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PubMed1990

[Medium-malignancy tumors of the parotid gland].

Among the 437 parotidectomies performed from 1966 to 1989, we observed 2 acinar-cell tumors and 11 mucoepidermoid carcinomas, ie. 3%. The acinar-cell tumors occurred in 2 men aged 45 and 71. A conservative complete parotidectomy was performed in both cases with a 6 and 7-year survival without local recurrence. The mucoepidermoid tumors affected 4 women and 7 men. The clinical appearance in 2 cases was highly suggestive of a malignant tumor, the picture including facial palsy, fixed gaze and adenopathy. In spite of excision completed by radiation therapy, the outcome soon was unfavorable. In the other 9 patients presenting with a limited tumor of the parotid gland, the facial nerve had to be partly sacrificed in 2 cases because no dissection was possible even under a microscope. The prognosis was generally favorable in the limited forms with 6/6 patients alive at more than 5 years and 3 patients alive at 3 years, 2 years and 1 year. Postoperative radiation therapy was not performed systematically, but only in 2/3 of cases (ill-delineated or ill-differentiated tumor).

Adolescent↗

PubMed1990

Bilateral Warthin's tumors in a Chinese--literature review and case report.

Warthin's tumor is an unusual benign salivary gland tumor. It is predominantly found in Caucasians and is rare in non-Caucasians. The chief affected area of the tumor is the parotid gland. Of all salivary gland neoplasms, Warthin's tumor is the only lesion which is truly multicentric so it may have a second primary lesion, not a recurrence. The peak incidence is in the sixth decade of life. In sexual distribution, there is a male predominance but the incidence of female is progressively increasing. According to Lemelas's study, the increase in female incidence may relate to the increasing population of cigarette smoking of women. Bilateral parotid gland involvement is uncommon. The chief treatment of the tumor is surgical excision. The surgical methods include enucleation, superficial parotidectomy, total parotidectomy. It is very important to protect the facial nerves from injury during surgery. In this paper, we report a case of bilateral metachronous Warthin's tumors with cystic degeneration of parotid glands in a Chinese. Other than literature review and case report, four different methods to protect facial nerves from injury were briefly described.

Adenolymphoma↗

PubMed1990

Malignant epithelial parotid tumours.

Formal parotidectomy was performed in 120 patients by one surgeon over 7 years. Eighteen patients were referred with malignant salivary tumours (eight recurrent). Low-grade tumours (LGT) were treated by surgery alone; untreated high-grade tumours (HGT) were treated by pre- or post-operative radiotherapy according to clinical findings. The aim of surgery was to obtain tumour clearance, to preserve the facial nerve where possible, and to perform radical neck dissection for HGT when peroperative jugulodigastric lymph node biopsy confirmed metastasis. Five patients (all HGT) with complete facial palsy due to tumour underwent radical parotidectomy; of the remainder, only one suffered further deterioration of facial nerve function after surgery. After 5 years median follow-up from presentation, four patients with HGT have died from metastases; one has developed local recurrence. No patient with LGT has died or developed local recurrence. The survival difference between patients with HGT and LGT is statistically significant (P less than 0.05). A logical management policy for malignant parotid tumours requires knowledge of tumour grade.

Adult↗

PubMed1990

Use of a hemostat/stimulator probe and dedicated nerve locator/monitor for parotid surgery.

Traditionally, parotidectomy is performed by the surgical routine of locating the main trunk of the extratemporal facial nerve followed by lateral lobectomy or total parotidectomy. The use of a dissecting/stimulating hemostat and of a continuous electromyography (EMG) locator/monitor was studied in terms of its effectiveness on the technique and outcome of parotid surgery.

Electromyography↗

PubMed1989

[Is there a role for radiotherapy in the treatment of patients with pleomorphic adenoma of the parotid gland?].

A group of 79 patients primarily operated (n = 63) or operated for local recurrence after previous surgery (n = 16) and irradiated post-operatively was studied retrospectively. Indications for radiation treatment were: enucleation and spill after pseudo-penetration of the capsule or remnants of tumour after partial or total parotidectomy respectively. During follow-up (4-16 years) only one of the patients, irradiated because of recurrence, had a second recurrence. No major complications or malignant degenerations took place. Partial or total parotidectomy with saving of the facial nerve is the treatment of choice rather than a combination of enucleation with radiotherapy. However, in case of remnants after radical surgery or re-excision for recurrent tumour postoperative irradiation appears to be indicated and effective.

Adenoma, Pleomorphic↗

PubMed1989

[Surgery for pleomorphic adenoma of the parotid gland evaluated by long term follow-up].

Fifty six cases with pleomorphic adenoma of the parotid gland were evaluated on local recurrences following surgical treatments which were performed from 1970 to 1983. The surgical treatments for the tumors were 11 extirpations and 45 parotidectomies. The recurrence in each treatment was observed in one (9%) and in none (0%), respectively. The average follow-up period is 11 years (from 5 to 19). The treatment of choice for pleomorphic adenoma is the parotidectomy, of the superficial, deep and/or posterior, lobes.

Adenoma, Pleomorphic↗

PubMed1989

[Pleomorphic adenoma of the parotid gland. Cases contribution].

Data relating to a series of 23 pleiomorphous adenomas of the parotid (19 primary forms and 4 previously operated recurrences) are reported. The ages most affected are the 4th, 5th and 6th decades with a higher incidence of females. The most commonly adopted surgery was extracapsular enucleoresection of the tumour (17 cases) followed by superficial parotidectomy (4 cases) and total parotidectomy (2 cases). No significant post-operative complications were observed. Anesthetic results were excellent. No recurrences were observed during follow-up.

Adult↗

PubMed1985

[Recurrent benign tumors of the parotid gland and their tendency for becoming malignant].

In 257 parotid adenomas lumpectomy led to tumour recurrence in 49.2%, superficial parotidectomy in 5.7% and total parotidectomy in 5.3%. 40 patients with recurrent tumours experienced eventually eight true malignant neoplasms. There were five carcinomas ex pleomorphic adenomas, one true malignant mixed tumour, and two undifferentiated carcinomas. Malignant transformation usually occurred with the 4th recurrence after 15.8 years. To prevent recurrence and secondary malignancy in parotid adenomas the lumpectomy technique should be omitted.

Adenoma↗

PubMed1988

[Cystadenolymphoma of the parotid gland. A study of 40 cases].

A statistical review of 40 cases of adenolymphoma (Whartin's tumor) of the parotid gland is presented. In 10% of the cases, other tumors are found in the same concerned gland. Therefore, the authors perform a subtotal parotidectomy rather than a simple removal of the tumor of a superficial parotidectomy. This policy reduces the risk of facial nerve injury by repeated dissection.

Adenolymphoma↗

PubMed1988

[Surgery of malignant parotid tumors].

Surgical treatment of malignant parotid tumors was described from the viewpoints of radical cure and postoperative function. The function of the parotid gland is originally the secretion of saliva, but this is generally compensated for by the remaining major and minor salivary glands. Therefore, postoperative dysfunction involves possible facial palsy, deformity of the face and Frey's syndrome due to extirpated gland parenchyma and surrounding tissues. For these reasons, preservation of the facial nerve is required and resection of the gland should be as limited as the condition demands. If these procedures are impossible, plastic surgery such as nerve grafting and skin or musculocutaneous flaps is utilized. Postoperative irradiation is not applied except for unusual cases. Because malignant tumors of the parotid gland are histologically and biologically very different, preoperative examination is important for select the subsequent treatment. Superficial parotidectomy for a tumor in the superficial lobe and total parotidectomy for one in the deep lobe is the general concept adopted today. However, uniform application of this concept does not seem to simultaneously fulfil both purposes. In order to satisfy radical and functional results, delicately applied surgical techniques applied to individual cases are recommended according to the findings of appropriate preoperative and intraoperative examinations.

Facial Paralysis↗

PubMed1987

[Surgically treated diseases of the parotid gland in childhood and adolescence].

Between 1969 and 1986 parotid gland surgery was performed on 86 children and adolescents in the ENT clinic of the University of Tübingen. Chronic recurrent parotitis was found to be the most common chronic inflammatory disease in our young patients. Total parotidectomy was done on 24 children. Because of the high incidence of potential complications the indication for a total parotidectomy in chronic parotitis should be carefully considered. A more hopeful attitude applies to the cystic tumours (haemangioma, lymphangioma and branchiogenic cysts). A solid tumour of the parotid gland in children and adolescents, however, necessitates surgical extirpation without delay because one-third of these tumours are malignant.

Adolescent↗

PubMed1985

[Godwin's tumor and Gougerot-Sjögren syndrome. Apropos of 2 cases].

Two new cases of pseudo-tumoral parotid benign lymphoepithelial lesion serve as the basis for a review of the clinical aspects of "Godwin tumour". This is a pseudo-tumoral parotid swelling of non-characteristic clinical appearance which has the radiological findings of a systemic type sialogram ("punctate marks" and diffuse parenchymatous spots). Histopathological examination shows lesions affecting the whole gland but predominant in the swollen area, sometimes surrounded by a connective tissue pseudo-capsule. These lesions are the same as those seen in Sjögren's syndrome. There are virtually no humoral immunological abnormalities such as auto-antibodies nor inflammatory laboratory abnormalities. Whilst the diagnosis of this rare condition may be considered in the presence of any isolated parotid swelling with a sialogram of systemic type, the diagnosis of a benign lymphoepithelial lesion, eliminating a lymphoma, can be made only by histopathological examination of the parotidectomy specimen. These lesions could be the pseudo-tumoral form of isolated, so-called primary, Sjögren's syndrome. Some of these isolated syndromes become more complete after several years with the appearance of auto-antibodies. Clinical, immunological and haematological surveillance of these benign lymphoepithelial lesions is thus necessary during the years following parotidectomy.

Female↗

PubMed1983

Primary parotid cancer: factors influencing recurrence.

Recurrent disease was evaluated in 82 patients with primary parotid cancer as a function of multiple parameters including cell type, stage of disease, and extent of surgery. Stage III disease had the highest rate of recurrence (89%). Recurrence in Stage III disease appeared independent of extent of primary surgical management. The poor prognosis, 12 per cent survival at five years, associated with recurrence suggests adjuvant modalities should be utilized in the initial treatment of Stage III disease. In Stage I disease, the extent of surgery becomes more critical. In patients with Stage I disease and low-grade malignancies, superficial parotidectomy is an acceptable method of treatment. This is valid provided surgical margins are free of disease. However, patients with high-grade malignancies and Stage I disease undergoing superficial parotidectomy have a high rate of recurrence, 45 per cent of our cases. The results suggest that more extensive surgery and/or adjuvant radiation should be utilized in this subgroup of patients.

Adolescent↗

PubMed1994

[Bilateral adenolymphoma (Warthin's tumor) of the parotid. The anatomicoclinical, diagnostic and therapeutic aspects of 2 cases].

Cystadenoma lymphomatosum or Warthin's tumor of the parotid glands appears bilateral in 8-10% of cases, synchronous (rarely), metachronous (frequently) and sometimes with multicentric aspects. After the review of the epidemiological, pathogenetic, clinical, radiographic and histologic data, the authors present two cases of bilateral Warthin's tumor, metachronous (7 years), nodular-isolated in the first one and metachronous (5 years), nodular-multicentric in the second one. The patients after CAT scan and NMR examinations, and a fine needle aspiration biopsy were treated with superficial parotidectomy with preservation of the facial nerve. In our experience the management of patients affected by Warthin's tumors, needs the following steps: CAT scan and NMR examinations to outline multiple and bilateral lesions, fine needle aspiration biopsy, superficial parotidectomy with preservation of the facial nerve, an extended follow-up (10 years after the last surgery).

Adenolymphoma↗

PubMed1993

[Reoperation of tumors of the parotid gland. Technical approach and consequences for the 7th cranial nerve. Apropos of 22 cases].

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends of the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial histological diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

Adult↗

PubMedDate not supplied

[Reoperation of tumors of the parotid gland, surgical approach and consequences for the 7th cranial nerve. Apropos of 42 cases].

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends on the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

Adenocarcinoma↗

PubMed1993

[Parotid metastases of malignant tumors of the head].

Tumors of the head as well as other distant tumors may metastasize to the lymph nodes of the parotid gland. Metastases from head malignancies are much more frequent than those arising in distant organs. The authors report their experience in three cases of parotid lymph nodal metastases from head neoplasms: nasal septum carcinoma, left external auditory canal carcinoma and right suborbital skin melanoma. In two cases nodal metastases appeared after the treatment of the primary malignant tumor; in one case metastases were simultaneous to it. All patients were treated surgically (total parotidectomy with facial nerve preservation) and in two cases a submaxillary and functional neck dissection was carried out. Only one patient is alive and disease-free at three years from operation. The authors believe that total parotidectomy performed for nodal metastases involving the parotid gland is to be considered a true "parotid dissection", either "curative" or "prophylactic", depending on whether it is carried out when lymph nodes are palpable or not.

Aged↗

PubMedDate not supplied

Surgical treatment of benign tumours of the salivary glands.

In this multicentre retrospective study 30 patients with benign salivary gland tumours are reviewed. Initial operation consisted of total parotidectomy in 6 patients, superficial lobectomy in 13 and tumour enucleation in 11. There were 5 recurrences, treated by enucleation in 1, superficial lobectomy in 2 and extensive total resection in 2 patients. In 18 cases a typical facial nerve dissection was performed. The resected specimens showed a pleiomorph adenoma in 24 cases and monomorph adenoma's in 6 cases. Complications were haematoma formation, Frey syndrome and facial nerve paresis. Recurrences were related to incomplete resection or fragmentation during operation. In this study benign tumours of the salivary glands proved to have a good prognosis, provided a total tumour excision with nerve dissection is performed; the excision should consist of a superficial lobectomy or total parotidectomy depending on the location of the tumour in the lateral or medial part of the gland.

Adenoma↗