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PubMed2003

Management of chronic parotitis: a review.

Chronic parotitis is an insidious inflammatory disorder, which is characterized by a recurrent, often painful, swelling of the gland or glands. Sialography remains the investigation of choice. Diagnostic siladenoscopy may complement or supersede sialography as the diagnostic procedure of choice, as more experience is gained in this technique and its use becomes more widespread. The management options are conservative or surgical, but controversy exists regarding the timing and method of surgical intervention. The surgical methods that have been described include injection of methyl violet - a sclerosing agent, ductal ligation, ductoplasty, tympanic neurectomy, and parotidectomy. Parotidectomy is considered the ultimate surgical option but because of its significant morbidity the exact technique and procedure that should be used remains contentious.

Anti-Inflammatory Agents↗

PubMed1978

The Frey syndrome: a review and double blind evaluation of the topical use of a new anticholinergic agent.

The symptom complex of localized facial gustatory sweating and flushing during mastication (The Frey syndrome) is a common sequela of parotidectomy with facial nerve dissection. A thorough review of the literature concerning the Frey syndrome is reported. The procedure of tympanic neurectomy has received special emphasis with a review of 73 cases of tympanic neurectomy. The treatment modalities available, if tympanic neurectomy fails, are discussed. Important guidelines for the safe use of topical therapy to control gustatory sweating are presented as an alternative to surgical therapy. The author studied 129 post parotidectomy patients in whom 60% noted symptomatic gustatory sweating, and approximately one-fourth fo these symptomatic patients requested topical anticholinergic therapy, with one patient electing tympanic neurectomy. The only form of medical treatment presently available utilizes the topical application of scopolamine, a drug having potentially significant central nervous system side effects if systemically absorbed. In an effort to find an effective drug for topical application with a more favorable therapeutic index than scopolamine, glycopyrrolate was investigated. Glycopyrrolate was compared in varying concentrations to topical scopolamine in a personally conducted double blind clinical trial involving 16 patients. Initial results of this investigation suggest that topical glycopyrrolate in concentrations 0f 0.5% and 1.0% provide complete effective control of gustatory sweating for at least several days duration after a single application. There have been no significant side effects with the use of topical glycopyrrolate to date. Commercial topical antiperspirants were also investigated and found to be of limited benefit.

Administration, Topical↗

PubMed1981

The incidence of neoplastic versus inflammatory disease in major salivary gland masses diagnosed by surgery.

What is the incidence of non-neoplastic diseases when dealing with masses of the major salivary glands? A knowledge of this information would aid the physician in making decisions relative to the management of the masses. Furthermore, the expected malignancy rate may need to be adjusted according to the findings of this study. Many reported series of salivary gland neoplasms show the relative incidence of benign vs. malignant neoplasms; however, not every patient with a mass of the salivary gland who comes to surgery is finally diagnosed as having had a neoplasm. Knowing the relative incidence of neoplastic vs. non-neoplastic salivary gland diseases has important diagnostic, therapeutic, and prognostic implications. Records of all patients who underwent either a parotidectomy or submandibular gland excision from 1975 to the present at the Eye and Ear Hospital of Pittsburgh were reviewed; 73% of the parotidectomies performed were done for neoplastic disease. A patient with a parotid mass has a likelihood of 1:10 of having a malignancy. Similarly, on a population basis, 1 submandibular mass in 12 will be malignant.

Diagnosis, Differential↗

PubMed1991

Sternocleidomastoid muscle transfer and superficial musculoaponeurotic system plication in the prevention of Frey's syndrome.

Parotidectomy may be associated with a significant depression in the retromandibular region and a significant incidence of gustatory sweating (Frey's syndrome). Superiorly and inferiorly based sternocleidomastoid flaps and posterior plication of the superficial musculoaponeurotic system were evaluated for their ability to ameliorate both consequences. Sixteen patients with sternocleidomastoid flaps and 16 patients with superficial musculoaponeurotic system plication were compared to a control group of 104 patients. The incidence of Frey's syndrome was 47.1% in the control group, 12.5% (P = 0.025) in the sternocleidomastoid flap group, and 0% (P = 0.005) in the superficial musculoaponeurotic system plication group. The surgical techniques are described. The prevalence of Frey's syndrome is discussed with respect to age, sex, radiation therapy, and the type of parotidectomy performed. The indications and contraindications of the three surgical techniques are described.

Fasciotomy↗

PubMed2003

Recurrent pleomorphic adenoma of the parotid gland in pediatric and adult patients: value of multiple lesions as a diagnostic indicator.

OBJECTIVE: Recurrent pleomorphic adenoma of the parotid gland is a significant problem. Rates have been as high as 40% in some series of patients who have undergone surgery for the primary lesion. In the imaging literature, anecdotal case reports show multiple lesions in recurrent pleomorphic adenoma. Our aim was to analyze the imaging of a series of patients to determine the reliability of multiple lesions as a tool in diagnosing recurrent disease. MATERIALS AND METHODS: Medical records of the patients with recurrent pleomorphic adenoma of the parotid gland referred to our institution were retrospectively reviewed. Before the second surgery, MR imaging had been performed in 15 patients. We retrospectively reevaluated and scored the MR imaging studies with particular attention paid to the location and number of the lesions and the remaining parotid gland tissue. RESULTS: On the basis of imaging findings, eight patients underwent enucleation, superficial parotidectomy had been performed in four patients, and three patients underwent total parotidectomy. For our group, the lesions were multiple in 73.3% of patients. CONCLUSION: To our knowledge, we present the first large series of imaging studies in recurrent pleomorphic adenoma of the parotid gland. Our findings show that recurrent pleomorphic adenomas are most likely to be multiple. Such multiplicity of lesions is a reliable diagnostic indicator of recurrent disease.

Adenoma, Pleomorphic↗

PubMed2001

Outcome of curative management of malignant tumours of the parotid gland.

PURPOSE: The optimal management of malignant parotid gland tumours remains to be defined precisely. Specifically, a further understanding of the tumour features that influence treatment outcome is needed. MATERIALS AND METHODS: A retrospective review was conducted on 184 patients who were registered at the Princess Margaret Hospital with a diagnosis of a primary malignant parotid gland tumour. RESULTS: All patients were initially managed with a parotidectomy, and postoperative x-ray radiation therapy (XRT) was administered to 159 patients. The actuarial 5-year cause-specific survival and locoregional control rates were 76% and 81%, respectively. The survival and locoregional control rates for patients treated with surgery alone versus surgery plus postoperative XRT were not statistically different. A multiple regression analysis identified only age and tumour category to be independently significant prognostic factors for both survival and locoregional control. CONCLUSION: We would recommend that patients with malignant parotid gland tumours be managed with parotidectomy, followed by postoperative XRT for tumours with residual disease, aggressive histology, and/or positive lymph nodes.

Adolescent↗

PubMed2002

Parotid gland tumours in 255 consecutive patients: Mount Sinai Hospital's quality assurance review.

Parotid neoplasms represent a diverse group of tumours found in the head and neck. Complications following parotidectomy, including Frey's syndrome, facial nerve paralysis, sialoceles, and parotid fistulae, have been well documented. A retrospective review of 255 patients treated surgically for parotid masses over an 8-year period at Mount Sinai Hospital in Toronto was reviewed as part of a quality assurance program. The sensitivity, specificity, and predictive values for fine-needle aspiration cytology were analyzed. The incidence of benign and malignant lesions is presented. The complications following parotidectomy are reviewed and in our series are consistent with the figures published in the literature.

Adolescent↗

PubMed1988

Surgical techniques of the parotid tumor.

101 cases with parotid tumors, including fourteen recurrent ones, were operated from 1976 to 1986. Surgical techniques of the recurrent cases were more complicated and difficult and often required plastic and reconstructive procedures for the skin, tissue and nerve defects. From the experiences mainly of the recurrent tumors, it was concluded that uniformly applied superficial or total parotidectomy was not always necessary but modified parotidectomy resecting sufficient and adequate tissues around the tumor should be planned individually from the prudent preoperative examinations.

Adenoma, Pleomorphic↗

PubMed1999

A complication of intraoperative facial nerve monitoring: facial skin burns.

OBJECTIVE: To report on three cases of severe facial skin burns resulting from intraoperative facial nerve monitoring in patients undergoing parotidectomies. STUDY DESIGN: This study is a retrospective case review. SETTING: A tertiary referral center. PATIENTS: This study includes three patients who underwent parotidectomies with concurrent facial nerve monitoring. RESULTS: Facial skin burns were proven to result from a technical defect of the intraoperative facial nerve monitoring device. Burns were sustained at electrode insertion sites and their extent was related to the duration of monitoring. The most probable explanation of these burns is electrolysis. CONCLUSIONS: Successful retracing of technical defaults with biomedical engineers at the device manufacturer have led to the upgrade of the facial nerve monitor apparatus. The benefits of facial nerve monitoring largely outweigh the fortuitous occurrence of skin burns reported in this study. Therefore, this complication should not represent a drawback to the use of facial nerve monitoring.

Adult↗

PubMedDate not supplied

Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings.

BACKGROUND AND PURPOSE: Infections caused by nontuberculous mycobacteria (NTM) commonly manifest as cervicofacial adenitis in otherwise healthy children. The aim of this study was to characterize the imaging findings of NTM infection of the head and neck in immunocompetent children. METHODS: The medical records and imaging examinations (CT in 10, MR in two) were reviewed in 12 immunocompetent children with NTM infection of the head and neck. RESULTS: The usual presentation (n = 9) was of an enlarging, non-tender mass with violaceous skin discoloration, unresponsive to conventional antibiotics. The duration of symptoms was 6 days to 5 months. Imaging revealed asymmetric adenopathy with contiguous low-density ring-enhancing masses in all patients. There was cutaneous extension in 10 patients. Inflammatory stranding of the subcutaneous fat was minimal (n = 9) or absent (n = 2) in 11 patients. The masses involved the submandibular space (n = 3), the parotid space (n = 2), the cheek (n = 1), the anterior triangle of the neck (n = 2), the submandibular and parotid spaces (n = 2), the parotid space and neck (n = 1), and the neck and retropharyngeal space (n = 1). Surgical management included incision and drainage only (n = 2), incision and drainage with curettage (n = 2), excisional biopsy after incision and drainage (n = 1), excisional biopsy only (n = 5), superficial parotidectomy only (n = 1), and superficial parotidectomy with contralateral excisional biopsy (n = 1). All patients improved in response to surgery and long-term antimycobacterial antibiotics. CONCLUSION: NTM infection of the head and neck has a characteristic clinical presentation and imaging appearance. Recognition of this disease is important; appropriate treatment is excision and, in selected cases, antimycobacterial therapy.

Child↗

PubMed1998

Parotid swellings: report of 110 consecutive cases.

Parotid swellings are uncommon. Over a twelve-year period, 110 cases of parotid swellings were treated at the Department of Plastic Surgery, Hospital Kuala Lumpur, of which 97 cases were histologically proven to be parotid tumours. 75% of these tumours were benign tumours, and 80% of the benign tumours were pleomorphic adenomas. Among the malignant tumours, 6 cases were adenoid cystic carcinoma and 5 were carcinoma ex-pleomorphic adenoma. There were equal number of male to female patients, with an age range of 14 to 83 years. There is a positive correlation between the final histological diagnosis and FNAC results in 74% of cases. Surgical treatment of choice for benign parotid tumours was near-total parotidectomy whilst for malignant tumours was total radical parotidectomy with sural nerve graft.

Adolescent↗

PubMed2000

[Warthin tumor. Report of eight cases and review of the literature].

We have studied 8 patients with Warthin's tumor of the parotid gland (WT). Seven of them were men and smoked more than a packet daily. Seven were operated with conservative superficial parotidectomy and the other one with total parotidectomy with facial preservation. Two had postoperative peripheral facial paresia which disappeared with medical treatment in few days. One of the operated suffered from postoperative Frey's syndrome.

Adenolymphoma↗

PubMed2000

[Treatment of salivary gland tumors in the past and at the present time at the 1st and 2nd Stomatology Clinics of the Charles University Medical School in Bratislava].

The retrospective study analyzes a group of 1021 patients (484 men and 537 women) with salivary gland tumours treated at the 1st and 2nd Departments of Stomatology in Bratislava within the years 1951-1996. This time period is divided into the past (1951-1980) and recent (1981-1996) periods. The trends in the diagnosis and treatment with the main emphasis on surgical procedures are mentioned. The most common operation were lateral parotidectomy (409 cases = 40.1%) and conservative parotidectomy (105 cases = 10.2%), enucleations were indicated rarely. Authors stress the necessity of team approach and cooperation of maxillofacial surgeons, radiologists, histopathologists, otorhinolaryngologists and oncologists. (Tab. 1, Fig. 2, Ref. 6.)

Humans↗

PubMedDate not supplied

[Monomorphic adenomas of the parotid gland: description of 3 clinical cases].

Three cases of monomorphic adenomas (two oncocytic adenomas and one basal cell adenoma) of the parotid gland are reported. The diagnosis is based on echography with fine needle biopsy and cervical computerized tomography. Because of the high percentages of multicentricity, the therapy of choice is superficial parotidectomy when the lesion is in the pre-neural lobe of the gland, or total parotidectomy in case of a deep mass.

Adenoma↗

PubMed2001

[Lymphatic metastases in the parotid region from malignant skin neoplasm of the head: considerations for surgical treatment based on personal clinical experience].

The present paper considers some of the problems linked to the surgical treatment of parotid metastases. The authors base these considerations on their limited personal cases and on the most accredited literature. In the presence of cutaneous malignancies of the upper portion of the face, accurate clinical-radiological evaluation must be made of the parotid and neck region. Elective parotidectomy is performed when the cutaneous carcinoma is quite extensive or located in proximity of the gland or when the case involves a melanoma. Depending on the oncological margins, a sub-total parotidectomy may be enough; however, the facial nerve must be sacrificed if there is a clinical deficit or if it is directly affected by the tumor. As the dimensions of the neoplasm increase, the feasibility of saving the nerve decreases. Prophylactic treatment of the neck is advisable in parotid metastases from cutaneous malignancies, particularly melanoma. Nevertheless, it is possible to perform a selective dissection, avoiding the V level of the neck as the incidence of its involvement is quite low. Prognosis for these tumors is extremely poor. Of the eleven patients surgically treated, only 4 (36%) survived: 2 passed away from other causes not involved in the base pathology; 2 for distant metastases but with no signs of local recurrence and 1 other for recurrence of the primary pathology in the maxillary sinus mucosa. There is no difference in the survival of the two main histological groups: 2 out of 3 of the patients with melanoma (67%) died as did 3 out of 5 (60%) of those with epidermal carcinoma. This does not, obviously, include the two patients who died from other causes.

Aged↗

PubMed2001

[Pleomorphic adenoma of the parotid gland in childhood].

BACKGROUND: The authors report the results of ten years' activity at the Pedodontic Surgery Unit in the Institute of Maxillofacial Surgery at the Second University of Naples and analyse the possibility of conservative treatment of pleomorphic adenoma in childhood. METHODS: The study includes 614 cases of salivary gland pathology. The authors illustrate the epidemiological, clinical and therapeutic characteristics of this type of lesion in childhood, emphasising that the data emerging from this study do not differ from the clinical and therapeutic management of pleomorphic adenoma in young patients reported in the literature. RESULTS: In particular, they emphasise that satisfactory therapeutic results can be achieved using conservative techniques, like conservative superficial parotidectomy. CONCLUSIONS: Conservative superficial parotidectomy has the advantage of being less radical and traumatic for a young patient, without provoking a significant increase in recidivation.

Adenoma, Pleomorphic↗

PubMed2000

[A clinicopathologic study on membranous basal cell adenoma].

OBJECTIVE: To investigate the clinicopathologic features and behaviour of membranous basal cell adenoma. METHODS: Twelve cases with membranous basal cell adenoma of salivary gland were analysed clinicopathologically. RESULTS: The tumors were composed of epithelial islands of various sizes and shapes. Its histologic finding was characterized by palisading of peripheral cells and excessive hyaline basal membrane. Four cases had co-existing dermal cylindromas of the scalp. In 8 cases, the tumors demonstrated multiple origin. One case showed malignant transformation and cervical lymph node metastasis. CONCLUSIONS: The differential diagnosis involved the solid variant of basal cell adenoma, basal cell adenocarcinoma, solid subtype of adenoid cystic carcinoma and basal squamous cell carcinoma. Total parotidectomy rather than superficial parotidectomy is suggested to avoid the recurrence of the tumor. A close follow up after treatment is necessary.

Adenoma↗

PubMedDate not supplied

[Metastasis of cutaneous squamous cell carcinoma of the face into the parotid area]].

Presence of planocellular skin carcinoma always implies the possibility of disease spreading into regional lymph nodes. The average occurrence of metastasis of this face carcinoma is about 5% (from 0.5% to 19.5%). This paper presents seven patients with lymphogenic metastasis of planocellular carcinoma of face skin into parotid region. All patients were treated surgically, and in three patients with extracapsular spreading of metastasis radiation therapy was applied. The choice of the extent of surgery was made on the basis of clinical status. In three patients with small solitary metastases superficial parotidectomy was performed as the only treatment method, and during the three-year follow up the disease did not recur. in other four patients radical procedure with total parotidectomy and elective neck dissection was done due to greater number and size of parotid gland lymph nodes. During the second year of treatment of these patients, disease dissemination and lethal outcome were recorded. The importance of surgical treatment of the primary tumor is emphasized, as well as obligatory pathohistologic examination of the tissue (determination of the depth of invasion, edges), and frequent follow-up of patients at risk with the aim of early detection of recurrence and occult metastases.

Aged↗