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PubMed1995

Frey's syndrome: prevention with temporoparietal fascial flap interposition.

The recent trend in management of Frey's syndrome has been the use of prophylactic procedures performed at the time of parotidectomy to prevent its symptoms postoperatively. An additional benefit of this approach is the prevention of the typical cheek contour deformity after parotidectomy. We reviewed our experience with interposition of a vascularized temporoparietal fascial flap between the parotid bed and overlying skin immediately after complete superficial parotidectomies to prevent Frey's syndrome and contour defects. The results of seven consecutive attempts revealed it to be an effective technique, achieving both goals in all patients with minimal morbidity.

Adult↗

PubMed2000

Prophylaxis against Frey's syndrome in parotid surgery.

In 1990 the authors reported their preliminary study of the prevention of Frey's syndrome in 55 patients utilizing a superficial musculoaponeurotic system (SMAS) flap in parotid gland surgery. During the past 10 years, numerous studies have supported their original thesis that interposition of living tissue between the resected gland bed and the skin could prevent the development of this complication. The authors have expanded their own patient population and now consider this a definitive study on the prevention of Frey's syndrome. A total of 160 patients are presented with a follow-up period of 5 to 22 years. All patients underwent subtotal or total parotidectomy performed by one of the authors. A history was acquired and testing for Frey's syndrome (Minor's starch iodine test) was performed. As a result of this approach, and in spite of the intensive search for it, no cases of Frey's syndrome were encountered. The hoped-for secondary benefit of preventing the postparotidectomy retromandibular depression was somewhat less satisfactory, although most patients remain satisfied with their appearance. The debilitating symptoms in Frey's syndrome, which is reported to have an incidence of 5% to 50% in the typical parotidectomy patient, can be avoided with thoughtful preoperative planning. The authors favor an aesthetic incision followed by the development of an SMAS flap. The parotidectomy is then performed using the surgeon's preferred technique. The SMAS flap is then placed into the bed of the resected parotid gland. This institutes a protective tissue barrier guarding against the aberrant anastomotic communication between the postganglionic secretomotor fibers intended for the parotid gland, and the now adjacent sweat glands. Their patient population is large enough to provide significant evidence that Frey's syndrome can be prevented, compared with a meta-analysis of parotid patients in multiple other studies in the literature. Assuming the patient's history and pathology does not preclude its use, the SMAS flap should be considered the standard of care for preventing Frey's syndrome in the postparotidectomy patient. If the SMAS flap is not available, a temporoparietal fascial flap has proved to be a good alternative.

Female↗

PubMed1999

Postparotidectomy facial nerve paralysis: possible etiologic factors and results with routine facial nerve monitoring.

OBJECTIVE: Analyze the incidence and factors responsible for postparotidectomy facial nerve paralysis when the surgery is performed with the routine use of facial nerve monitoring. STUDY DESIGN: A prospective, nonrandomized study. METHODS: Seventy consecutive patients underwent parotidectomy with intraoperative facial nerve monitoring. Two devices were used: a custom mechanical transducer and a commercial electromyograph-based apparatus. All patients were analyzed, including those with cancer and those with deliberate or accidental sectioning of facial nerve branches. The outcome variables were the motor facial nerve function according to the House-Brackmann grading scale (HB) at 1 week (temporary paralysis) and 6 to 12 months (definitive paralysis). Facial nerve grading was performed blindly from reviewing videotapes. RESULTS: The overall incidence of facial paralysis (HB>1) was 27% for temporary and 4% for permanent deficits. Most of the deficits were partial, most often concerning the marginal mandibular branch. Temporary deficits with HB scores of greater than 2 were only present in patients with parotid cancer or infection. Permanent deficits were present in three patients, including one patient with facial nerve sacrifice. Factors significantly associated with an increased incidence of temporary facial paralysis include the extent of parotidectomy, the intraoperative sectioning of facial nerve branches, the histopathology and the size of the lesion, and the duration of the operation. CONCLUSIONS: Despite a stringent accounting of postoperative facial nerve deficits, these data compare favorably to the literature with or without the use of monitoring. An overall incidence of 27% for temporary facial paralysis and 4% for permanent facial paralysis was found. Although the lack of a control group precludes definitive conclusions on the role of electromyograph-based facial nerve monitoring in routine parotidectomy, the authors found its use very helpful.

Adolescent↗

PubMed1995

Aesthetic considerations in extirpation of melolabial lymphatic malformations in children.

Surgical treatment of lymphatic malformations in the nasolabial region of children has produced disappointing results. Attempts to remove them through a preauricular incision have generally required a synchronous superficial parotidectomy in an attempt to prevent facial nerve injury. However, incomplete removal with this approach is common, leading to multiple surgeries, infections, facial nerve injury, and when parotidectomy is performed, a lateral facial concavity. To avoid these complications and still extirpate the lymphatic malformation, an alternative direct external technique has been employed since 1986. A retrospective review of nine children with melolabial lymphatic malformations so managed was undertaken to assess treatment outcome. All patients underwent computed tomography (CT) or, more recently, magnetic resonance imaging (MRI) scans to define the anatomic limits of the lymphatic malformation and its relationship to the facial musculature. Scans differentiated localized lesions (resectable) from diffuse lesions (unresectable). All patients underwent direct external soft-tissue excisional debulking by means of melolabial incisions with perialar and/or supra-white roll extensions as needed. The mean age at time of surgery was 5.6 years. Complications were considered minor: One patient developed a small hematoma for which no specific treatment was necessary; four patients required antibiotics for cellulitis. The mean age at follow-up was 5.25 years. The mean number of procedures necessary to achieve final outcome was 3.25. The mean number of episodes of postoperative cellulitis was 1.8. There was a high level of patient and parent acceptance of facial scars. No patient required secondary scar revision. The external approach addresses the pathology directly, removes a greater overall percentage of abnormal tissue than the traditional hemirhytidectomy approach, and avoids potential injury to the facial nerve and the deforming concavity resulting from parotidectomy.

Adolescent↗

PubMed1989

An approach to malignant parotid tumours.

A series of 30 patients with malignant parotid tumours selected for surgical treatment is presented. There were 18 males and 12 females, with an age range of 12-80 years. All presented with a parotid lump, one had an associated painful facial nerve palsy and one had clinically involved neck nodes. Four had previous surgery, surgical biopsy or radiotherapy. Pre-operative fine needle aspiration was performed on one patient. Postoperative radiotherapy was administered to 14 patients. Follow-up was for a mean of 5.5 years. The primary tumour was controlled by surgery alone in 15 of the 16 patients. There was one local recurrence and two patients in this group died from distant metastases. Of the group receiving postoperative radiotherapy, there was one local recurrence, one local and neck recurrence and one death from distant metastases. Mobile, discrete tumours can be treated by parotidectomy with preservation of the facial nerve and the selective use of radiotherapy. The malignant tumour with restricted mobility but no facial palsy is treated by parotidectomy, sacrificing only involved branches and postoperative radiotherapy. The clinically fixed lesions with facial palsy demand total parotidectomy in operable cases, nerve sacrifice and postoperative radiotherapy.

Adolescent↗

PubMed1998

Parotid and submandibular sialadenitis treated by salivary gland excision.

BACKGROUND: The purpose of the present study was to compare and contrast the clinicopathological features and treatment outcome of chronic sialadenitis involving the parotid and submandibular glands, among patients who were treated by excision of the affected gland. METHODS: In a series of 88 patients treated over an 8-year period, 47 had parotid sialadenitis and 41 had submandibular sialadenitis. In the parotid group, 63% of patients were symptomatic for longer than 6 months compared with 27% in the submandibular group. Calculi were implicated in the disease process in 24% of patients with parotid sialadenitis, compared with 73% of patients with submandibular disease. RESULTS: Patients with parotid sialadenitis had superficial (n = 14) or near-total parotidectomy (n = 35), while those with submandibular sialadenitis underwent total gland excision. Complications occurred twice as frequently in the parotidectomy group. The rate of temporary facial nerve weakness was 29% after parotidectomy while marginal mandibular nerve dysfunction occurred after 12% of submandibular excisions. Both procedures were highly effective in permanently relieving the symptoms of sialadenitis. CONCLUSIONS: Parotid sialadenitis is infrequently associated with stones and tends to run a longer course before surgical intervention is necessary. Submandibular sialadenitis usually presents earlier, is secondary to calculi and requires early intervention.

Chronic Disease↗

PubMed1981

Metastatic malignant disease to the parotid gland.

A survey of over 250 consecutive parotidectomies performed at The Mason Clinic indicates a surprising incidence of metastatic malignant disease to the parotid gland. Four percent of all parotidectomies performed indicated a metastatic focus of malignancy from an ;unsuspected primary outside areas of the head and neck usually implicated in parotid disease. Twenty-five percent of all cancer discovered at parotidectomy was metastatic malignant disease to the parotid gland. The most common site was the lung. A high index of suspicion, evaluation of pathologic specimens by electron microscopy, and detailed metastatic work-up for patients with malignant disease in parotid lymph nodes are recommendations which should be considered by the surgeon performing parotid procedures.

Adenocarcinoma↗

PubMed1984

Capsular significance in parotid tumor surgery: reality and myths of lateral lobectomy.

Historically, parotid gland surgery has evolved from an operation of surgical enucleation to that of lateral lobectomy or total parotidectomy with facial nerve dissection. While the enucleation operation originally resulted in recurrence rates as high as 45% in some series, the technique of lateral lobectomy has resulted in recurrence rates of 2% in benign tumors. However, the currently recommended procedure of lateral lobectomy or total parotidectomy with facial nerve preservation for benign or low grade malignant tumors is not a pure en bloc resection in most cases, and in fact enucleation in part or total is often the reality of the operation. Tumor characterization, technical features, and operative findings of parotid gland surgery are examined in 100 consecutive cases. In over 60% of the cases, superficial or total parotidectomy with facial nerve preservation incorporated the principle of limited enucleation or capsular dissection at some point in the technique. The illusion that en bloc removal of parotid tumors with wide surgical margins is discredited. The reality of the procedure and the reasons for its success are examined.

Carcinoma↗

PubMed1999

[Tumors of the parotid glands in the material of the Department of otolaryngology of the Medical Academy in Warsaw in 1986-1995].

In the Department of Otolaryngology, Medical Academy in Warsaw, 332 patients were surgically treated between 1986 and 1995 because of parotid gland tumors. In 275 cases benign tumors, in 57 cases--malignant tumors were observed. The majority of benign tumors were pleomorphic adenoma (61.45%) and lymphadenoma (22.54%); the majority of malignant tumors were adenocarcinoma (28%), adenoid cystic carcinoma (21%), mucoepidermoid carcinoma (15.78%). All patients with benign tumors were surgically treated, patients with malignant tumors were operated on and irradiated. The surgical procedure used superficial parotidectomy and total parotidectomy with preservation of facial nerve where possible. Ten patients required total parotidectomy with facial nerve resection because of malignant tumors, six patients had neck dissection performed. Of the 57 patients treated on account of malignant tumors 43 survived; 14 patients died of a local recurrence or generalization neoplasm disease.

Academic Medical Centers↗

PubMed1999

Facial nerve functionality after parotid tumors surgery.

The purpose of this study is to show the connection among tumor histology, surgical treatments and facial nerve postoperative functionality. A retrospective review was conducted on 69 patients with benign and malignant parotid tumors: they underwent surgical treatment for benign and malignant parotid tumors at the Maxillofacial Division of Rome University "La Sapienza" from 1988 to 1997. In our series of patients, we performed conservative superficial parotidectomy, conservative total parotidectomy and radical parotidectomy. Tumor enucleation was reserved for those neoplasms with a limited and restricted mass. The surgical approach was based on mass extension and on histopathologic features. Our findings showed that a careful and a timely diagnosis is very important in order to select a conservative surgical treatment for benign and intermediate grade of malignancy tumors with limited dimensions. Most aggressive histological types, and large mass dimensions require a radical treatment with consequent facial nerve postoperative dysfunctions. Our experience demonstrates that this surgical approach provides a very high rate of success in the cure of tumors and a low rate of facial nerve postoperative dysfunctions.

Adenoma↗

PubMed2000

Long-term results of tympanic neurectomy for chronic parotid sialectasis.

BACKGROUND: Chronic parotid sialectasis presents as troublesome recurrent swellings of the parotid salivary gland during swallowing and mastication. The main treatment options are parotidectomy with its associated high morbidity and tympanic neurectomy. AIM: The aim of this study is to present the long-term results of our experience about tympanic neurectomy for chronic parotid sialectasis. PATIENTS AND METHODS: Twenty two patients underwent tympanic neurectomy (14 males; 8 females) between 1983 and 1999 with an mean follow up of over six years. The hallmark of our surgery is to interrupt as many branches of the tympanic nerve as possible by extensively drilling in the hypotympanum and below the basal turn of cochlea, with removal of the anterior and posterior branches. RESULTS: 17 of the 22 patients had a marked to total reduction in symptoms on follow-up. Four patients were troubled enough to go on to undergo a superficial parotidectomy. There was no significant morbidity associated with the procedure. CONCLUSION: Tympanic neurectomy performed by an experienced otologist should be the preferred surgical option for chronic parotid sialectasis, with parotidectomy being reserved for those patients who fail to improve.

Adolescent↗

PubMed1992

Parotid gland tumours: a 15-year experience.

Between 1973 and 1988, 302 patients underwent surgical operations for parotid gland swelling. Primary operations were performed in 293 cases, while secondary operations for recurrent tumour were performed in nine cases. A total of 244 patients (80.8%) were found histologically to have either a benign parotid tumour or a tumour-like lesion, while 58 patients (19.2%) were diagnosed as having malignant tumours. Two hundred and eighty-nine patients underwent superficial and total conservative parotidectomy and in 13 cases a radical parotidectomy was performed. The median follow-up was 5 years (range 1-15 years). Permanent facial nerve palsy, tumour recurrence, Frey's syndrome and parotid fistula were recorded as 0.7, 0.7, 2.1 and 0.4%, respectively. Thus, with full understanding of the surgical anatomy of the parotid gland and correct tumour identification, preservation of the facial nerve and serious postoperative complications can be minimized following superficial and/or total conservative parotidectomy.

Adolescent↗

PubMedDate not supplied

An audit of surgery for seventy-one primary parotid tumours.

Seventy-one consecutive patients who presented with lumps in the parotid gland over an eight year period (1981-1989) were analysed. Two-thirds of the patients presented with a history of swelling for over one year, while a quarter (24%) had a parotid mass for over five years at initial referral. The pathology of these masses was diverse, with pleomorphic adenoma being the commonest (64%). Superficial parotidectomy was the commonest procedure employed (50/71) with local excision being performed only in the initial part of our series (15/71). There were five cases of permanent facial palsy, four following radical resection for malignancy. Tumour recurrence rate was 2/15 (13%) in cases treated by local excision while none of the 50 patients treated by superficial parotidectomy had tumour recurrence at a mean follow-up of five years. Only three patients developed Frey's Syndrome. It is recommended that increased community awareness of early referral of a parotid mass is necessary, as surgical treatment in the form of superficial parotidectomy, which is the ideal procedure for such lumps, carries minimal morbidity when performed by a surgeon with a special interest in parotid surgery.

Adolescent↗

PubMed1978

Therapy of parotid tumors.

A therapy schedule is presented for the surgical treatment of parotid tumors, based on the experience gained from more than 600 operations for parotid tumors. The individual surgical techniques (lateral parotidectomy, total parotidectomy with preservation or resection of the facial nerve, with or without reconstruction of the nerve) are selected depending on the histologic findings in the tumors. The fact is stressed that in a tumor disease the lateral parotidectomy constitutes the minimal operation. The different tumors can be divided into four groups. The operative treatment of tumors of the facial nerve in its extratemporal course is particularly mentioned since clinically these growths usually appear to be parotid tumors.

Adenoma, Pleomorphic↗

PubMedDate not supplied

[Intra-parotid lymph node metastasis of malignant skin neoplasms of the head].

More than 75% of parotid metastases represent a secondary localization in the parotid region lymph nodes of malignancies arising from the skin of the head. Among 94 parotidectomies performed at the Otolaryngologic Clinic of the University of Brescia in the years 1980-1987, 21 were primary malignant growths and of these 5 (23.8%) proved to be intraparotid lymph node metastases of previously resected cutaneous tumors of the face (1 melanoma and 4 squamous cell carcinomas). Parotid metastases were treated by lateral (3 cases) or total parotidectomy (2 cases) with preservation of the facial nerve; in 4 cases a homolateral neck dissection of the functional type was performed in the same session (N+ in 1 case only). Three out of four patients with squamous cell carcinoma were subsequently submitted to Co60 radiation therapy. Four patients died 1 to 22 months after the treatment: in three, death was due to a local recurrence or a distant metastasis; in 1 case to osteoradionecrosis with no signs of relapse of the tumor. One patient only treated with total parotidectomy, functional neck dissection (N-) and postoperative radiation therapy is still alive and free of disease 18 months after surgery.

Aged↗

PubMed1989

Current management of salivary gland tumors. Part 2.

The authors base their treatment of salivary gland malignancies on the size of the primary and the histopathologic diagnosis. Group 1 includes smaller tumors in the T1 and T2 classification with cell types that are associated with slow growth. A parotidectomy is usually sufficient therapy for tumors in this group. Group 2 contains T1 and 2 tumors with more aggressive behavior. Total parotidectomy is indicated here, with postoperative radiotherapy. T3 tumors and patients with nodal metastasis or recurrent tumors make up group 3. Radical parotidectomy with sacrifice of the facial nerve is usually required for a sufficient tumor-free margin in these patients, and postop radiotherapy is also necessary. Group 4 includes T4 lesions. Extent of disease dictates magnitude of excision and amount of postop radiotherapy.

Combined Modality Therapy↗

PubMed1986

[Benign lympho-epithelial lesion (Blel) of the parotid. Godwin's tumor. A case with cystic ectasia and calcinosis].

We report a case of a benign lymphoepithelial lesion of the parotid gland known as Godwin's tumor. This swelling of the parotid gland, appears as a tumor clinically as well as in scintigraphy and echography. The individual features of this tumor are recognized only during the histological examination: massive infiltration of the lobules of the parotid by a proliferative lymphoid tissue with differentiation to germinal centers and atrophy of the glandular acini. The treatment consists of a superficial parotidectomy. The frozen section avoids a total parotidectomy. In our case, the histological picture is quite particular due to the extensive cystic ductal dilatation and the presence of some calcifications. This aspect permit us to bring together the BLEL and the pseudotumoral calcinosis of the parotid gland. Those two lesions, occur under a context of disfunction, and they could be associated to a Gougerot-Sjögren (GS) syndrome. The BLEL could be considered as the pseudotumoral form of an isolated GS which could be completed after many years with the apparition of auto anti-bodies. The BLEL evoluates as a benign tumor but it's correlation with a malignant lymphoma or a lymphoepithelial carcinoma is also possible. Therefore it is important to follow-up these patients clinically, hematologically and immunologically after their parotidectomy.

Calcinosis↗

PubMed1985

Surgical treatment of parotid gland tumors.

Fifty patients (27 females, 23 males) operated on for parotid neoplasms are reported. Eleven patients (22%) had benign tumors, 31 (62%) mixed tumors and 8 (16%) malignant tumors. Among patients with benign neoplasms, 10 (90,9%) were treated by enucleation (En.) and 1 (9,1%) by superficial parotidectomy (S.P.). Twenty-five patients (80,6%) with mixed neoplasms were operated on by total conservative parotidectomy (T.C.P.), 3 (9,7%) by S.P. and 3 (9,7%) by En. Three cases (37,5%) of malignant neoplasms were treated by T.C.P., and 5 (62,5%) by total demolitive parotidectomy (T.D.P.), associated to lateral lymphadenectomy in 3 patients. On the basis of a follow-up concerning 41 patients and of data from the literature, the authors report their present surgical approach for mixed tumors, underlining their preference for T.C.P., and limiting S.P. only to some selected cases.

Adolescent↗