) with preoperative weakness achieved 10-year survival when radical parotidectomy was used. Obtaining clear margins at the initial setting appears to offer improved survival.

Adult↗

PubMed1989

[Surgery of pleomorphic adenoma of the parotid gland].

In literature opinion is divided, whether for treatment of pleomorphic adenoma in the parotid gland partial parotidectomy is adequate or complete parotidectomy is necessary. In a retrospective analysis of 123 complete parotidectomies in pleomorphic adenomas the macroscopic tumor extension was compared with the microscopic findings. Additionally 35 pleomorphic adenomas were examined in histological serial sections. The retrospective analysis showed in 6%, the serial sections in 11% microscopic tumor in the macroscopic tumorfree inner lobe. A clinical follow-up examination of 85 patients operated by complete parotidectomy because pleomorphic adenoma resulted in a relapse-quota of 3.5%. The function of the facial nerve was in most cases normal, in 8.2% a weakness of the mandibular branch was found. These results indicate that the risk to leave tumor can be reduced evidently by a complete parotidectomy.

Adenoma, Pleomorphic↗

PubMed1980

Treatment of parotid neoplasms.

Over a 25-year period 124 patients were admitted to St. Joseph's Hospital, Toronto with parotid neoplasms; 102 had benign and 22 had malignant lesions. Of 75 pleomorphic adenomas, 26 were enucleated and 11 of them (42%) recurred; no instances of recurrence followed parotidectomy. In 19 patients with Warthin's tumour there were no recurrences following any of the methods of excision. Mucoepidermoid carcinoma occurred in nine patients; eight tumours were of low-grade malignancy. All were treated by parotidectomy and there were no recurrences. Four patients had malignant mixed tumour--two with long-standing parotid masses; in three patients this malignant tumour occurred years after regional radiotherapy. Facial weakness was permanent in three patients after total parotidectomy. The correct treatment of parotid neoplasms is superficial parotidectomy or, for deep lobe tumours, total parotidectomy. Radiotherapy is used for unresectable or suspected residual carcinoma.

Adenolymphoma↗

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↗

PubMed1998

Metastatic tumours of the parotid gland.

Twenty patients (12 men and 8 women, median age 69 years) with metastatic tumours in the parotid gland who presented over a 12-year period were evaluated retrospectively. Preoperative investigations included fine needle aspiration cytology (n = 11) and computed tomography or magnetic resonance imaging (MRI) (n = 14). Most tumours originated from the head and neck region, the two main types being squamous cell carcinoma (n = 10) and malignant melanoma (n = 7). All 20 presented with a parotid mass and 11/20 (55%) had associated lymphadenopathy. Eleven patients (55%) underwent superficial, five total, and four radical, parotidectomy. Neck dissection was required in 16 patients (80%), and all 11 patients with clinically palpable lymph nodes had evidence of tumour in the neck dissection specimens. Half of all patients (n = 10) received adjuvant postoperative radiotherapy. Three-quarters of the patients (n = 15) were alive after a mean follow-up of 31 months and only one developed a marginal recurrence. The cumulative 5-year survival rate was 51%, and there was no significant difference (P = 0.48) in the 3-year survival rates of patients who had radical compared with those who had modified neck dissections. Patients who had superficial parotidectomy had a longer overall survival compared with those who had total or radical parotidectomy (P = 0.04) perhaps reflecting the advanced nature of tumours that required total or radical excision of the gland. We conclude that superficial parotidectomy is usually an adequate treatment for secondary parotid tumours (when disease is clinically limited to the superficial lobe), and we suggest that patients in whom metastatic disease of the parotid gland is suspected do not require neck dissection if they have no palpable lymph nodes and MRI shows no evidence of spread. There seems to be no survival advantage in radical over modified neck dissection.

Adolescent↗

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↗