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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↗
PubMed1995

[Intraoperative facial nerve monitoring in parotid surgery].

Neurophysiological monitoring of cranial motor nerves has proved to be of value in cerebellopontine and skull base surgery. Unfortunately, facial nerve monitoring has been used infrequently for routine parotid gland surgery because suspicion of expense, possible unreliability and the requirement for extra personnel. This study presents clinical experience at the University of Erlangen with facial nerve monitoring during parotid gland surgery done by residents. Advantages are also emphasized for the experienced ENT-surgeon for use during revision parotidectomy. In 35 consecutive patients with benign parotid gland tumors intraoperative monitoring of the facial nerve was done using two different two-channel electromyography units. Bipolar coaxial electrical stimulation was superior to the monopolar stimulation mode. The average operative time and postoperative functional results were compared with those of a control group consisting of 24 patients without monitoring. Findings demonstrated a reduction is operative time and better functional outcome in the patient group with monitoring. Additionally four patients had to undergo total revision parotidectomy because of recurrent benign tumors, while one patient suffered from chronic parotitis due to sialolithiasis and required complete parotidectomy for relief of symptoms. No patient developed permanent facial paresis and nerve monitoring proved to be very helpful for identification and protection of the facial nerve in scar tissue.

Electric Stimulation↗
PubMed1994

[Pleomorphic adenoma of the parotid gland. Results of surgical treatment].

Twenty years experience of lateral parotidectomy as suspical treatment for pleomorphic adenoma are reviewed. All cases were managed at the ORL Clinic of the University of Zürich. 167 patients were followed for the frequency of possible recurrent tumors. Three patients (3/123) operated primarily developed a recurrences. Recurrences appeared after an average of 10 years, ranging from 1-30 years. The follow-up time varied from 1 to 21 years (average, 8 years). 39% (13 of 33) of the patients, who were re-operated for a recurrent tumor, developed another recurrence. The second recurrence appeared after an average of 10 years, ranging from 1-22 years. A persistent partial paresis of the facial nerve was found in 1% of the patients operated primarily and in 9% of the patients operated more than once. No paralysis was seen. We now choose "en-bloc" resections of pleomorphic adenomas without intra-operative opening of the tumor capsule as the treatment of choice. This treatment was possible in 83% of all cases, using a lateral parotidectomy. If tumor extends into the medial parotid lobe, total parotidectomy is required.

Adenoma, Pleomorphic↗
PubMed1994

Salivary gland neoplasms in children.

We reviewed 20 children with salivary gland neoplasms treated at the National Cancer Center Hospital between 1964 and 1990. Retrospective analyses of pathological features and the clinical courses of these cases constituted the bases of the present study. The age of onset was late childhood in 19 cases, ranging from 9 to 20 years, but one patient was 1 year old. Approximately half (55%) the neoplasms were malignant. Histologically, all the benign neoplasms were pleomorphic adenomas (nine cases) and the most common malignant neoplasm was mucoepidermoid carcinoma (six cases, 55%), followed by adenocarcinoma (three cases, 27%), adenoid cystic carcinoma (one case, 9%) and malignant mixed tumor (one case, 9%). Recurrences of pleomorphic adenomas occurred only in the three patients initially treated with enucleation; meanwhile, five patients treated with superficial parotidectomy, and one with submandibular glandectomy, had no recurrence. Recurrences of malignant tumors occurred in all six patients initially treated with enucleation only and in one with superficial parotidectomy but not in two patients treated with total parotidectomy. In seven patients treated with prophylactic neck dissection, no metastasis was identified pathologically. The results support no enucleation of the tumor being applied at the first operation for curing both benign and malignant salivary gland tumors. The indication for radical neck dissection appears to be limited.

Adenocarcinoma↗
PubMedDate not supplied

How we have treated parotid gland tumors.

Since the Clinic was established in 1972 to the end of 1994 at the Clinic for Maxillofacial Surgery of the Military Medical Academy 782 patients with tumors of the parotid salivary glands of glandular origin were treated. This number included only patients with sufficient data for the relevant analysis. There were 659 (85.53%) benign and 123 (14.47%) malignant tumors. They are rare in the age 0-20. Their incidence increases after the third decade, reaching the maximum in the sixth decade. The most frequent tumors were of 3 cm diameter (36.24%). The average size of tumors varied from 3 to 6 cm in diameter (29.36% of cases). Tumors larger than 15 cm are extremely rare. All patients were surgically treated: subtotal parotidectomy was done in 55.23%, total in 38.61% and radical in 6.16%. Transient facial nerve injuries were recorded in 18.63% of cases (mainly at total parotidectomy). Out of 94 patients with malignant tumors of the parotid gland, 78.13% survived for 2 years and 48.89% for 5 years. Recurrence rate for benign parotid tumors was 2.38%, and for malignant 17.62% (after total parotidectomy) and 26.12% (after the radical one).

Adolescent↗
PubMed1998

First branchial cleft anomalies: a study of 39 cases and a review of the literature.

OBJECTIVES: To identify the clinical and anatomical presentations and to discuss the guidelines for surgical management of anomalies of the first branchial cleft. DESIGN: Retrospective study. SETTING: Three tertiary care centers. PATIENTS: Thirty-nine patients with first branchial cleft anomalies operated on between 1980 and 1996. INTERVENTION: All patients were treated surgically. Complete removal of the lesion required superficial parotidectomy with facial nerve dissection in 36 cases. The relationship of the facial nerve and anomalies is discussed. RESULTS: Anatomically, 3 types of first branchial cleft anomalies are identified: fistulas (n=11), sinuses (n=20), and cysts (n=8). Clinically, 3 types of presentation are noted: chronic purulent drainage from the ear (n=12), periauricular swelling in the parotid area (n=18), and abscess or persistent fistula in the neck located above a horizontal plane passing through the hyoid bone (n=21). A membranous attachment between the floor of the external auditory canal and the tympanic membrane was observed in 10% of cases. The facial nerve was located lateral to the anomaly in 39% of cases. CONCLUSIONS: Before definitive surgery, many patients (n=17) underwent incision and drainage for infection owing to the difficulties in diagnosing this anomaly. Wide exposure is necessary in most cases, and a standard parotidectomy incision allows adequate exposure of the anomaly and preservation of the facial nerve. Complete removal without complications depends on a good understanding of regional embryogenesis, a knowledge of the circumstances surrounding discovery, an awareness of the different anatomical presentations, and a readiness to identify and protect the facial nerve during resection.

Adolescent↗
PubMed1998

Regional lymph node metastasis from cutaneous squamous cell carcinoma.

OBJECTIVE: To characterize clinical presentation and prognostic factors in patients with histologically proven regional lymph node metastasis from cutaneous squamous cell carcinoma of head and neck origin. DESIGN: Retrospective, nonrandomized case series. SETTING: Tertiary referral center. PATIENTS: Forty-five patients treated between 1984 and 1995 with regional metastatic squamous cell carcinoma of cutaneous head and neck origin. INTERVENTION: Forty-one patients underwent neck dissection (20 with parotidectomy) and 4 patients underwent parotidectomy alone. Thirty-six patients (80%) received postoperative radiation therapy with a mean dose of 60 Gy (range, 34-71 Gy). MAIN OUTCOME MEASURES: Recurrences and survival by univariate analysis using the Kaplan-Meier product-limit method. The log-rank test was used to evaluate prognostic significance of clinical variables. RESULTS: Follow-up ranged from 2 months to 10 years (mean, 21 months). Compared with historical controls, a greater percentage of patients in our population with regional lymph node metastasis had primary lesions greater than 2 cm in diameter and 4 mm deep. Overall 2- and 5-year survival rates were 33% and 22%, respectively, while 5-year disease-free survival rate was 34%. Clinical staging of the neck proved to be the only factor of prognostic value (P<.01). Treatment failures occurred in 22 patients. CONCLUSIONS: For the small subset of patients with regional metastasis from cutaneous squamous cell carcinoma, survival remains poor despite multimodality treatment. Clinical stage of the neck was the only factor that predicted outcome.

Adult↗
PubMed2002

Patient education and informed consent in head and neck surgery.

OBJECTIVE: To examine the effects of an educational intervention, in the form of printed material, on patient knowledge and recall of possible risks from parotidectomy or thyroidectomy. DESIGN: Prospective, randomized, controlled study conducted during a 9-month period. SETTING: Head and neck surgery clinic of an academic tertiary care hospital. PATIENTS: One hundred twenty-five consecutive patients older than 16 years who were undergoing thyroidectomy or parotidectomy at the head and neck surgery clinic were recruited. Four patients were excluded from analysis because their follow-up interview was not within the required limits. INTERVENTION: At the preoperative visit during the routine consent process, both groups received a verbally delivered checklist of risks specific for the surgery to be performed. The intervention group was also given a pamphlet with written information accompanied by illustrations. MAIN OUTCOME MEASURES: The effectiveness of the educational intervention was determined by comparing the average rate of risk recall between the intervention and control groups. The effects of age, sex, level of education, and time between the consent and recall interviews on recall rate were also assessed. RESULTS: The overall risk recall rate for both procedures was 39.1%. The recall rate of the intervention group was 50.3% compared with 29.5% for the control group (P<.001). CONCLUSIONS: The intervention consistently improved risk recall for all patients regardless of age, sex, and level of education. Patients' ability to recall potential risks was significantly increased by an educational intervention; all patients would benefit from this intervention.

Adolescent↗
PubMed1979

Facial nerve in recurrent benign pleomorphic adenoma.

Improvements in the treatment of benign and malignant tumors in the parotid gland have substantially reduced the incidence of recurrence. This has come about primarily be the abandonment of the enucleation techniques and the development of lateral lobectomy operation. The recurrence rate for benign mixed tumor in the parotid gland is variously reported in the ranges of 0.5% to 10%. Because the benign mixed tumor comprises approximately 65% of the tumors in this gland, this complication assumes an important and specific role. A review of this problem establishes the principles of management, extending from simple reexcision through total parotidectomy with preservation of the facial nerve, and radical parotidectomy with resection of the facial nerve and immediate nerve grafting.

Adenoma, Pleomorphic↗
PubMed1986

Surgical treatment of recurrent pleomorphic adenoma of the parotid gland.

Recurrent pleomorphic adenomas of the parotid gland warrant consideration because of the potential for facial nerve injury occurring with surgical treatment and the risk of malignant conversion. Forty-eight cases of recurrent pleomorphic adenoma treated at the University of Michigan, Ann Arbor, between 1935 and 1975 were retrospectively analyzed. The results of surgical procedures for recurrence were determined with respect to tumor control and resultant facial nerve function. Malignant conversion developed in three (6%) of 48 cases. The results of this study underscore the importance of adequate surgical excision of initial recurrences as well as primary tumors to prevent tumor recidivism. Tumor control rates and facial nerve preservation are enhanced with formal parotidectomy for recurrent tumor when feasible. In cases in which facial nerve identification and dissection is not possible, en bloc total parotidectomy offers effective, though not absolute, control of extensive recurrence.

Adenoma, Pleomorphic↗
PubMed1987

Infection following uncontaminated head and neck surgery.

The efficacy of perioperative antibiotic administration during major head and neck surgery in which the wound is contaminated by saliva has been clearly established. This study was undertaken to ascertain the incidence of postoperative wound infection encountered in patients undergoing major head and neck surgery in which no contamination occurred. The records of 438 patients who had undergone parotidectomy, thyroidectomy, or submandibular gland excision were reviewed retrospectively. Eighty percent of the patients had received no perioperative antibiotic therapy. Infections developed in three (0.7%) patients during one month following surgery. One of these patients had received perioperative antibiotic prophylaxis. These data clearly demonstrate the non-efficacy of antibiotics administered in patients undergoing parotidectomy, thyroidectomy, or submandibular gland excision when no infection exists prior to surgery.

Aged↗
PubMed1992

Salivary gland neoplasms in children.

Of 29 patients, aged 3 to 16 years, with nonvasoformative salivary gland tumors, 21 had malignant tumors. Mucoepidermoid carcinoma was the most common; adenocarcinoma, adenoid cystic carcinoma, and acinic cell carcinoma were equally represented. Pleomorphic adenoma was the exclusive benign lesion, occurring in eight patients. Mean follow-up for patients with malignant lesions was 13.6 years (minimum, 3.5 years). Absolute 2- and 5-year survival rates were 100% and 90%, respectively. Mean follow-up for benign lesions was 15.9 years; none recurred. Superficial or total parotidectomy is the treatment of choice for malignant parotid neoplasms. Benign parotid lesions are adequately controlled with parotidectomy based on extent of disease. Facial nerve sacrifice can often be avoided. We advocate postoperative radiotherapy for high-grade lesions or those with adverse prognostic factors, such as soft-tissue extension and perineural invasion.

Adenocarcinoma↗
PubMed1997

Application of medical thermography to the diagnosis of Frey's syndrome.

BACKGROUND: In Frey's syndrome, the secretory parasympathetic fibers of the parotid gland are thought to communicate with the sympathetic nerve fibers of sweat glands and blood vessels of the skin following parotidectomy. Miscommunication results in subjective gustatory sweating and facial flushing, which appear early with postoperative mastication. In this study, we compared the efficacy of medical thermography to the Minor's starch-iodine test to determine the presence of gustatory sweating in Frey's syndrome. METHODS: Patients were considered to have Frey's syndrome if signs of gustatory sweating and localized skin flushing of the parotid region were present. In four patients who had undergone unilateral parotidectomy, gustatory sweating and facial flushing were present after gustatory stimulation, and the presence of Frey's syndrome was confirmed with Minor's starch test in all patients. Infrared thermography was then performed, and the same area measured. The contralateral side served as an internal control for each patient. RESULTS: Before gustatory stimulation, the isothermal pattern of the diseased side and the nonoperative side was similar. Stress thermography using a sialogogue (lemon, 3 mL) showed a cold spot at the operative site in all four patients with Frey's syndrome. The contralateral nonoperative side showed normal skin temperature distribution in all patients. Minor's test was positive in all patients. CONCLUSIONS: Thermography is a noninvasive, facile test that provides a qualitative visual analysis of the cutaneous capillary response in Frey's syndrome following parotid surgery.

Adenocarcinoma↗