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PubMed2003

Primary and metastatic cancer of the parotid: comparison of clinical behavior in 232 cases.

OBJECTIVES/HYPOTHESIS: Parotid malignancy may develop as a primary cancer of salivary tissue or by metastatic involvement of parotid lymph nodes. The aim of the study was to compare the clinical behavior of primary and metastatic parotid cancers by analyzing patterns of treatment failure and clinical outcomes. STUDY DESIGN: Retrospective review of clinical and pathologic data prospectively accessioned onto a computerized database. METHODS: A prospectively documented series of 232 parotidectomies carried out for treatment of cancer from 1988 to 1999 was reviewed. There were 177 male and 55 female patients with a median age of 65 years (age range, 17-97 y). Median follow-up time was 4 years. Pathological groups included 54 patients with primary parotid cancer, 101 with metastatic cutaneous squamous cell carcinoma, 69 with metastatic melanoma, and 8 with other metastatic cancers. RESULTS: Neck nodes were clinically positive in 12 patients with primary cancer, 24 patients with squamous cell carcinoma, 16 with melanoma, and 2 with other metastatic malignancies. Conservative parotidectomy, preserving the main trunk of the facial nerve, was performed in 185 patients, and 47 patients had a radical parotidectomy sacrificing the facial nerve. There were 54 therapeutic and 110 elective neck dissections. Adjuvant radiotherapy was given to 39 patients with primary cancer, 86 with squamous cell carcinoma, 50 with melanoma, and 8 in the other metastatic group (78% of the patients in the series). Local control rates at 5 years in the four groups were 86%, 75%, 94%, and 100%, respectively (P <.01). Survival rates at 5 years were 77%, 65%, 46%, and 56%, respectively (P <.01). CONCLUSIONS: The pattern of parotid malignancy is unique in Australia because of the high incidence of skin cancer, which can metastasize to the parotid gland. Metastatic cutaneous malignancy predominates. The pattern of failure and outcome varied depending on histological findings. Local failure occurred most often in metastatic squamous cell carcinoma, whereas patients with melanoma had the highest incidence of distant spread.

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↗

PubMed2002

Accuracy of fine-needle aspiration biopsy for Warthin's tumours.

BACKGROUND: Although the overall accuracy of fine-needle aspiration biopsy (FNAB) for salivary gland neoplasms has been well established, definitive results for Warthin's tumour (WT) are lacking. For most salivary gland tumours, surgery is recommended because of progressive enlargement and the risk of malignant transformation. This behaviour is unusual with WT, and surgery is usually advocated for pathologic confirmation. A highly accurate diagnosis of WT by FNAB may justify conservative management for the asymptomatic patient. However, if the reliability of this diagnostic procedure is questionable, there should be little hesitation in recommending parotidectomy. METHODS: A retrospective study design was used to evaluate the accuracy of FNAB for parotid WTs. All consecutive parotid FNABs and parotidectomy specimens from 1992 to 2000 were reviewed, and cases suggestive of WT were identified. The fine-needle cytology and histopathology results were then correlated. The true-positive, false-positive, and false-negative rates were tabulated to determine the sensitivity and positive predictive value (PPV) of FNAB for WT. RESULTS: A total of 41 patients were included in the study. Of these, 33 patients had FNABs suggestive or diagnostic of WT that were confirmed following parotidectomy (true positives = 33). In 4 patients, the FNAB incorrectly suggested WT, with the surgical histopathology confirming different diagnoses (false positives = 4) (3 acinic cell carcinomas and 1 pleomorphic adenoma). Four patients had surgically confirmed WTs with FNABs suggestive of other diagnoses (false negatives = 4) (1 cystic squamous cell carcinoma, 1 simple cyst, 1 "inflammatory process," and 1 "negative for malignant cells"). The sensitivity and PPV were 89.2% and 89.2%, respectively. CONCLUSION: Although the sensitivity and PPV in this study are high, the false-positive rate is clinically significant given the type of lesions missed. Three acinic cell carcinomas and one pleomorphic adenoma were misdiagnosed as WT on FNAB. One must be cautious in recommending conservative management for parotid tumours even when a WT is suggested by FNAB.

Adenolymphoma↗

PubMed2006

Tisseel to reduce postparotidectomy wound drainage: randomized, prospective, controlled trial.

BACKGROUND: Tisseel (Baxter Corp. Ontario, Canada) is a fibrin-based tissue glue that has been widely used to reduce wound drainage, achieve hemostasis, and decrease surgical complications. To date, Tisseel has not been evaluated in a randomized prospective trial for use in parotid surgery. OBJECTIVES: To determine whether the use of Tisseel in parotidectomy decreases postoperative wound drainage, the duration of percutaneous drainage, the length of hospital stay, and the frequency of complications. METHODS: Sixty consecutive parotidectomy patients were randomized into two groups: a group treated with 2 cc of Tisseel prior to wound closure and a control group. Postoperative wound drainage was measured for all patients by blinded hospital staff. The duration of percutaneous drainage, duration of hospital stay, and incidence of complications at the 3-week follow-up were assessed. RESULTS: A statistically significant difference in total drainage volume (p < .02) and frequency of postoperative seroma (p < .05) was demonstrated between patients treated with Tisseel prior to wound closure and the control group. CONCLUSION: The use of Tisseel in parotidectomy patients prior to wound closure significantly decreases total drainage volume and the frequency of postoperative seroma.

Adult↗

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↗

PubMed2002

[Recurrent benign tumors of parotid gland: the role of the surgery].

Parotid gland tumor recurrences can prove problematic both in terms of facial nerve trauma during surgery and for the possible transformation into malignancy. Between 1981 and 2001 a total of 40 patients (23 women, 17 men; average age 48; age range 20-79 years) underwent surgery for recurrent parotid gland tumors. The average time between the first and the second surgical procedures was approximately 10 years. Five subjects underwent surgery several times for the same pathology. The Authors feel that MRI imaging is an essential tool for the evaluation of infiltrations into the soft tissues. The following surgical procedures were performed: enucleation in 2 cases; exofacial partial parotidectomy (PP) in 1; lower polar PP with functional neck dissection in 1; total parotidectomy (TP) with preservation of the facial nerve in 31 cases; TP with functional neck dissection in 2; TP with sectioning of the facial nerve in 2 and TP with transmandibular buccopharyngectomy and myocutaneous gran dorsal muscle flap in 1 case. Histology proved positive for the following: pleomorphous adenoma in 21 cases, adenocarcinoma in 11, aggressive fibromatosis in 2, cystadenolymphoma in 1, parotiditis in 1, lipoma in 1, cystic lymphoid hyperplasia in 1, histiofibrosarcoma in 1 and neurofibrosarcoma in 1. The surgical technique used was retrograde dissection of the facial nerve starting from one of the peripheral branches. Post-operatively, whenever a facial paralysis was encountered it proved difficult to recover. Paralysis of the nerve was permanent only in the 2 subjects where sectioning proved necessary because of infiltration by carcinoma. In 6 subjects recovery of the paralysis took one year, in 4 it took 6 months and in 2 other cases 3 months. In 22 cases there was only a slight paralysis of some branches which recovered during the post-operative period. We do not have definitive data on 4 subjects either because the period of time since surgery is still too short or because they did not come in for subsequent check-ups. The results of our study show that total parotidectomy should be the treatment of choice in case of benign parotid gland tumors and in particular for pleomorphic adenoma.

Adult↗

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↗

PubMed2002

[Surgical resection of infantile hemangioma of parotid gland].

OBJECTIVE: To seek an effective approach of treatment to infantile hemangioma of parotid gland. METHOD: Nineteen cases of infantile hemangioma of parotid gland were analyzed retrospectively. The operative methods were as follows: Superficial parotidectomy (15 cases), total parotidectomy(3 cases), superficial parotidectomy and inner hemangioma ligation in parotid(1 cases). The neck-nape shin flap repair(3 cases),"Dissection outside the false capsule" and facial nerve anatomy are applied in the operation. RESULT: Three cases showed a partial facial nerve paralysis after operation. One cases needed a blood transfusion (200 ml) in the operation. The follow up was beyond 1 year with excellent results. CONCLUSION: "Dissection outside the false capsule, facial nerve anatomy and the neck-nape skin flap repair are applied in the operation. These treatment methods are effective and radical. It is worthy of wide application".

Child↗

PubMed2005

Minimally invasive surgery for parotid pleomorphic adenoma.

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve--defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve--is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved To test this hypothesis, the author conducted a retrospective study of 30 patients--15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms ofmorbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.

Adenoma, Pleomorphic↗

PubMed2005

Acinic cell carcinoma of the parotid gland: a 15-year review limited to a single surgeon at a single institution.

The course of acinic cell carcinoma of the parotid gland following surgical and nonsurgical interventions is variable. The objective of this study was to report our experience in treating this disease and to evaluate the factors that might be involved in the treatment of the tumor and the prognosis of the patient. To limit the contributory variables that are usually found in most studies, we included only those patients (n = 11) who had been treated by a single surgeon at a single institution from 1988 through 2003. Hospital and office records were evaluated for demographic information, signs and symptoms, treatment modalities, pathology, and outcomes. Additional follow-up data were obtained through telephone interviews. For the most part, treatment included either superficial parotidectomy or total parotidectomy with facial nerve preservation; 1 patient with coexisting adenocarcinoma underwent a more radical procedure, and 4 patients underwent adjuvant radiation therapy. The most prevalent morphologic pattern of these tumors was microcystic. Follow-up ranged from 1 year and 3 months to 10 years and 9 months (mean: 4 yr and 11 mo). During that time, we found no recurrences of acinic cell carcinoma and no evidence of metastatic disease. Therefore, we conclude that acinic cell carcinoma can be successfully treated with a superficial or total parotidectomy with sparing of the facial nerve. Radiation therapy may provide adjunctive benefit.

Adolescent↗

PubMed2005

Treatment of complications of parotid gland surgery.

Although several reports in the literature have documented the surgical technique, and the oncological outcome achieved with parotidectomy, only a few articles have described the complications of parotid gland surgery and their management. Several complications have been reported in parotid surgery. We re-classified the complications of parotidectomy in intra-operative and post-operative (early and late). The commonest complications after parotidectomy are temporary or permanent facial palsy and Frey's syndrome.

Facial Paralysis↗

PubMed2005

Major salivary gland diseases. Multicentre study.

This multicentre study involved 28 Italian ORL Centres responding to a questionnaire sent by us which allowed recruitment of a high large number of cases of parotid neoplasms observed over a 10-year period. Statistical data obtained partly confirmed previous findings. Benign tumours account for 80% of case histories with a relationship 1:4 M/F, the most frequent being pleomorphic adenoma (57.3% of cases), followed by Warthin's tumour (32.4%), this rating not having been confirmed in case histories (8-10%) in the literature. Malignant tumours instead were fewer in number compared to the literature (14% vs 25-30%); the most frequent being mucoepidermoid carcinoma (18.2%) of which 44% G1, 33% G2 and 23% G3. Adenoid-cystic carcinoma was observed in 15.3% and < or = 10% for all the other most frequent histological malignant neoplasms. Diagnostic work-up included echotomography and fine-needle aspiration biopsy, less used imaging techniques were computed tomography, magnetic resonance imaging, Sialo-computed tomography. During this multicentre investigation more widespread use of imaging techniques has, however, been observed. The greater use of ecotomography and of fine-needle aspiration biopsy was due to simplicity of application and low cost offering good sensitivity and specificity. Surgical treatment of benign tumours consisted, in 50% of cases, in superficial paroditectomy and in approximately 30% of total paroditectomy. Enucleoresection was limited to approximately 15% of neoplasms, enucleation to <10% of cases with only 2% of pleomorph adenoma due to the well-known anatomo-pathological characteristics which may lead to relapse. For malignant neoplasms, total parotidectomy was performed in approximately 50% of cases, while in the remaining 50% an almost equal rate of superficial parotidectomy was carried out and enlarged parotidectomy, with or without sacrificing the facial nerve, which was rebuilt in 60% of cases. The lateral neck dissection most frequently carried out was of functional type in 54% and selective type in 46% with removal of levels I-III and II-IV in approximately 60% of cases. Sentinel lymph node was observed in a limited number of centres. When no clinically evident lymph nodes were present (NO) considering the tumour histotype, two thirds of patients underwent surgery or radiotherapy, while in the remainder the wait-and-see attitude was prefered. Post-operative-complementary radiotherapy was very frequently performed instead of chemotherapy. Oncological results obtained were compared with those reported in the literature: in fact for all benign neoplasms relapse ratings are about 5%, while for malignant tumours the worst prognosis was in squamous cell carcinoma with median of 37.7 on survival and metastasis rate of 16.5%. Finally, mucoepidermoid carcinoma tumours showed best survival, followed by adenoid-cystic carcinoma with ranges, respectively, 83 and 81.

Adult↗