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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↗

PubMed1998

Preoperative electroneurography (ENoG) in parotid surgery: assessment of facial nerve outcome and involvement by tumor--a preliminary study.

BACKGROUND: Facial electroneurography (ENoG) is an established and reliable method for assessing neural degeneration in various conditions affecting the facial nerve. The facial nerve may be subclinically involved by parotid tumors, but estimating such involvement preoperatively may be difficult when facial function is normal. The hypothesis that preoperative ENoG: (1) can detect subclinical facial nerve degeneration as a measure of involvement by parotid tumors and (2) can predict facial nerve function following parotidectomy was prospectively evaluated in the present study. METHODS: Twenty-two patients undergoing parotidectomy for tumors were tested preoperatively with ENoG, and their facial nerve function was graded pre- and postoperatively (House-Brackmann system). Eight patients had malignant tumors and 14 benign tumors. RESULTS: In patients with malignant tumors, lower percentage of preoperative ENoG response indicated nerve involvement that was not evident on clinical examination and correlated significantly (p = .035) with postoperative facial nerve dysfunction. Preoperative ENoG reduction of greater than 80% was found in all patients whose facial nerve was infiltrated by tumor. In 14 patients with benign tumors, preoperative ENoG results had no correlation with postoperative facial function. CONCLUSIONS: In malignant tumors, even when facial function is clinically intact, a low preoperative ENoG response may predict facial nerve involvement by the tumor. The lower the preoperative ENoG response, the poorer is the expected postoperative facial nerve function. There was no such correlation in benign parotid tumors.

Action Potentials↗

PubMed1986

Influence of local surgery and radiotherapy on the natural history of pleomorphic adenomas.

We have analysed the interval between first treatment and tumour recurrence in 65 patients with parotid pleomorphic adenomas which had recurred following local excision. Our results indicate that 5 years is an inadequate period of follow-up and that 10-20 years may be more realistic. Radiotherapy given to 17 patients after local excision of their tumours was found to have had no significant advantageous effect in terms of recurrence-free interval either before or following formal parotidectomy or in limiting the ultimate surgery required. Major complications directly attributable to radiotherapy developed in at least 3 of these 17 patients. Malignant transformation of the pleomorphic adenoma has occurred in three patients, two of whom had been subjected to radiotherapy. We advise that caution is exercised in the interpretation of results of local excision and radiotherapy in this disease. In view of the fact that an alternative and apparently superior treatment is available in the form of formal parotidectomy, we urge that this should be universally adopted for the management of both primary and recurrent pleomorphic adenomas.

Adenoma, Pleomorphic↗

PubMed1988

Parotid tumours: a review of parotid tumour surgery in the Northern Regional Health Authority of the United Kingdom 1978-1982.

A review of inpatients treated for parotid tumours during the 5-year period 1978 to 1982 in the Northern Regional Health Authority of the United Kingdom revealed 376 new parotid tumours and 28 recurrent tumours. The incidence of new parotid tumours was 2.4 per 100,000 and of pleomorphic adenomas 1.5 per 100,000 per annum. Local excision was the most common operation and was employed to remove 156 (67.2 per cent) of the 232 pleomorphic adenomas but there was evidence of incomplete excision in 60 (38.5 per cent) of these tumours. Incomplete excision also occurred in 12 (15.8 per cent) of the 76 pleomorphic adenomas removed by conservative parotidectomy. Global temporary facial nerve palsy was more common after conservative parotidectomy for benign tumours (21.8 per cent) than after local excision (3.7 per cent) but global permanent nerve palsy only occurred after local excision (0.9 per cent). The widespread use of local excision resulted in its use in 12 (27.3 per cent) of the 44 malignant tumours. The low incidence of parotid tumours and their treatment by a relatively large number of surgeons resulted in limited experience for surgeons and few opportunities for training in parotid surgery.

Adenoma↗

PubMed1990

Unremarkable parotid tumours that prove to be malignant.

Of 539 patients with clinically unremarkable lumps treated by formal parotidectomy, subsequent histological examination indicated that 20 of these lesions were malignant. After a follow-up of 1-18 years, only one patient has suffered a recurrent tumour and none has died from disease related causes. The results indicate that formal parotidectomy is an acceptable means of treating the small number of malignant tumours presenting in this way, and strengthen the argument that attempts to obtain a histological diagnosis before treatment are contraindicated.

Humans↗

PubMed1995

Malignant epithelial parotid tumours: a rational treatment policy.

Formal parotidectomy was undertaken in 271 patients by one surgeon over 11 years. Forty patients were treated for malignant salivary tumours (nine were recurrent). Low-grade tumours (45 per cent) were treated by surgery alone, untreated high-grade tumours (55 per cent) by surgery and radiotherapy, before or after operation, depending on clinical findings. The aims of surgery were to obtain tumour clearance, to preserve the facial nerve if possible, and to perform radical neck dissection for palpable malignant lymphadenopathy proven cytologically and for high-grade tumours when intraoperative jugulodigastric lymph node biopsy confirmed metastasis. Four patients sustained facial weakness as a result of surgery. At a median of 46 months follow-up two patients had developed local recurrence. Eleven patients with high-grade but none with low-grade tumours died from metastases. Patients with high-grade lesions with facial weakness from malignant infiltration and those with lymphatic metastasis have a significantly worse prognosis than those without. Locoregional control of parotid cancers can be achieved by formal parotidectomy and selective irradiation without routine sacrifice of the facial nerve.

Adolescent↗

PubMed2003

Parotid gland surgery: 4-year review of 118 cases in an Asian population.

BACKGROUND: To determine the presentation and management of parotid lesions requiring excision in a largely Chinese Asian population. METHODS: Retrospective study of 118 consecutive parotidectomies. RESULTS: Thirty-seven percent were Warthin's tumor (WT), 33% pleomorphic adenoma (PA), 21% other benign disease (OBD), and 9% malignant tumor (MT). Mean age was significantly different between benign (51 years) and malignant (40 years) lesions. MT decreased above 50 years, but increased five times with pain and two times with a noninferior pole lesion. Sensitivity of fine-needle aspiration (FNA) for differentiating benign from MT = 78%, for WT =5 8%, for PA =82%, for OBD = 28%, and for MT = 38%. CT scans did not alter WT management. Facial nerve (FN) paresis was not associated with histology, tumor size, site, or parotidectomy type. CONCLUSIONS: This is the first report documenting that most benign parotid tumors are WT and not PA. MT risk is greater in those less than 50 with pain and a noninferior pole lesion. Cystic lesions such as WT require great care in the evaluation of FNA findings.

Adenolymphoma↗

PubMed2001

Do nodal metastases from cutaneous melanoma of the head and neck follow a clinically predictable pattern?

BACKGROUND: Potential lymphatic drainage patterns from cutaneous melanomas of the head and neck are said to be variable and frequently unpredictable. The aim of this article is to correlate the anatomic distribution of pathologically involved lymph nodes with primary melanoma sites and to compare these findings with clinically predicted patterns of metastatic spread. METHODS: A prospectively documented series of 169 patients with pathologically proven metastatic melanoma was reviewed by analyzing the clinical, operative, and pathologic records. Clinically, it was predicted that melanomas of the anterior scalp, forehead, and face could metastasize to the parotid and neck levels I-III; the coronal scalp, ear, and neck to the parotid and levels I-V; the posterior scalp to occipital nodes and levels II-V; and the lower neck to levels III-V. Minimum follow up was 2 years. RESULTS: There were 141 therapeutic (97 comprehensive, 44 selective) and 28 elective lymphadenectomies (4 comprehensive dissections, 21 selective neck dissections, and 3 cases in which parotidectomy alone was performed). Overall, there were 112 parotidectomies, 44 of which were therapeutic and 68 elective. Pathologically positive nodes involved clinically predicted nodal groups in 156 of 169 cases (92.3%). The incidence of postauricular node involvement was only 1.5% (3 cases). No patient was initially seen with contralateral metastatic disease; however, 5 patients (2.9%) failed in the contralateral neck after therapeutic dissection. In 68% of patients, metastatic disease involved the nearest nodal group, and in 59% only a single node was involved. CONCLUSIONS: Cutaneous malignant melanomas of the head and neck metastasized to clinically predicted nodal groups in 92% of patients in this series. Postauricular and contralateral metastatic node involvement was uncommon.

Head and Neck Neoplasms↗

PubMed2005

Parotid area lymph node metastases from cutaneous squamous cell carcinoma: implications for diagnosis, treatment, and prognosis.

BACKGROUND: Parotid area lymph node metastasis from primary scalp and facial cutaneous cancers is a poorly recognized clinical entity partly because of the long time lapse between the index lesion and regional spread. METHODS: A retrospective review of the University of Wisconsin Tumor Registry and Head and Neck Oncology Tumor Board was performed over a 10-year period from 1989 to 1999. One hundred two patients with a malignant parotid mass were identified. Of these, 20 patients were identified with parotid region squamous cell carcinoma and prior index skin cancer of the face or scalp. These patients were analyzed regarding presentation, diagnostic evaluation, interval between index lesion and metastasis, treatment method, and long-term outcome. RESULTS: Approximately 20% of patients (20 of 102) in this series with a malignant parotid mass had presumed metastasis from an identifiable skin primary tumor. The mean time from index lesion to presentation of regional spread was 13.5 months. Seventy percent of the patients (14 of 20) underwent surgery followed by radiation as locoregional therapy, whereas 30% underwent surgery alone. Six (30%) of 20 patients required some degree of facial nerve sacrifice. Three patients (15%) experienced subsequent locoregional failure. Two of six patients from the surgery alone group and one of 14 patients who received surgery plus radiation therapy experienced locoregional relapse. CONCLUSIONS: Parotid area lymph node metastases from scalp and facial cutaneous carcinomas require aggressive therapy to optimize locoregional control. The addition of radiotherapy after parotidectomy is important and should be considered for optimal disease control. Selective neck dissection or radiation may be warranted at the time of parotidectomy. This combined approach is associated with high locoregional control rates and is generally well tolerated.

Carcinoma, Squamous Cell↗

PubMed2007

Management of Frey syndrome.

Almost all patients who undergo parotidectomy will to some extent develop Frey syndrome (auriculotemporal syndrome or gustatory sweating) after surgery, because of aberrant regeneration of cut parasympathetic fibers between otic ganglion and subcutaneous vessels. However, only the minority of these patients needs treatment. The syndrome consists of gustatory sweating, flushing, and warming over the preauricular and temporal areas. Thick skin flap and partial superficial parotidectomy are the most important techniques to minimize the risk of developing symptomatic Frey syndrome. Intracutaneous injection of botulinum toxin A is an effective, long-lasting, and well-tolerated treatment of Frey syndrome. If recurrence occurs, the treatment can be repeated.

Botulinum Toxins, Type A↗

PubMedDate not supplied

Merkel cell carcinoma of the ear.

All the consultants agree that, given this patient's history, a common skin tumor like squamous cell or basal cell carcinoma is unlikely. Melanoma or Merkel cell carcinoma belong in the differential. Interestingly, the consultants all suggest a biopsy of the lesion prior to other testing, and because this tumor is so accessible, a biopsy should not interfere with further testing or treatment. Drs. Weymuller and Marks would then proceed with a CT scan; Dr. Ridge favors an MRI scan. While a chest-ray is in order to rule out metastases, Dr. Weymuller also suggests immunocytochemistry. All the experts agree that the primary tumor should be excised. Dr. Weymuller would perform a total parotidectomy with facial nerve preservation, while Drs. Marks and Ridge suggest a superficial parotidectomy with facial nerve preservation. Drs. Weymuller and Ridge would also perform a modified radical neck dissection. In the absence of cervical disease, Dr. Marks would treat the neck primarily with radiotherapy. Only Dr. Weymuller favors immediate reconstruction and would use a lower trapezius island flap or a large rotational flap. Drs. Marks and Ridge prefer primary closure or skin graft. Drs. Weymuller and Ridge would treat this patient with combined therapy, giving radiotherapy to the primary area and the neck postoperatively at a dose of 55-60 Gy. However, Dr. Marks would treat the primary site postoperatively and the neck primarily with radiotherapy. He would treat the primary site with 59.40 Gy and the neck with 50.40 Gy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

Epithelial-myoepithelial carcinoma of salivary gland with metastasis to lung: report of a case and review of the literature.

A 63-year-old man was initially seen with multiple pulmonary nodules 14 years after a left parotidectomy for an epithelial-myoepithelial carcinoma of salivary gland. Eight and 18 months after parotidectomy, the patient had local recurrence of his salivary gland tumor. He remained disease-free before being seen with pulmonary nodules, which were evaluated by open lung biopsy. The pathologic features of the pulmonary nodules were identical to the salivary gland tumor resected 14 years earlier. This is the fourth reported case of epithelial-myoepithelial carcinoma of salivary gland metastasizing to a distant site.

Adenocarcinoma↗

PubMedDate not supplied

Functional facial nerve weakness after surgery for benign parotid tumors: a multivariate statistical analysis.

A retrospective study was done on 64 patients who underwent superficial or subtotal parotidectomy for a primary benign tumor of the parotid gland. Factors, such as age, sex, smoking, alcohol consumption, type of surgery, duration of surgery, pathology of lesion, and size of lesion, were reviewed in a multivariate statistical analysis to determine if any factor alone or in combination contributed to the development of functional facial nerve weakness postoperatively. Only the age of the patient was found to have a statistically significant causal relation using the Pearson chi-square method (p = 0.015). The marginal mandibular branch was affected in nine of 10 cases. Different surgical approaches cited in the literature are discussed, along with the possible role of ischemic injury to the facial nerve during parotidectomy.

Adenolymphoma↗

PubMed1978

Meibomian gland adenocarcinoma of the eyelid with neck metastasis.

Meibomian sebaceous gland adenocarcinoma of the eyelid is a rare lethal neoplasm. It accounts for less than 1% of all eyelid tumors. There are approximately 200 cases described in the literature. The incidence of regional metastases is 17-28%. Once metastases are present, only half of the patients survive five years. Presented are two cases with neck node metastases. In one of the patients the primary lesion was initially treated with radiation therapy with an unsuccessful result. Subsequently full thickness, wide excision of the lower lid was required to control the primary. Eyelid oculoplastic reconstruction was performed using a masolabial rotation skin flap lined with nasal septal composite graft (cartilage and mucosa). Orbital exenteration was necessary to control the primary tumor in the other patients. The regional metastases in both patients were treated with parotidectomy with preservation of the facial nerve, radical neck dissection and postoperative radiation therapy. One of the patients with poorly differentiated adenocarcinoma died due to brain metastasis. I feel that combined treatment of radical surgery to the primary site, parotidectomy, radical neck dissection and planned postoperative radiation therapy may improve the five-year survival of patients with regional node metastases.

Adenocarcinoma↗

PubMed1993

Facial nerve morbidity following parotid surgery for benign disease: the Cleveland Clinic Foundation experience.

Standard surgical management for benign tumors of the parotid gland requires either superficial, subtotal, or total parotidectomy with preservation of the facial nerve. Although this approach is effective in minimizing recurrence, the resultant facial nerve morbidity is seldom addressed. Two hundred fifty-six consecutive patients who underwent parotid surgery for benign neoplasia at this institution in the past 15 years are reviewed, with attention to postoperative facial nerve function. Immediate dysfunction was frequently encountered (46.1%), but permanent dysfunction was uncommon (3.9%). The incidence of long-term dysfunction may be higher in revision cases and when an extended (total or subtotal) parotidectomy is performed.

Facial Nerve↗

PubMed2006

Salivary gland neoplasms in children: the experience of the Istituto Nazionale Tumori of Milan.

BACKGROUND: Epithelial salivary gland tumors are very uncommon in pediatric age. We report a series of 52 cases treated at the Istituto Nazionale Tumori of Milan, Italy, over a 30-year period. These results are presented in conjunction with a literature review of salivary tumors with a view to providing an up-to-date overview of the clinical course, prognosis, and treatment options for this rare tumor. PROCEDURE: Fifty-two cases of epithelial salivary tumors were reviewed and the clinical-pathological information concerning tumor characteristics, therapy, and follow-up were collected. Patients' age ranged between 4 and 18 years. RESULTS: The major salivary glands were the main site of tumor occurrence (79% of cases arose in parotid glands); 37 patients had benign tumors (pleomorphic adenoma), 15 had malignant tumors (12 mucoepidermoid carcinoma, 9 low grade). All the patients were treated by surgery; local relapses after parotidectomy were 4% and 25%, in benign and malignant tumors, respectively. When tumor enucleation was performed, recurrences occurred in 50% of benign neoplasms. At the time of the report, all patients with benign tumors were alive, 35(95%) without evidence of disease; only one patient with malignant tumor died of disease. CONCLUSIONS: Epithelial salivary glands tumor in children had different characteristics compared with their adult counterpart with respect to the frequency of histotypes and site of occurrence, but their prognosis seems to be similar. Parotidectomy (total or superficial) is the best choice for achieving good cure rates in both benign and malignant tumors.

Adenoma, Pleomorphic↗