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PubMed1998

Chronic non-specific parotid sialadenitis.

Chronic non-specific sialadenitis of the parotid gland is an insidious inflammatory disorder which is characterised by intermittent, often painful, swelling of the gland. The disease tends to progress and may lead to the formation of a fibrous mass. The purpose of this paper is to review our experience in the surgical management of patients with chronic non-specific parotid sialadenitis. In a consecutive series of 100 patients treated for benign parotid disease, 19 were found to have chronic non-specific sialadenitis; 10 were male and 9 female. Mean age was 46 years and the mean duration of symptoms was 4.6 years. Sialography was performed in two-thirds of the patients and 17 patients were treated by superficial parotidectomy. Thirteen patients developed temporary facial nerve weakness and three Frey's syndrome. Three patients complained of temporary paraesthesia of the cheek, and two developed painful neuroma of the greater auricular nerve. Although there were two cases of infection of the parotid duct remnant, no recurrence of deep lobe sialadenitis or fistula formation was noted. Histologically, 3 lesions showed mild chronic sialadenitis, the rest had widespread involvement of the gland, and prolonged duration of symptoms was associated with extensive and severe involvement of the gland. Superficial parotidectomy has a very high success rate, with minimal long-term complications, and should be offered early in established cases, to reduce unnecessary morbidity.

Adult↗

PubMed2002

Pleomorphic adenoma of the parotid in childhood.

INTRODUCTION: Pleomorphic adenoma is a benign growth that most often appears in the parotid gland where it is the most frequent type of tumour. Its appearance in childhood is rare and there are no large series available in this age group for comparison with its presentation in adults. Surgical treatment is similar in children and in adults; whilst the prognosis is good, they may become malignant and metastasize. MATERIAL AND METHOD: In this study, we present seven parotid pleomorphic adenomas in childhood treated in our Department and a review of the literature. The following data were evaluated: sex, age, affected side, clinical symptoms and period of evolution of the symptoms, surgical technique applied and complications observed. RESULTS: The mean age at presentation was 12.4 years. All patients were males with the right side affected in five patients. The treatment was conservative superficial parotidectomy in five patients, conservative total parotidectomy in one, and an enucleation including a wide safety margin in the last case. None of the patients exhibited any permanent postoperative complication. The mean follow-up was 41.3 months (26-58 months).

Adenoma, Pleomorphic↗

PubMed2000

[Water-jet dissection in parotid surgery--initial clinical results].

INTRODUCTION: The most frequent complication following parotidectomies is postoperative facial nerve dysfunction. In animal experiment we successfully studied the technique of water-jet-dissection for safe and functional preservation in facial nerve dissection in parotid gland surgery. The aim of the present study was to evaluate our animal experiments clinically. METHODS: Until November '99 ten patients with benign parotid gland tumors (4 female, 6 male, age 32-77 years) underwent lateral or latero-segmental parotidectomies using water-jet-dissection ("Hydro-Jet", Andreas Pein Medizintechnik GmbH, Schwerin, Germany). All operations were performed under permanent intraoperative facial nerve monitoring ("Neurosign 100", Fa. Inomed, Tenningen, Germany). The postoperative facial nerve function was measured daily by the House-Brackmann and Stennert-Paresis-Index for at least one week. RESULTS: A quick parotid gland and safe facial nerve dissection could be performed in all operations using the 120 microns-nozzle with effective working pressures from 30-50 bar. In addition strong connective tissue fibers were transected with scissors. Intraoperative facial nerve lesions did not occur and cardiopulmonary complications due to eventual cutting-fluid-resorption were not seen. After surgery all patients had a normal facial nerve function. DISCUSSION: The results of our studies showed that the technique of water-jet-dissection provides safe facial nerve dissection and preservation during parotid gland surgery. CONCLUSIONS: The tissue selective cutting qualities of the new surgical method are an excellent alternative compared to standard dissection methods in parotid surgery.

Adult↗

PubMedDate not supplied

[Clinical, histopathologic and immunohistochemical studies of chronic sialectatic parotitis in childhood and adolescence].

UNLABELLED: Chronic sialectatic parotitis (CSP) causes problems in differential diagnosis and therapy. CSP shows the typical clinical features of chronic recurrent parotitis and will be investigated histopathologically only after ultimative parotidectomy. The etiology and pathogenesis of these unspecific inflammations is still unknown. Therefore no causal therapy is available and a lot of different trials (sialogoga, gland massage, infrared light, antibiotics, antiphlogistics, Trasylol, duct occlusion, duct ligation, gland denervation, radiotherapy) are not successful in the long run. MATERIAL AND METHOD: The salivary gland registry of the University of Hamburg (1965-1996) contains 22 infants and juvenile patients showing very severe courses of CSP. These cases have been investigated clinical (ultrasound, sialography), histopathological (paraffin embedded sections, histomorphometry of the ectatic duct lumina) and immunohistochemical (CK-MNF, AKTIN, KiM4) in a retrospective study to research the pathogenesis of CSP. RESULTS: Recurrent and always very dolent parotid swelling occurs between the age of 3 and 14 years for the first time. The courses vary from 3 months until 25 years. Local findings as well as ultrasound and sialographic features allow no certain differentiation of chronic recurrent parotitis. Conservative therapy fails in each case and leads to the necessity of surgical treatment. Histopathological three different stages of development can be observed: Initial stages show regular lobular architectonic structure of the parotid gland parenchyme with duct ectasies surrounded by slight inflammation of lymphocytes and plasmacells. Advanced stages are characterized by an increase of periductal inflammation and the appearance of lymphfollicels. Nearly complete lymphatic transformation of the parenchyme with destruction of the lobular formation dominates the terminal "immunologic" stage. Some cases show multiple myoepithelial islands within this lymphatic stroma typically observed in benign lymphoepithelial lesions. Whether bacteria nor primary obstructive changes can be observed. The histomorphometric analyses of the average and maximal luminal duct diameters show marked increase of 39% respectively 46% from and- vanced to terminal stages of CSP. Therefore the pathognomonic duct ectasies seem to depend on the progredient inflammation and are not due to a hereditary malformation of the duct system. Immunohistochemical terminal stages show follicular lymphatic hyperplasia (KiM4) expressing overshooting humoral immune reaction of MALT. CONCLUSION: Concerning the pathogenesis CSP corresponds to a immunopathological disorder of MALT and seems to be a prestage of benign lymphoepithelial lesion. Consequently important changes in the diagnosis and therapy of CSP lead to early histopathological investigation to differentiate the stage of inflammation. In stage III conservative parotidectomy should be carried out because spontaneous healing can not be expected. In contrast initial cases should be treated at first by glucocorticoids and immunosuppressives.

Adolescent↗

PubMed2001

Salivary flow dynamics after parotid surgery: a preliminary report.

BACKGROUND: Tumors in the parotid gland may affect salivary flow. The effects of tumor on glandular function and postoperative changes in both resected gland and contralateral gland were not formerly reported. We prospectively evaluated salivary flow rates and composition in patients undergoing parotidectomy preoperatively and postoperatively. METHOD: Stimulated parotid saliva from 17 patients undergoing parotidectomy was collected bilaterally preoperatively and postoperatively by using a parotid cup. Subjective complaints were recorded. Salivary flow rates, sodium, potassium, and amylase levels were evaluated. RESULTS: None of the patients complained of "dry mouth" before or after surgery. Analysis of the individual results revealed 3 patterns of preoperative and postoperative response, compatible with either a preoperative or postoperative compensatory mechanism in the contralateral gland. The postoperative decrease in flow rate corresponds with the amount of gland removed. Salivary electrolyte composition was unchanged. CONCLUSION: This study is the first to demonstrate the effects of parotid tumors and their surgery on salivary flow and a compensatory response and its different patterns in human parotid glands after their excision.

Adolescent↗

PubMed2004

Role of open incisional biopsy in parotid tumors.

OBJECTIVE: Parotid gland enlargement due to diffuse pathologic processes represents a diagnostic challenge for the surgeon. In such cases, fine-needle aspiration is inconclusive and superficial parotidectomy is usually performed. MATERIAL AND METHODS: The authors treated eight patients who underwent open incisional biopsy of the parotid gland with continuous monitoring of the facial nerve. RESULTS: In all cases, fine-needle aspiration cytology did not provide a definitive diagnosis while open incisional biopsy provided an accurate diagnosis of a lymphoproliferative disorder, with no operative complications. CONCLUSION: In certain infiltrative parotid diseases such as lymphoepithelial or lymphoproliferative diseases, when fine-needle aspiration biopsy is insufficient as tissue architecture is an important component of the pathological diagnosis, an open incisional biopsy can be considered. This procedure can provide an accurate histological diagnosis while avoiding superficial parotidectomy.

Adult↗

PubMed1998

Membranous basal cell adenoma of the salivary gland: a clinicopathologic study of 12 cases.

Twelve cases with membranous basal cell adenoma of the salivary gland were analysed clinicopathologically. Its histology was characterized by palisading of peripheral cells and an excessive hyaline basal membrane. The differential diagnosis involved the solid variant of basal cell adenoma, basal cell adenocarcinoma, solid subtype of adenoid cystic carcinoma and basaloid squamous cell carcinoma. Four cases had coexisting dermal cylindromas of the scalp. Screening for skin lesions of the scalp or other locations is suggested. In 8 cases, the tumors demonstrated multifocal origin. Total parotidectomy rather than superficial parotidectomy is suggested to avoid the recurrence of the tumor. One case showed malignant transformation and cervical lymph node metastases. A close follow-up after treatment is necessary.

Adenoma↗

PubMed1998

Surgical techniques for benign parotid tumors: segmental resection vs extracapsular lumpectomy.

In 80 patients surgical techniques for benign parotid gland tumor have been reviewed and evaluated. Segmental resection was introduced during partial superficial parotidectomy. The superficial lobe of the parotid gland was divided into four sections according to the distribution of the tumors. Total parotidectomy was applied to remove deep lobe and recurrent tumors, together with the superficial lobe, followed by retrograde dissection of the facial nerve. This technique was termed the hamburger technique. Furthermore, with a margin of normal tissue, extracapsular lumpectomy was used. Segmental resection is at method of extirpation by dissecting the facial nerve, whereas extracapsular lumpectomy is a method of extirpation by dissecting the tumor itself with a safety margin.

Adenolymphoma↗

PubMed1986

Hemangioma of the masseter muscle: a case report and review of the literature.

The case of a patient with a hemangioma of the masseter muscle is presented. The treatment in this case was superficial parotidectomy and resection of the hemangioma. A review of the literature reveals that the masseter muscle is a fairly uncommon location for hemangiomas. Among the cases reported the diagnosis was rarely made preoperatively. Most authors recommended that superficial parotidectomy be done as part of the surgical excision.

Adult↗

PubMed2000

Prudent management of the mid-cheek mass: revisiting the accessory parotid gland tumor.

OBJECTIVES/HYPOTHESIS: The head and neck surgeon's fascination with parotid surgery arises from the gland's spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid-cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided. STUDY DESIGN: This is a retrospective review of our experience with four accessory parotid gland neoplasms and five other masses mimicking this lesion. METHODS: A literature review and retrospective chart review. RESULTS: Over a 6-year period, we have encountered four true accessory lobe tumors, all pleomorphic adenomas. These presented very similarly to four other more commonly encountered masses not of salivary origin and one normal but hyperplastic accessory parotid gland. All were removed through a wide parotidectomy-style approach modified by extending incisions anterosuperiorly and inferoanteriorly. The only complication was a minor salivary fistula in one patient. There were no permanent facial paralyses. CONCLUSIONS: Accessory parotid gland neoplasms are rare and may present as innocuous extraparotid mid-cheek masses. A high index of suspicion, prudent diagnostic skills (including fine-needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and meticulous surgical approach (extended parotidectomy-style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions.

Adult↗

PubMed2002

Parotid gland metastasis from renal cell carcinoma.

OBJECTIVE: To discuss the diagnosis and management of metastatic renal cell carcinoma presenting as a parotid mass by studying such cases. STUDY DESIGN: Retrospective review. METHODS: Identification of 24 previously reported cases of renal cell carcinoma metastatic to the parotid gland in the English language literature and an analysis of a total of 25 patients including our case. RESULTS: Parotid metastasis was the initial presenting sign of the malignancy in the kidney in 14 of 25 (56%) cases; 11 of 25 (44%) cases presented with metachronous metastasis to the parotid. The most common presenting complaint was parotid mass. No case presented with facial paralysis. In three of six (50%) patients, fine-needle aspiration biopsy was diagnostic. CONCLUSIONS: In the majority of cases, parotid metastases are the first clinical sign of the renal cell carcinoma. Fine-needle aspiration biopsy can provide crucial information without parotidectomy as in our case. Parotidectomy with facial nerve preservation should be considered as a therapeutic option for solitary parotid metastasis.

Aged↗

PubMed2004

Recurrent pleomorphic adenoma of the parotid gland: a prospective histopathological and immunohistochemical study.

OBJECTIVES/HYPOTHESIS: Histopathological characteristics and proliferation indices of recurrent pleomorphic adenoma were described in a series of 31 patients who were referred to the authors' clinic for revision surgery. STUDY DESIGN: Prospective series of 31 patients. METHODS: Serial sections of surgical specimen using the whole-organ sectioning technique were carried out for light microscopic examination after total parotidectomy and periparotid fat resection. The nodules were examined with special reference to localization, amount, size, histological subtypes, capsular alterations, and the amount of nodule spilling. Expression of proliferation markers (Ki67/MIB-1) according to the size and histological subtypes of the nodules was also investigated. RESULTS: Most recurrences were multinodular, and the number of nodules was much higher than expected, ranging from 1 to 157. The myxoid subtype was predominant. Eighty percent of the patients exhibited widely distributed nodules also lying outside the scar. These nodules contained only a thin pseudocapsule and often lacked complete encapsulation. The majority of multinodular recurrences of parotid pleomorphic adenoma consisted of small nodules (less than 1 mm in diameter). Smaller nodules showed similar or higher levels of proliferative activity than larger nodules. CONCLUSION: The extended multifocal distribution of tumor recurrences after insufficient resection of pleomorphic adenoma (most often after enucleation) can explain a high incidence of further recurrences. Therefore, a total parotidectomy including removal of surrounding fat tissue seems to be appropriate for the initial treatment of recurrent pleomorphic adenoma.

Adenoma, Pleomorphic↗

PubMed1984

The anatomy of the lymph nodes of the parotid gland.

A series of 17 parotid glands were obtained by radical parotidectomy. Between 1 and 11 lymph nodes were found in them. Superficial parotidectomy only leaves an average of 1 node in the deep parotid. There is a 1 in 4 chance of there being no nodes left. There were no nodes easily accessible immediately under the deep part of the parotid gland. There seems to be a discrepancy between the number of nodes found in a radical surgical specimen and serial sections of the area. This suggests a significant number may be left in the skin flap. The place of excision of this skin is discussed.

Humans↗

PubMed1987

Mucoepidermoid tumour of the parotid gland: a very difficult prognostic evaluation.

The correct management of mucoepidermoid tumours is still debatable because of their unpredictable biological course. The issue discussed is that of identifying biological characteristics of these tumours which may have predictive value. Sixteen patients with a mucoepidermoid tumour of the parotid gland, treated at the ENT Clinic of Bologna University over a 15-year period, were reviewed. The follow-up of each patient has been related to the surgical management, in order to evaluate whether superficial parotidectomy provides adequate treatment. No prognostic differences were noted between total and superficial parotidectomy when the latter was clinically appropriate. The histopathological specimens from these patients were reviewed in an attempt to correlate the histological grade of tumour with the course of the disease. Our data suggest that histological evaluation of malignancy alone is insufficient for accurate prognosis. We think that the clinical presentation (facial nerve palsy, pain, etc.) predicts the prognosis with greater accuracy.

Adolescent↗

PubMed1987

Physiological factors affecting secretion of parotid hormone.

A parotid hormone (PH) that stimulates a dentinal fluid transport (DFT) mechanism in rat teeth is part of the hypothalamic parotid gland endocrine axis (HPEA). Infusion of a porcine hypothalamus-thalamic tissue extract (PHTE) into anesthetized rats stimulates the DFT mechanism in intact animals but is ineffective in parotidectomized rats. Infusion of PHTE into intact conscious pigs raises the plasma titer of immunoreactive PH (iPH) five- to eightfold. Parotidectomy prevents the response. The feeding of pig chow is a potent stimulus for iPH secretion: an 11-fold increase is reached within 10-20 min, and the response is directly related to the length of the feeding stimulus. No response is obtained after parotidectomy. The secretion of saliva and iPH from the parotids occurs independently of each other, suggesting different control mechanisms for each function. The immediate secretion of iPH in response to feeding and its relationship to DFT stimulation may represent a systemic physiological process by which resistance of teeth to decay is enhanced at a time when the acidogenic potential of the oral microbes is maximum.

Animals↗

PubMedDate not supplied

Merkel cell carcinoma: report of seven cases.

Merkel cell carcinoma (MCC) is an infrequent, highly malignant, primary skin tumor derived from neuroendocrine cells. Most MCCs occur in elderly individuals, on sun-exposed areas of the body, with the head and neck being the most common sites. We present 7 patients (2 male and 5 female, age 45-80 years) suffering from MCC and treated between 1993 and 2000. All tumors were located on the head and neck and varied from 0.9 to 2.3 cm in size. Five of the patients had stage II disease, 1 patient had stage Ia disease and 1 patient had stage III disease. Six of the patients had positive regional lymph nodes. All patients had local excision of the tumor. Six of them also had lymph node dissection and in 5 of them a superficial parotidectomy was performed. Five patients received adjuvant radiotherapy and 3 of them also received chemotherapy. Local and cervical lymph node recurrence was observed in only 1 patient. Metastases occurred in 5 patients. One patient died within 10 days for other reasons. The patient with the stage III tumor had a survival of 7 months. The other 5 patients had survivals varying from 15 to 54 months. MCC is a skin tumor with very poor prognosis and high recurrence and metastatic rates. Its treatment is still under discussion. Radical excision of the tumor is the main method of treatment. Selective lymph node dissection is suggested. Superficial parotidectomy seems necessary, especially if the tumor is on the auricle. Adjuvant radio- and chemotherapy may extend survival in case of small-size tumors.

Aged↗

PubMed1998

Botulinum toxin type A for Frey's syndrome: a preliminary prospective study.

Fourteen patients with severe Frey's syndrome (occurring after conservative parotidectomy) managed with intracutaneous injection of botulinum toxin type A were prospectively evaluated. Results were analyzed for effectiveness, complications, and adverse effects. Complications were not encountered. The only adverse effect noted was a temporary and slight partial paresis of the upper lip of 3 months' duration in 2 patients. Permanent paresis was not encountered. Frey's syndrome was always controlled within 2 days following the intracutaneous injection of botulinum toxin A. Frey's syndrome recurrence was not encountered with a follow-up duration that varied from 3 to 9 months (mean follow-up 7 months). This preliminary report confirmed that in patients who have Frey's syndrome after conservative parotidectomy, the intracutaneous injection of botulinum toxin is a valuable treatment option that should be further investigated.

Adolescent↗

PubMed1998

Extracorporeal shock wave lithotripsy of parotid stones. Results of a prospective clinical trial.

The extracorporeal shock wave treatment of parotid stones is a rather new therapy. Its usefulness was determined in a prospective study. Seventy-six patients (36 female, 40 male, 2 to 80 years of age) with symptomatic, sonographically detectable solitary sialoliths of the parotid gland were treated with an extracorporeal piezoelectric shock wave therapy after unsuccessful conservative therapy (sialagogues, gland massage, bougienage of the secretory duct). At most, 3 treatments per patient were performed. Altogether, 38 of the 76 patients (50%) were free of stones and no longer suffered from complaints after completion of shock wave treatment and a mean follow-up period of 48 months (range 6 to 71 months). During the follow-up period, in no case could renewed stone formation be observed. Residual stone fragments were detectable in 20 patients (26%), but did not cause further symptoms. Thirteen patients (17%) with residual stone fragments stated a significant improvement of their complaints after therapy. Five patients (7%) did not observe any changes of their pretherapeutic complaints and underwent parotidectomy. The therapeutic success was not influenced by stone size or by stone localization within the gland. During the follow-up period, no side effects of the therapy were identified. With stones of the parotid gland, extracorporeal shock wave lithotripsy is -- after one has used conservative therapies (sialagogues, gland massage) -- the treatment of choice, avoiding in the majority of cases a parotidectomy with its operative risks (paresis of the facial nerve, Frey's syndrome).

Adolescent↗