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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↗

PubMed2006

Deep plane cervicofacial flap: a useful and versatile technique in head and neck surgery.

BACKGROUND: Large oncosurgical defects of the cheek present a challenging reconstructive problem, especially when skin resections are combined with other procedures such as parotidectomy and/or neck dissection. METHODS: We present our experience with the deep plane cervicofacial flap (DPCFF) for reconstructing zone 1 (n=7), zone 2 (n=6), and zone 3 (n=5) cheek defects resulting from excision of primary cutaneous malignancies (n=13) and metastatic parotid (n=6) and/or neck (n=4) disease with skin involvement. The patients were between 65 and 88 years of age (mean, 76.7 years). The design of the flap was determined by the location of the defect and the need for simultaneous parotidectomy and/or neck dissection. Sixteen flaps were anteriorly based, whereas two were posteriorly based. RESULTS: Twelve patients underwent simultaneous parotidectomy (n=11) and/or neck dissection (n=10) and/or facial reanimation procedures (n=6). The size of the cutaneous defects ranged from 4 x 4 to 10 x 10 (mean, 5.6 x 5.3) cm. Eight patients received postoperative adjuvant radiotherapy to the primary site and/or parotid bed and neck. Superficial marginal flap necrosis occurred in one of the three patients who received definitive radiotherapy before salvage surgery and repair with DPCFF. Other complications included one hematoma, one ectropion, and one retraction of the lower eyelid. Apart from mild facial contour deficiency in two patients, excellent functional and cosmetic outcome with good skin color and texture match were achieved in all patients. CONCLUSIONS: The DPCFF is a versatile reconstructive technique in head and neck surgery. It provides a simple solution for a variety of cheek defects as an excellent alternative to regional or free tissue transfer. It can be used when simultaneous parotidectomy and/or neck dissection and/or facial reanimation procedures are required. This composite musculo-fascio-cutaneous unit is reliable with excellent vascularity, because it has an axial blood supply. Division of the facial suspensory ligaments during elevation of the flap in the sub-superficial musculo-aponeurotic system (SMAS) plane increases the mobility of this flap, which facilitates transfer.

Aged↗

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↗

PubMed2001

[Frey syndrome].

AIMS: The incidence of Frey's syndrome after parotidectomy as cited in the literature varies distinctively. Strategies for successful treatment are also assessed differently. PATIENTS: Between 1980 and 1994 a total of 372 parotidectomies were performed in 364 patients at the Bochum University Hospital. RESULTS: After an average of 18 months following parotidectomy, 86 patients (23.5%) developed Frey's syndrome. Thirty-five patients were treated with scopolamine ointment. The symptoms improved in nine cases after an average of 25 months of therapy. Of the patients receiving no treatment (n = 20), seven improved after an average follow-up of 20 months. Therapy with scopolamine ointment did not elicit significantly better results compared to no treatment at all. CONCLUSION: Gustatory sweating after parotidectomy still has to be regarded as an unpleasant complication which is difficult to cure.

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↗

PubMed2005

Patterns of use of facial nerve monitoring during parotid gland surgery.

OBJECTIVE: To determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States. STUDY DESIGN AND SETTING: A questionnaire encompassing surgeon training background, practice setting, patterns of facial nerve monitor usage during parotid gland surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between facial nerve monitor usage and dependent variables were examined by using the chi(2) test. Magnitudes of the associations were determined from odds ratios calculated using logistic regression. RESULTS: A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy employed facial nerve monitoring some or all of the time. Respondents were 5.6 times more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed more than 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertent nerve injury if they performed more than 10 parotidectomies per year. Surgeons who employed monitoring in their practice were 20.8% less likely to have a history of a parotid surgery-associated lawsuit. Additional information regarding surgeon demographics, types of nerve monitors used, and reasons for and against monitor usage are discussed. CONCLUSION: Permanent facial nerve paralysis after parotidectomy occurs in 0-7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.

Clinical Competence↗

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↗

PubMed2007

[Multiple primary pleomorphic adenomas of the unilateral parotid gland].

BACKGROUND: Classical lateral parotidectomy is the standard surgical procedure for the management of lateral lobe parotid pleomorphic adenomas in most clinical centres. Extracapsular dissection and subtotal lateral parotidectomy are alternatively discussed in current literature and preferred by many authors. CASE: We report on a 20-year-old patient with multiple primary pleomorphic adenomas in the unilateral parotid gland, which preoperatively presented as a solitary tumour node. CONCLUSION: Considering this case we focus on the distinctive surgical procedures for the management of parotid pleomorphic adenomas. We work out, why lateral or even total parotidectomy are justified in the treatment of solitary palpable tumours and why we account lateral parotidectomy as the standard surgical procedure for the management of lateral lobe parotid pleomorphic adenomas.

Adenoma, Pleomorphic↗

PubMed2002

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.

Adenoma, Pleomorphic↗

PubMed1999

Parotid selective lymphadenectomy in malignant melanoma.

Malignant melanoma of the head and neck can metastasize to lymph nodes within the parotid gland. Selective lymphadenectomy is the modern method of staging regional lymph node basins in clinically localized melanoma. This procedure involves intraoperative lymphatic mapping and directed, selective removal of the first draining nodes or sentinel lymph nodes (SLNs). Historically, the assessment of parotid lymph nodes would involve a superficial parotidectomy with facial nerve dissection. Since 1993, 28 patients with localized melanoma of the head and neck have demonstrated lymphatic drainage to parotid lymph nodes on preoperative lymphoscintigraphy. The overall success rate of parotid selective lymphadenectomy is 86% (24 of 28 patients). Of the 28 patients, there were 6 early patients in whom blue dye alone was utilized intraoperatively, and the success rate is 50% (3 of 6 patients). When blue dye and radiocolloid mapping techniques are combined, the parotid selective lymphadenectomy is successful in 95% of patients (21 of 22 patients). Four of the 24 patients (17%) had metastases to the SLNs and underwent therapeutic superficial parotidectomy and/or modified radical neck dissection. After completion of the therapeutic superficial parotidectomy, 1 of the 4 patients was found to have an additional parotid (nonsentinel) node with melanoma metastases. None of the patients incurred injury to the facial nerve by parotid selective lymphadenectomy. To date, 2 of 28 patients (7%) have had regional recurrence to the parotid gland. Failure of the SLN technique may occur when blue dye alone is used, when human serum albumin (not sulfur colloid) is the radiocolloid, when prior wide excision and skin graft is present before lymphatic mapping, and when all SLNs are not retrieved. We conclude that parotid selective lymphadenectomy is a safe and reliable alternative to superficial parotidectomy for staging clinically localized melanoma of the head and neck.

Adult↗

PubMed2001

Surgical techniques in the treatment of pleomorphic adenoma of the parotid gland: our experience and review of literature.

This paper presents a retrospective study carried out on a sample of 100 patients affected by pleomorphic adenoma of the parotid gland and treated at the Department of Maxillofacial Surgery at the University of Rome "La Sapienza" between January 1, 1989 and December 31, 1997. For the diagnosis of this neoformation, cytological tests were performed on material taken from the neoformation using fine needle aspiration and ultrasound scan. In some selected cases, a CT examination of the head and neck with medium contrast or Nuclear Magnetic Resonance (NMR) was carried out. This study sets out to examine the most suitable treatment to be followed for the removal of the pleomorphic adenoma of the parotid gland. In 56 cases the patients underwent a superficial, conservative parotidectomy. Forty one patients had a total parotidectomy with the facial nerve left intact and one patient had a total parotidectomy where the marginal mandibular nerve of the facial nerve was damaged. The remaining two patients involved in the study were suffering from a recurrent pleomorphic adenoma and in these two cases a total parotidectomy was performed where the facial nerve was killed. The removal of the cranial nerve VII in these patients proved necessary because the nerve fibers had adhered to the surrounding scar tissue of the tumor, either after previous surgery or due to repeated chronic phlogosis of the gland.

Adenoma, Pleomorphic↗

PubMed2002

The efficacy of corticosteroids in postparotidectomy facial nerve paresis.

OBJECTIVE: To determine whether the administration of perioperative corticosteroids is effective in ameliorating facial nerve paresis after parotidectomy. STUDY DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical trial at a university medical center. METHODS: Patients scheduled for parotidectomy and who met inclusion criteria were invited to enroll in the protocol. They were stratified according to the anticipated surgery (superficial or total parotidectomy) and then received one of two doses of dexamethasone (0.51 or 1.41 mg/kg divided into three doses) or placebo solution immediately preoperatively and then every 8 hours for 16 hours postoperatively. The facial nerve was graded for proportion (percentage) of function at each of the four major regions (frontal, orbital, midface and upper lip, and lower lip). The early postoperative function and rate of return of function were compared among the treatment groups. RESULTS: Forty-nine patients were enrolled and evaluated (18 in the control group, 16 receiving low-dose dexamethasone, and 15 receiving high-dose dexamethasone). No therapeutic advantage of dexamethasone treatment could be appreciated with respect to the degree of early postoperative nerve function (81.3% for control patients vs. 69.5% for dexamethasone-treated patients [ =.239]). Similarly, the median time to recovery of complete facial nerve function was 60 days in the control group and was 150 days in the dexamethasone-treated patients. CONCLUSIONS: Dexamethasone administration in patients undergoing parotidectomy is not justified. Despite the relatively modest risk profile of dexamethasone, we were unable to demonstrate any benefit in patients who were treated with either low-dose or high-dose steroids compared with placebo-treated patients in a randomized, controlled trial.

Adult↗

PubMed2000

Our experience with surgical dissection of the facial nerve in parotid gland tumours. (A preliminary report).

Conservative parotidectomy is a primary method in the surgical treatment of parotid gland tumours. The classic parotid gland surgery uses the styloid process as a landmark for dissection of the facial nerve. The anatomical variations of the styloid process, however, prevent it from being always used as a reference landmark in this operative approach. This requires finding reliable invariable anatomical landmarks to be applied in the facial nerve dissection. The author presents his experience from the surgical treatment of 37 patients (25 females and 12 males) with tumours of the parotid gland. Adenoma was verified in 31 patients and 6 patients had a low malignancy carcinoma stage I. The mean age of the patients was 52 +/- 2.4 years. Conservative parotidectomy was performed in 28 patients (75.67%) and lateral parotidectomy in 9 patients (24.32%). The insertion of the posterior belly of digastric muscle on the mastoid process and tympanomastoid fissure were the primary landmarks used in the conservative parotidectomy. The proposed surgical technique was assessed as more reliable and less traumatic. Transient paralysis of the facial nerve occurred in 7 patients (18.9%) and subsided without treatment within 6-8 months. Based on his experience the author finds these anatomical landmarks easily recognizable and reliable start-points in facial nerve dissection that reduce the risk of traumatic injury of the facial nerve.

Adenoma↗

PubMed2001

[Facial nerve dysfunction after various surgical managements for benign parotid tumor].

OBJECTIVE: To observe the incidence of facial nerve dysfunction following parotidectomy and the relationship of the extent of parotid gland resection and the histopathology types. METHODS: Clinical observation of 99 patients who underwent parotid surgery from 1996 to 2000 was studied to analyse the relation between facial nerve dysfunction and the extent of parotidectomy with House-Backmann grading system. RESULTS: The overall incidence of facial dysfunction (HB > 1) was 36.4% for temporary and 3% for permanent dysfunction; Most of the dysfunction were partial and most concerning the marginal mandibular branch (34/99). The temporary facial dysfunction rate in total parotidectomy is higher than that of superficial and local parotidectomy. CONCLUSION: The dysfunction of facial nerve branches is correlated with the surgical managements. The most facial never dysfunction is temporary. The size of the lesion and the histopathology types will influence the choice of surgical managements. A proper surgical managements would reduce the incidence of facial dysfunction.

Adenoma, Pleomorphic↗

PubMed1999

[Clinic analysis of surgical treatment for benign parotid tumour 55 cases].

OBJECTIVE: To investigate the relationship between 3 kinds of surgical methods and the postoperative recurrence and complication of patients with the benign parotid tumours. METHOD: The records of benign parotid tumours cases (55 patients), who were treated in 1987-1997 at our hospital, were retrospectively analysed. The operative methods as follows: local excision (20 patients), superficial parotidectomy (28 patients), total parotidectomy (7 patients), facial nerve was anatomied during operation for 35 patients. RESULT: The rate of tumour recurrence, partial facial nerve paralysis, parotid gland fistula and Frey's syndroms after operation were 14.6% (8/55), 14.6% (8/55), 7.3% (4/55) and 7.3% (4/55) respectively. CONCLUSION: The operation of superficial parotidectomy or total parotidectomy should be perfromed for benign parotid tumour cases, facial nerve should be anatomied during operation, for reducing tumour recurrence and facial nerve paralysis.

Adolescent↗