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PubMed1982

[Surgical treatment of chronic parotitis (author's transl)].

Of 58 patients whose parotid glands were extirpated because of a chronic parotitis, 90% could be cured. The rate of success of this operation is reduced to 70-80% if its is based on those 31 patients alone who showed the typical symptoms of a chronic-recurrent parotitis. The incidence of persisting facial pareses is about twice as high as after removal of non-inflamed parotid glands. This figure is based on seven patients suffering, with one exception, from only slight disorders of innervation in the region of the angle of the mouth. In our opinion total parotidectomy is the method of choice for the treatment of chronic parotitis, if all attempts at conservative treatment have failed. We attribute our failures to remaining glandular parenchyma that was both inflamed and still secretory-active. To further improve the rate of success of parotidectomy, its combination with procedures suitable for occlusion of the duct system is proposed. In this way one should succeed in completely eliminating any secretory-active gland tissue.

Chronic Disease↗

PubMed1983

[Malignant tumors of the salivary glands: early diagnosis, follow-up and therapy].

Problems of early recognition, postoperative care, and therapy were studied in 207 patients with malignant tumors of the salivary glands, who were treated from 1965 to 1975. Early recognition of these malignant tumors is hampered by the circumstance that only a very short time span is available for diagnosis of the highly malignant types and by the lack of knowledge about specific risk groups among the population. Important for postoperative care is the high rate of local tumor recurrence, especially of salivary-duct, mucoepidermoid, acinic-cell, and adenoid-cystic carcinomas, ranging from 71% to 83%. Late recurrence is frequent. There is also a close connection between local recurrence and lymphogenic or hematogenic formation of metastases. The therapy of choice for malignant tumors of the salivary glands is surgery and, depending on the tumor type, postoperative irradiation. Chemotherapy is at present still of minor importance. Histologic tumor type and tumor stage determine the extent of the surgical procedures, which range from lateral parotidectomy with preservation of the facial nerve to radical parotidectomy with or without reconstruction of the facial nerve. In spite of radical surgery, many malignomas of the salivary glands, particularly the adenoid-cystic carcinomas, tend to recur. In such cases the long-term prognosis is poor and cannot be improved by postoperative irradiation. Supplemented by the experience gained in postoperative care, we have summarized the guidelines along which these 207 salivary-gland malignomas were treated into a modified concept of therapy.

Female↗

PubMed2004

[Squamous cell carcinoma of the external ear. A carcinoma of old age which requires individualized therapy planning].

METHODS: Data for all patients with ear malignancies being operated in our department between August 1988 and March 2001 were retrospectively analyzed for tumor localisation, stage, biometric data, anesthesiological risk factors, therapy and recurrence of the disease. RESULTS: Thirty of 79 patients (29 male, one female; average age 77.2 years, range 54-99 years) with cutaneous malignancies of the external ear were diagnosed as SCC ( n=32 SCC). A total of 17 SCC were smaller than 2 cm, 12 were between 2-5 cm, and three were larger than 5 cm. Only two patients had regional nodal disease, none had distant metastases. The anesthesiological risk was estimated according to the recommendations of the American Society of Anesthesiologists (ASA); 16/30 patients were classified as group 3 or 4, having severe general disease with a decrease in vitality or even vital risks. A total of 24 SSC were primarily operated under local anesthesia. Depending on histology, localisation and size of the SCC local excision, partial or total removal of the auricle was performed. In the remaining 8/32 cases, the primary intervention was performed under general anesthesia, mostly in combination with an ipsilateral neck dissection and a superficial parotidectomy. In 8/32 cases, the SCC had to be re-operated after primary R1 resection. Altogether, eight patients received radiotherapy. In 5/32 cases there was a recurrence of the disease. The average follow-up period of the 13 patients who are still alive is 50 months (17-113). One patient died as a result of the metastasized SCC and 16 patients died due to other diseases. DISCUSSION: Considering the high age and the age-associated general diseases of the patients with SCC of the auricle, differentiation between a radical concept of therapy and its risks and possible therapy-related damage is important. Therefore, individual concepts such as partial removal of the pinna without neck dissection and parotidectomy for the N(0) stage are justified if relevant anesthesiological risk factors have to be taken into account.

Age Distribution↗

PubMed2006

[Malignant fibrous histiocytoma in the parotid gland. Case series and literature review].

BACKGROUND: Malignant fibrous histiocytoma (MFH), a soft tissue sarcoma that is predominantly localized in the extremities and retroperitoneum, rarely occurs in the head and neck. This study presents the clinicopathological features of three patients with MFH of the parotid gland treated at the ENT department of the University Hospital of Muenster (Germany) between 1991 and 2002. PATIENTS: The clinical course of all three patients was defined by a rapidly growing mass in the parotid area. Surgical therapy was the first treatment of choice. In two patients, radical parotidectomy was performed, whereas one patient underwent partial parotidectomy. Selective neck dissection was performed in one case. In two cases, post-surgical treatment involved radiation and/or chemotherapy. Two patients died as a consequence of local recurrence within the first year after diagnosis, whereas one patient is alive and free of disease after a follow up of 14 months. CONCLUSION: Our own experiences, taken together with those reported in the literature, suggest that clear surgical margins are probably the most important factor for avoiding a recurrence and to improve disease free survival.

Aged, 80 and over↗

PubMed1999

[Sjögren syndrome and bilateral MALT lymphoma of the parotid gland].

Sjögren's syndrome is an important autoimmune disease in the head and neck. Patients have an increased arrival risk of up to 6% per year for developing B-cell lymphomas, including mucosa-associated lymphoid tissue (MALT) lymphomas. The following case report shows this relation and the difficulty of differentiating clinically recurrent swelling of the parotid gland in Sjögren's syndrome from malignant lymphoma. A 64-year-old woman had a 2-year history of indolent, recurrent swelling of both parotid glands. Blood examination showed elevated ESR and a hypergammaglobulinemia. Immunosuppressive therapy produced no improvement. Two years after the diagnosis of Sjögren's syndrome, swelling of the left parotid gland persisted. Superficial parotidectomy of the left side was performed and histopathological examination revealed a MALT-related lymphoma. Subsequent parotidectomy of the right side also showed infiltration of the gland by a MALT lymphoma. Postoperative radiation therapy was given. During the follow-up period no recurrence or systemic disease was detected. Patients with Sjögren's syndrome should be examined regularly by the otolaryngologist. If a lymphoma cannot be ruled out, open biopsy must be considered for histological diagnosis. Prognostic factors for developing a lymphoma are possibly a high ESR and hypergammaglobulinemia. Further prognostic factors have to be evaluated.

Blood Sedimentation↗

PubMed2001

[Clinical aspects and therapy of extratemporal facial neurinoma].

BACKGROUND AND OBJECTIVE: Extratemporal facial nerve neurinomas are rare. In the present study, the epidemiology, clinical presentation and in particular surgical treatment of this entity was analysed under special focus on facial nerve preservation. PATIENTS/METHODS: 22 patients with an extratemporal facial nerve neurinoma of the parotid gland, treated at the University-ENT-Clinic Hamburg-Eppendorf during 1977-1997 were analysed retrospectively. RESULTS: All patients presented with a unilateral parotid mass, on ultrasound examination regularly an encapsulated intraparotideal tumor. 16 patients (72.7%) had regular facial nerve functioning. 6 patients (27.3%) with partial or complete peripheral facial nerve paralysis were treated with partial or radical parotidectomy because of malignancy possibility. In the group of patients with intact facial nerve, latero-facial (superficial) parotidectomy with segmental nerve resection was undertaken in 9 cases (56.3%) because nerve-continuity was not siezable within the tumor area. In 7 cases (43.7%), tumor-enucleation was feasable with complete nerve preservation. Intraoperative frozen section in a total of 4 (18.2%) patients always showed the correct histopathological diagnosis. No tumor-recurrence was observed in the 15 cases (68.6%) which underwent follow-up. CONCLUSIONS: In case of extratemporal neurinoma of the parotid gland, preparation of the facial nerve during surgery is often impossible, leading to segmental nerve resections. This decision, however, is made without proof for malignancy. In recognition of the biological behaviour of this entity the authors recommend that after tumor exploration a biopsy should be taken from the periphery of the tumor to exclude malignancy. After diagnosis of a neurinoma a nerve preserving (wait-and-see) approach appears justified.

Adolescent↗

PubMed2001

[Effectiveness of botulinum toxin A in the treatment of gustatory sweating].

Frey's syndrome is present in almost all patients after parotidectomy. Gustatory sweating reduces quality of life. Injections of botulinum toxin A have recently been described as effective. This study was designed to evaluate the efficacy of this new treatment. Nineteen patients with severe gustatory sweating following superficial parotidectomy were treated. One unit/cm2 botulinum toxin A was injected intracutaneously into the affected area once. Minor's starch iodine test was performed to prove the outcome of therapy 4 weeks later. Eight patients lost their sweating. However, another seven patients had some blue spots on their cheeks. In four patients whose sweating had extended beyond the hairline, remnants of gustatory sweating showed up. Overall, the affected area of gustatory sweating could be reduced by botulinum toxin A from an average of 31 cm2 before treatment to 4 cm2 after treatment. Although there were some remnants of sweating in a few patients, Frey's syndrome was gone in all cases. No side effects could be observed. Intracutaneous injections of botulinum toxin A are highly effective and safe in treatment of gustatory sweating.

Adult↗

PubMed2005

The surgical anatomy of the parotid fascia.

UNLABELLED: Currently, there are no reports in the literature of the parotid fascia suggesting that this structure is crucial to the identification of the facial nerve trunk (FNT). Traditional surgical and anatomical descriptions of this fascia report it as a collection of connective tissue large enough to be described by the unaided eye. This study was performed to investigate the composition and limit of the fascia surrounding the parotid gland. An appreciation of these on safe and effective parotid surgery was also considered. HISTO-ANATOMICAL STUDY: Microsurgical step-by-step dissection was performed on 18 adult cadavers (n=36) to define the composition, arrangement, and attachment of the parotid fascia. Samples were subjected to the Masson Trichrome Technique (1990). CLINICAL STUDY: A total of 18 patients presented for parotidectomy. Eight patients had a pleomorphic adenoma and ten had lympho-epithelial disease of the parotid gland. Boundaries of parotid fascia were posteriorly-mastoid process, anteriorly--ramus of mandible, superiorly--cartilage of external acoustic meatus, and inferiorly-imaginary line joining tip of mastoid process to ramus of mandible. These landmarks formed a quadrangular space. HISTO-ANATOMICAL STUDY (N=36): Parotid fascia formed a fibrous meshwork over the gland. In the upper two-thirds, fascia was thick and strong; in the lower one-third, fascia was thin. Soft tissue arrangement (from superficial to deep): dermis, subcutaneous fat, superficial cervical fascia, deep cervical fascia. CLINICAL STUDY (N=18): The technique described was applied consistently in all patients. Mean time for localization of FNT was 11 min (range 7-18 min). In two patients (both with an underlying inflammatory disorder of the parotid gland), a transient facial nerve palsy developed postoperatively. In both patients, this settled within 7 weeks of operation. The true surgical potential of the parotid fascia during parotidectomy has been reported.

Adenoma, Pleomorphic↗

PubMed2005

Acinic cell carcinoma of the parotid gland in a child.

Acinic cell carcinoma of the parotid gland in children is an extremely rare occurrence. We present a 13-year-old girl with acinic cell carcinoma of the parotid gland. Removal of the superficial lobe of the parotid gland (superficial parotidectomy) was performed because the tumor was completely encapsulated by fibrous tissue and had not invaded the deep parotid gland. There is no clinical evidence of recurrence or metastasis 4 years after surgery. In our view, when tumors are completely encapsulated and do not adhere to the facial nerves, superficial parotidectomy is the best surgical treatment in children.

Adolescent↗

PubMed1975

Parotid gland tumors. Clinicopathologic study.

The clinical findings and histologic features of 154 parotid gland tumors treated at the Health Sciences Centre, Winnipeg, Canada, from 1957 to 1970 were reviewed. The study illustrates a wide variation in the natural history and degree of malignancy of parotid tumors. Approximately 80 per cent were benign; among these, mixed tumors were by far the commonest. For most benign tumors, the recommended surgical treatment is wide local excision with an adequate margin of normal glandular tissue, except when subtotal or conservative total parotidectomy is required because of the size or location of the tumor. The facial nerve should be visualized and preserved. This approach prevents recurrences and minimizes facial nerve injury, since risk of neural injury increases with the extent of the surgical procedure. Total removal of the gland on the basis of the multicentricity or malignant transformation of these tumors is not supported by the findings of this study. For malignant tumors a more radical procedure, that is, subtotal or total parotidectomy with or without node dissection, with sacrifice of the facial nerve if necessary is advisable, depending on the type and anatomic location of the tumor.

Adenocarcinoma↗

PubMed1994

Primary malignancy of the salivary gland in children.

Seventeen pediatric patients with a major salivary gland malignancy (16 parotid, 1 submaxillary) were reviewed. Eight patients presented with carcinoma. The usual presentation was a mass over the affected gland. Six patients had localized disease, which was treated by excision. This was accomplished by either a total or subtotal parotidectomy or resection of the submaxillary gland. Two patients received adjuvant radiation therapy. All six patients with localized carcinoma are alive, without evidence of disease. Two patients presented with metastatic disease and died of the disease despite treatment with multiagent chemotherapy, and in one case, radiation therapy. Nine patients had rhabdomyosarcoma (RMS). The usual presentation was a mass at the angle of the mandible. Five patients had involvement of one or more cranial nerves, and two had concomitant cervical adenopathy. Eight patients had a biopsy and then were treated according to an existing prospective institutional protocol. The ninth patient initially underwent a superficial parotidectomy. Seven patients received radiation therapy. In one patient, rapid progression of the disease precluded this treatment. Seven patients died of progressive local and distant disease 2 months to 2 years (median, 6 months) from the time of diagnosis. Two patients are alive, without evidence of disease, 3 and 7 years after presentation. We conclude that carcinoma should be managed with complete excision. For RMS of the salivary gland, a biopsy should be performed, and treatment should consist of chemotherapy and radiation therapy.

Adolescent↗

PubMed1994

Familial occurrence of pleomorphic adenoma.

Pleomorphic adenoma is the most common neoplasm found in the parotid gland. The familial occurrence of any salivary gland neoplasm is rare. There are 8 previous reports in the literature of familial occurrence of salivary gland tumors. Two of these report the occurrence of pleomorphic adenoma of the parotid gland in siblings; all 4 patients were adults. We report here an 11-year-old male who presented with a left parotid mass and underwent parotidectomy. The mass proved to be a pleomorphic adenoma. His sister presented 9 years later at the age of 15 years with a similar mass also in the left parotid area. She underwent superficial parotidectomy which revealed the mass to be a pleomorphic adenoma. We believe these are the youngest siblings reported to date in which familial pleomorphic adenoma has occurred.

Adenoma, Pleomorphic↗

PubMed1994

Salivary gland neoplasms in children: a 10-year survey at the Children's Hospital of Philadelphia.

Fifteen salivary gland tumors were treated at The Children's Hospital of Philadelphia between 1982 and 1991. Eight of these lesions were malignant and 7 were benign. All of the benign tumors were pleomorphic adenomas. For these, superficial parotidectomy or excision of the submandibular gland was the treatment of choice. One child had recurrence 2 years after her initial surgery. Among the malignant lesions, mucoepidermoid carcinoma was diagnosed in 5 children, and acinic cell carcinoma in 3. Six malignant tumors involved the parotid gland, while 2 originated in the submandibular salivary gland. Superficial or total parotidectomy, or excision of the submandibular gland was performed, according to the nature and the location of the lesion. The facial nerve was sacrificed in one patient because of extensive involvement of the nerve. A 2-year survival rate of 100% was achieved, and all the patients were free of disease at the end of the follow-up period. Successful management of salivary gland lesions in children requires a high index of suspicion of possible malignancy and complete surgical removal as the initial treatment. Radiation therapy is recommended in the management of those patients with microscopic residual tumor and/or nodal involvement.

Adenoma, Pleomorphic↗

PubMed1990

Surgery of the parotid region: a new approach.

Many disorders of the parotid gland require treatment by subtotal or total parotidectomy. In such situations functional and esthetic complications may arise due to the location of the incisions or from permanent or temporary injuries to the facial nerve. This report describes a modified revision that gives good esthetic and functional results. A review of a similar series of cases treated surgically by the same surgeons using Yoel and Bilesio's technique showed no differences in morbility associated with parotidectomy performed using the proposed incision.

Adolescent↗

PubMedDate not supplied

Facial nerve schwannomas: a report of four cases and a review of the literature.

OBJECTIVE: To evaluate both the surgical approaches and results of the facial nerve schwannoma cases as diagnosed in our clinic in line with the literature. MATERIAL AND METHODS: The files of 4 cases diagnosed in our clinic as facial nerve schwannoma between 1996 to 2002 were reviewed retrospectively. All the cases were evaluated with detailed history; ear, nose, and throat examination; computed tomography; and/or magnetic resonance imaging. If required, electromyography and audiometric evaluations were made. Fine-needle aspiration cytology was also performed in appropriate cases. The surgical approach used was determined depending on the tumor location and its extent. Facial nerve reconstruction was accomplished if the integrity of the nerve could not be protected. Cases were followed up for facial nerve function, complications, and recurrence. RESULTS: The tumors occurred in the vertical (n = 2), internal auditory canal (n = 1), and the peripheric segment (n = 1) of the nerve. As symptoms, facial paralysis (n = 2), hearing loss (n = 3), tinnitus (n = 1), otorrhea (n = 2), parotid mass (n = 2), and external auditory canal mass (n = 1) were observed. Radiologic investigations provided important informations. However, fine-needle aspiration cytology did not contribute to a correct preoperative diagnosis. The superficial parotidectomy approach (n = 1), retrosigmoid approach (n = 1), and transmastoid-superficial parotidectomy combined approach (n = 2) were used. The integrity of the nerve could not be protected in 3 of the cases. After the reconstruction surgery, the facial nerve function was evaluated as House-Brackmann grade 3 for all 3 cases at the mean 38.6 months follow-up time. No tumors have recurred during follow-up. CONCLUSION: Facial nerve schwannoma is a rare tumor. Through improved surgical and reconstruction techniques, postoperative morbidity is at acceptable levels. The rate of recurrence is low. It should be kept in mind for differential diagnosis of facial nerve paralysis.

Adult↗

PubMedDate not supplied

Mucosa-associated lymphoid tissue lymphoma presented as diffuse swelling of the parotid gland.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct subtype of lymphoma. Parotid MALT lymphoma is a rare tumor that is hard to diagnose by fine-needle aspiration cytology. Therefore, partial parotidectomy is often required for a pathological diagnosis. We report a case of MALT lymphoma presented as unilateral diffuse swelling of the parotid gland, who was diagnosed by partial parotidectomy and underwent radiotherapy.

Biopsy, Fine-Needle↗

PubMedDate not supplied

The role of botulinum toxin in postparotidectomy fistula treatment. A technical note.

PURPOSE: Parotid fistula is a well-known complication of parotidectomy or penetrating injury of the parotid gland. The management of parotid fistula has been controversial, and numerous conservative and surgical treatment methods have been described. METHODS: We report 3 cases of parotid fistula after partial parotidectomy, which were treated by botulinum toxin injection under electromyographic control into the residual substance of parotid gland. RESULTS: Complete healing of the fistula was achieved with a single botulinum toxin treatment in all patients. No side effects were observed after the treatment. The patients are disease-free after 21, 18, and 14 months, respectively. CONCLUSIONS: In the considered cases, the localized injection of botulinum toxin into the parotid gland resulted to an effective and long-lasting treatment of postparotidectomy fistula.

Botulinum Toxins, Type A↗

PubMed2005

Multiple synchronous and metachronous neoplasms of the parotid gland: the Chichester experience.

Parotid neoplasms are usually solitary and multiple tumours occurring in an individual are uncommon. The incidence and implications of multiple synchronous and metachronous tumours remains relatively unknown. We reviewed the case notes of 606 patients who had parotidectomies for neoplastic lesions over a 30 year period and identified 30 patients (5%) with multiple primary tumours. There were 24 patients with synchronous tumours and 6 with metachronous tumours. Sixteen of the synchronous tumours (67%) were ipsilateral, whereas all six metachronous tumours were contralateral. Preoperative examination was effective at detecting bilateral tumours but poor at detecting multiple ipsilateral tumours. Multiple tumours were likely to be of the same histology (n=24, 80%) and Warthin's was by far the most common multiple tumour. Ipsilateral tumours of differing histological types and identical tumours other than Wartin's were uncommon. All but one patient had superficial parotidectomies and there were no recurrences.

Adenocarcinoma↗