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PubMed1997

Informed consent in head and neck surgery: how much do patients actually remember?

OBJECTIVE: This study was conducted to evaluate the effectiveness of informed consent in head and neck surgery by testing patient recall of potential complications from thyroidectomy, parathyroidectomy, and parotidectomy. DESIGN: A prospective design was used. SETTING: The setting was an academic tertiary care centre. METHODS: Fifty-four patients undergoing thyroidectomy, parathyroidectomy, or parotidectomy were consented by verbal contact by the operating surgeon with a specific preoperative checklist of complication and side effects. One week to 2 months after consent, the patients were surveyed for recall of potential complications. MAIN OUTCOME MEASURES: Rate of recall was related to various parameters including patient age, sex, level of education, occupation, and length of time from the consent interview to the recall interview. RESULTS: The overall recall rate for all procedures was 48%. Those patients who recalled over 50% of the complications were younger (p = .04) and better educated (p = .04). The gender of the patients did not appear to influence recall success (p = 1.00), even when facial scar or paralysis was considered. CONCLUSION: A significant relationship exists between education level and patient age and the rate of patient recall of potential complications of surgery.

Adult↗

PubMed1997

[Tumors of the parotid gland].

Tumors of the parotid are the most frequently encountered salivary gland tumors. Knowledge of the histology and anatomy of the salivary gland is important when considering the histiogenesis of salivary gland tumors, requiring close cooperation between the pathologist and the surgeon. Most tumors are benign epithelial formations. Pleomorphous adenomas predominate. Superficial lobectomy is adequate treatment. When the tumor involves a deep lobe, total parotidectomy is indicated. Treatment of malignant tumors depends on the histology, its TNM stage and other factors. Total parotidectomy with lymphadectomy and radiotherapy are needed in case of high grade malignancy. In children, vascular neoplasias are the most frequent, followed by malignant tumors. Their histological features and treatment are the same as for adults.

Adenoma↗

PubMedDate not supplied

[Lymphoma of the parotid salivary gland].

INTRODUCTION: Lymphomas appear mostly in lymph nodes and parenchymal organs such as liver and spleen, while other localizations are less frequent. They are classified as Hodgkin and non-Hodgkin types, and these two are divided into subtypes, according to cell morphology and the characteristics of concurrent elements. Parotid salivary gland lymphomas are rare primary tumours of this region, although 80% of all salivary gland lymphomas, appear in parotid. They originate from intraparotid or periparotid lymph nodes, or from lymphoid elements of other pathological states in the gland such as sialadenitis, cysts with the presence of lymphoid tissue, parenchymal neoplasms with lymphoid component present and autoimmune illnesses, esp. Sjögren syndrome. Many authors (2-15) who have issued publications on this topic in foreign professional literature in the past ten years, agree that the primary localization of lymphomas in parotid salivary gland is very rare, although in recent decades more frequent than earlier (5). In majority of cases they appear on one side, although there are very rare cases of described parotid salivary glands on both sides. The illness most often starts as painless, soft knob in the region of parotid salivary gland. Other discomforts are very rare, and mostly appear as a feeling of pressure and mild painful sensations in the region of the change. In case of facial nerve paresis and/or strong pains, as well as adenopathy, there is a justified suspicion of carcinoma (20). The treatment is surgical. The method chosen is parotidectomy. According to histological type and clinical stadium, it includes radiotherapy or polychemotherapy. The prognosis depends on histological type of tumour, that is clinical stadium, and shows no specific characteristics compared with other forms of disease appearing outside parotid salivary gland. CASE DESCRIPTION: The patient aged 66 was admitted to the ward with a tumefaction in the right parotid region. Family case history: negative. Personal case history excerpt: over 20 years of rheumatism, chronic bronchitis and hypertension. Present discomfort: tumefaction in the right parotid region, noticed about a year and a half earlier. The tumefaction was about 3 cm in diameter, painless to palpation, rubbery and smooth. She came to the Otolaryngology ward on May 31, 1995, when it was established that she had a tumour of the right parotid region and chronic otitis media on the left side. She was admitted on August 7, 1995. Local test results: the right parotid region contained a tumor of irregular round shape, about 6 cm in diameter, soft and painless to palpation, with smooth surface, the skin over the tumor was hyperaemic and sporadically livid. ORL status excerpt: subtotal reniform perforation of the left tympanic membrane enclosing all parts except the attic, with slight transparent secretion. Enlarged lymph nodes were not palpable. On August 10, 1995, under general endotracheal anaesthesia, a pre-operative aspiration of tumor was performed in three positions. The obtained substance contained blood, after which it was decided to perform an excision biopsy, which was done in the lower portion of the tumor. Histopathological analysis did not give a clearly defined character of tumor, so that hospitalisation was indicated and scheduled for further treatment. On the second admission on October 10, 1995, general condition and local results remain unchanged. On October 12, 1995, total parotidectomy was performed under general endotracheal anaesthesia. A tumor of about 5 cm in diameter and the removed salivary gland were sent to histopathological tests. The post-operative course was normal, the function of the facial nerve was preserved. Histopathological results: well-differentiated malignant lymphocyte lymphoma. The patient was sent to polychemotherapy on Cyclophosphamide Oncovin Pronisin (COP) protocol. One year after the surgery, the local findings are regular. (ABSTRACT TRUNCATED)

Aged↗

PubMed1998

[Bilateral acinar cell carcinoma of the parotid gland].

Authors have described a case of bilateral acinic cell carcinoma of parotid gland. The patient has been treated successfully by left superficial parotidectomy and right total parotidectomy followed by complementary Co 60 therapy. During 3 years after surgery the patient revealed no recurrence of the disease. Clinical course, histology and pathology have also been presented. The authors have pointed out the difficulties in diagnosing ACC because of the variety of histological pictures and unclear terminology.

Carcinoma, Acinar Cell↗

PubMed1997

[Exposure of the facial nerve in the masseteric region during parotid surgery. Technical aspects and value].

With an accurate understanding of facial soft-tissue anatomy, deep plane rithydectomy can be performed in safe and precise fashion. We report our experience of 19 cases of parotidectomy using this superficial musculo-aponeurotic system mobilization anterior to the gland. In all cases (two recurrences), it was thus possible to safely expose at least two terminal branches of the lower facial nerve in the masseteric area without jeopardizing the facial nerve. During a second operation for recurrent tumor or in the case of some lesions as inferior and anterior intraglandular cyst, the distant branches of the nerve can be uncovered by a backward dissection. The easiest to identify seems to be the terminal branches in the masseteric area, as it is directly accessible after cutaneous undermining in an area generally not dissected during previous operations and with preserved anatomic relations. In other cases this technique enables one to expose the parotid gland completely and facilitates anterograde facial nerve dissection by its terminal exposure. The superficial musculo-aponeurotic system dissection allows its backward transposition, in the absence of any contraindication, so as to prevent retromandibular depression following a parotidectomy.

Facial Nerve↗

PubMed1998

Traumatic neuromas of the head and neck.

An interesting case of a traumatic neuroma of the greater auricular nerve provides the impetus for a discussion of head and neck neuromas. Traumatic neuromas of the head and neck are relatively rare. Division of the greater auricular nerve during parotidectomy occasionally results in a traumatic neuroma. We report a case of a 73-year-old woman who presented with a traumatic neuroma nine years after undergoing superficial parotidectomy with dissection of the facial nerve for a mixed tumor. The patient had a 1.5 cm x 1.0 cm mass located below the old surgical site over the anteromedial border of the sternocleidomastoid muscle. The patient's past history was significant for Frey's syndrome, which is the result of abnormal neurologic growth. On first impression, the tumor was thought to be a recurrence of neoplastic disease; however, because of the evaluation, traumatic neuroma was suspected. An attempt at fine-needle aspiration of the mass was too painful to be carried out. At surgery, a whitish tumor was excised which, on final pathologic examination, revealed traumatic neuroma. The surgical literature is reviewed and the subject of head and neck neuromas, including their evaluation and management, is thoroughly discussed. Knowledge of this possible diagnosis may spare the patient and the surgeon needless worry, as well as unnecessary procedures, once tumor recurrence has been ruled out.

Aged↗

PubMed1998

Primary malignant lymphoma of the parotid gland.

OBJECTIVES: To document the clinicopathologic features of primary malignant lymphoma of the parotid gland based on analysis of our cases and to compare the results with similar studies in the literature. DESIGN: Retrospective, nonrandomized case study. SETTING: Academic, tertiary medical center. PATIENTS: Forty-one consecutive cases of malignant lymphomas of the parotid gland were identified among 820 patients who had undergone parotid surgery during the course of 22 years. Thirty-three (80%) of these were primary lymphomas and were included in the study. Eight (20%) occurred in patients with a history of malignant lymphoma and were therefore excluded. INTERVENTION: Diagnosis was established by open parotid biopsy in 8 patients, superficial lobectomy in 23, and total parotidectomy in 2. After diagnosis, lymphomas were staged and treated with local irradiation and/or chemotherapy. RESULTS: Fifteen men and 18 women aged 26 to 100 years (mean, 66 years) had an enlarging painless mass on initial examination. Seven (21%) had an underlying autoimmune disease and 20 (61%) had Ann Arbor stage 1 disease at diagnosis. Of 25 patients available for a minimum 2-year follow-up, 16 (64%) were alive with or without disease. Histological grade was the only prognostic feature associated with outcome (P<.01). CONCLUSIONS: Our study, when viewed collectively with those in the literature, indicates that malignant lymphomas of the parotid gland are uncommon and often not suspected clinically. The disease affects both sexes equally and is unusual before the age of 50 years. Most are B-cell, non-Hodgkin lymphomas, and about 80% of patients have Ann Arbor stage I or II disease at diagnosis.

Adult↗

PubMed1999

Malignant melanomas of the parotid: comparison of survival for patients with metastases from known vs unknown primary tumor sites.

BACKGROUND: Malignant melanoma (MM) rarely affects the parotid, and usually this diagnosis will herald a search for a primary skin neoplasm. Occasionally, no primary tumor is ever found, raising questions regarding prognosis and the issue of primary melanoma of the parotid. OBJECTIVE: To evaluate retrospectively the clinical and histological features of MM involving the parotid in 19 patients. DATA SOURCES: Pathology and hospital files at 3 tertiary care university hospitals. STUDY SELECTION: Patients with MM within the parotid with adequate histopathologic and immunohistochemical documentation, as well as clinical information regarding patient outcome. DATA EXTRACTION: In 6 patients, no extraparotid MM was ever identified. After parotidectomy, 5 patients (including 1 patient who died of other causes) were melanoma free at a mean of 4.2 years (range, 14 months to 7.5 years). Only 1 patient died of disease after 17 months. An extraparotid primary tumor was present in 13 patients, 10 with dermal and 3 with mucosal sites. At follow-up, only 1 of these patients was disease free after 2 years. Nine patients died of melanoma after a mean of 2.6 years (range, 10 months to 5 years); the other 3 had evidence of metastatic disease at a mean of 4.3 years (range, 3-6 years). Nondermal sites of primary tumors were the nasal cavity, sclera, and conjunctiva. DATA SYNTHESIS: Patients with metastatic MM from unknown primary tumors have a longer disease-free survival than those with metastases from known primary disease. CONCLUSIONS: Although rare, MM should be considered in the differential diagnosis of parotid tumors. Unusual mucosal or ocular sites should be considered in the search for possible primary tumor sites to avoid treatment delay. These data support the idea that patients with metastatic MM from unknown primary tumors may follow a more improved course than that of patients with metastases from known primary disease.

Adult↗

PubMed2000

Pediatric parotid masses.

OBJECTIVE: To evaluate the incidence, types, and treatment outcomes of pediatric parotid lesions. DESIGN: Retrospective case review, histological tissue review, and literature review. SETTING: Tertiary care center. PATIENTS: All patients aged 18 years and younger with parotid masses evaluated and treated at the Mayo Clinic, Rochester, Minn, from January 1, 1970, to December 31, 1997. RESULTS: Parotid masses were identified in 118 children (60 boys and 58 girls). At diagnosis, the ages of patients were from birth through 18 years, and 72 (61.0%) were aged 10 years and older. An asymptomatic mass was the most common presentation. Forty-three patients (36.4%) had infectious or inflammatory lesions, 56 (47.5%) had benign lesions, and 19 (16.1%) had malignant lesions. The most common benign lesions were pleomorphic adenoma (22.9%) and hemangioma (10.2%). The most common malignant lesions were mucoepidermoid carcinoma (6.8%) and acinic cell carcinoma (3.4%). The most common treatment was total parotidectomy (40.7%). Surgical complications included temporary facial nerve weakness in 22 (18.6%) patients, permanent facial weakness in 11 (9.3%), and permanent paralysis in 2 (1.7%). Pleomorphic adenoma recurred in 4 (14.8%) of 28 patients and mucoepidermoid carcinoma in 3 (37.5%) of 8 patients. One patient with adenoid cystic carcinoma died of the tumor. CONCLUSIONS: Although pediatric parotid masses are unusual, they can represent a variety of pathological diagnoses, including malignancy. We advocate prompt evaluation and treatment of these masses, and suggest guidelines for their management, based on diagnosis.

Adolescent↗

PubMed2000

Cervical sentinel lymph node biopsy for melanomas of the head and neck and upper thorax.

OBJECTIVE: To describe a clinical experience with sentinel lymph node biopsy (SLNB) of head and neck nodal basins for clinical stage I melanomas draining to these areas. DESIGN: Consecutive clinical case series with a mean follow-up of 10.7 months. SETTING: University tertiary care referral medical center. PATIENTS: Seventy patients with clinical stage I cutaneous melanoma who underwent SLNB of cervical and/or parotid lymph node basins. INTERVENTIONS: Patients underwent same-day preoperative technetium Tc 99m lymphoscintigraphy followed by SLNB using gamma probe and blue dye (66 patients) and blue dye alone (4 patients). Patients with histological evidence of tumor (here in after "positive") according to SLNB results underwent modified cervical completion lymph node dissection, including parotidectomy, as appropriate. Patients without histological evidence of tumor (hereinafter "negative") according to SLNB results were followed up clinically without undergoing completion lymph node dissection. MAIN OUTCOME MEASURES: The rates of SLNB success, SLNB positivity, completion lymph node dissection positivity, complications, and SLNB false-negative results were determined by clinical follow-up. RESULTS: Locations of melanomas in the 70 patients were the face (n = 20), neck (n = 14), ear (n = 9), scalp (n = 9), and upper thorax (n = 18). Locations of basins that underwent biopsy (n = 104) were in the cervical (n = 68), parotid (n = 19), and axillary (n = 17) regions. The mean Breslow thickness was 2.1 mm (range, 0.4-12.0 mm). Sentinel lymph node biopsy was successful in 103 basins (99%). The mean number of sentinel lymph nodes per basin was 2.5 (range, 1.0-8.0). Positive sentinel lymph nodes were found in 12 patients (17%) and 15 basins (14%). Sentinel lymph node biopsy results correlated with the American Joint Committee on Cancer tumor stage (P = .05) and a Breslow thickness of 1.23 mm or greater (P = .03). Additional tumor-containing nodes were noted in 5 (42%) of the 12 patients who underwent completion lymph node dissection, and these results correlated with the presence of multiple positive sentinel lymph nodes (P = .01). There were complications in 3 patients (4%) (seromas in 2 patients and temporary spinal accessory nerve paresis in 1 patient). One nodal recurrence in a basin that was negative according to SLNB results (SLNB with blue dye only) was noted (false-negative rate, 2%). The results of SLNB were accurate in 69 patients (99%). CONCLUSIONS: Sentinel lymph node biopsy using lymphoscintigraphy and blue dye to manage cutaneous melanomas draining to the head and neck nodal areas is reliable and safe. Sentinel lymph node biopsy results correlated with a Breslow thickness of 1.23 mm or greater and the American Joint Committee on Cancer tumor stage. Completion lymph node dissection is recommended after determining positive SLNB results.

Adolescent↗

PubMed2000

Limitations of magnetic resonance imaging in the evaluation of perineural tumor spread causing facial nerve paralysis.

OBJECTIVE: To present and discuss the clinical presentation and treatment in patients with long-duration unilateral facial paralysis and normal magnetic resonance imaging (MRI) findings. DESIGN: Case series. SETTING: Ear, nose, and throat department of the University of Cologne, Cologne, Germany. PATIENTS: A total of 486 patients with unilateral facial paralysis who were treated from 1986 to 1998. Besides the usual diagnostic workup, a complete electrophysiological evaluation, including investigations such as needle electromyography and neuromyography (also known as electroneurography), of the facial nerve was performed at repeated intervals. In 19 patients, a malignant tumor was delineated with ultrasonography or MRI. In 8 of these patients, the initially performed MRI did not detect any parotid gland lesion causing the paralysis, whereas long duration of the paralysis and electroneurography indicated malignancy. RESULTS: Exploration surgery was performed as total parotidectomy in these 8 patients and malignant parotid gland tumors were proved in all 8 patients. CONCLUSIONS: Individuals with facial nerve paralysis without any signs of regeneration 6 months after the onset of paralysis and/or persistent electrophysiological evidence of ongoing neuronal degeneration should undergo surgical exploration of the parotid gland and facial nerve, even if MRI studies show no tumoral lesion.

Adenocarcinoma↗

PubMed2000

First branchial cleft cyst excision with electrophysiological facial nerve localization.

OBJECTIVE: To assess the safety and efficacy of surgical excision of selected first branchial cleft cysts using electrophysiological rather than anatomical location of the facial nerve. DESIGN: Retrospective review of consecutive surgical procedures by a single surgeon, using a consistent technique during a 9-year period. SETTING: Tertiary pediatric medical center. PATIENTS: Eleven children with first branchial cleft cysts. INTERVENTIONS: Selected first branchial cleft cysts were removed using a smaller surgical approach than that generally advocated. The facial nerve was localized using electrophysiological means rather than superficial parotidectomy and identification of the nerve trunk and branches. MAIN OUTCOME MEASURES: Successful removal of the lesion, avoidance of facial nerve injury, incidence of Fry syndrome, and cosmesis. RESULTS: Eleven patients underwent surgical excision of first branchial cleft cysts during a 9-year period. Ten lesions were removed without the need for anatomical localization of the facial nerve trunk. There was no facial weakness, recurrence of the lesions, or Fry syndrome during a follow-up of 6 months to 7 years. Cosmesis was superior. CONCLUSION: Electrophysiological location of the facial nerve may, in the appropriate setting, replace anatomical localization for first branchial cleft cysts that are (1) superior to the stylomastoid foramen and (2) not previously infected or surgically violated.

Branchioma↗

PubMed2002

A prospective study of intraoperative lymphatic mapping for head and neck cutaneous melanoma.

BACKGROUND: Intraoperative lymphatic mapping and sentinel lymph node biopsy have been used successfully to stage regional lymphatics for trunk and extremity melanomas. However, the accuracy and applicability of these techniques in the head and neck have not been determined conclusively. OBJECTIVE: To report the results of a prospective trial of intraoperative lymphatic mapping and sentinel lymph node identification in patients with head and neck cutaneous melanoma. METHODS: Using technetium Tc 99m--labeled sulfur colloid and isosulfan blue, intraoperative lymphatic mapping and sentinel lymph node identification were performed in 43 patients with melanomas of intermediate thickness. After the sentinel lymph nodes were identified in situ, an elective dissection of levels I through V or II through V was performed, based on the location of the primary tumor. The parotid, postauricular, and suboccipital lymphatics were dissected as clinically indicated. The sentinel lymph nodes were isolated ex vivo and evaluated pathologically by serial sectioning, and the accuracy of the lymphatic mapping was determined. RESULTS: Intraoperative lymphatic mapping identified 155 sentinel lymph nodes in 94 nodal basins, with a mean of 3.6 sentinel nodes and 2.2 basins per patient. Sentinel nodes were located in the parotid gland in 19 patients (44%), necessitating superficial parotidectomies, and they were distributed throughout nonadjacent nodal basins in 18 patients (42%). Nine patients (21%) had metastatic disease in 1 or more sentinel nodes, 3 of whom had metastatic disease in a nonsentinel node. No patient who had negative sentinel nodes had a positive nonsentinel node (false-negative incidence, 0). CONCLUSIONS: Although intraoperative lymphatic mapping accurately identifies sentinel lymph nodes for head and neck cutaneous melanomas, the multiplicity of these nodes, their widespread distribution, and their frequent location within the parotid gland may preclude sentinel lymph node biopsy in many patients. Therefore, we advocate selective lymphadenectomy of sentinel nodal basins, allowing histological staging of the regional lymphatics with limited morbidity. However, further study is necessary to define the true role of sentinel lymph node identification for head and neck cutaneous melanoma.

Head and Neck Neoplasms↗

PubMed2003

Anatomical variations of the facial nerve in first branchial cleft anomalies.

OBJECTIVE: To review our experience with branchial cleft anomalies, with special attention to their subtypes and anatomical relationship to the facial nerve. STUDY DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Ten patients who underwent resection for anomalies of the first branchial cleft, with at least 1 year of follow-up, were included in the study. The data from all cases were collected in a prospective fashion, including immediate postoperative diagrams. INTERVENTION: Complete resection of the branchial cleft anomaly was performed in all cases. Wide exposure of the facial nerve was achieved using a modified Blair incision and superficial parotidectomy. Facial nerve monitoring was used in every case. MAIN OUTCOME MEASURES: The primary outcome measurements were facial nerve function and incidence of recurrence after resection of the branchial cleft anomaly. RESULTS: Ten patients, 6 females and 4 males,with a mean age of 9 years at presentation, were treated by the senior author (P.J.K.) between 1989 and 2001. The lesions were characterized as sinus tracts (n = 5), fistulous tracts (n = 3), and cysts (n = 2). Seven lesions were medial to the facial nerve, 2 were lateral to the facial nerve, and 1 was between branches of the facial nerve. There were no complications related to facial nerve paresis or paralysis, and none of the patients has had a recurrence. CONCLUSIONS: The successful treatment of branchial cleft anomalies requires a complete resection. A safe complete resection requires a full exposure of the facial nerve, as the lesions can be variably associated with the nerve.

Adolescent↗

PubMed2003

Preoperative and postoperative electroneurographic facial nerve monitoring in patients with parotid tumors.

OBJECTIVE: To assess the value of clinical (House-Brackmann grading) and neurophysiological (conventional electroneurography) monitoring of the facial nerve before and after (at day 10 and day 80) microsurgical parotidectomy in a group of patients with parotid tumors. STUDY DESIGN AND SETTING: From January 7, 1999, to February 27, 2001, 33 patients were evaluated for parotid neoplasms confirmed by cytologic examination: 27 were benign and 6 were malignant epithelial tumors. All patients underwent preoperative electroneurography of the affected side and the normal contralateral side. RESULTS: Preoperatively, 27 of 33 patients with benign lesions had normal facial nerve function on clinical and neurophysiological evaluation, while 3 of 6 patients with malignant lesions showed compound muscle action potential abnormalities of amplitude and latency, in the absence of facial nerve deficits. At the first postoperative evaluation, 2 of 6 patients with epithelial cancer and 4 of 27 patients with benign tumors had an absence of voluntary activity and compound muscle action potentials after nerve stimulation at the stylomastoid foramen; 1 patient with a malignant lesion and 5 patients with benign tumors had a transient facial palsy with amplitude reduction or latency prolongation of compound muscle action potential. This abnormality persisted in 2 of 27 patients at the second evaluation performed at day 80 after surgery. In 2 of 6 patients with malignant lesions, the day-80 electroneurogram showed a complete absence of nerve conduction. CONCLUSION: Electroneurography is a sensitive tool for monitoring clinically silent facial nerve function deficits in the context of preoperative tumor-induced damage and postsurgical early and late follow-up of nerve function.

Adult↗

PubMed1977

A reevaluation of the Frey syndrome following parotid surgery.

The Frey syndrome, or gustatory sweating, is an accepted complication of parotid gland surgery that may occur with varying degrees of secerity. Since misdirection of auriculotemporal secretomotor nerve fibers has been found to play an important role in the development of the syndrome, a study was initiated to attempt mechanical interference with the regenerating fibers of the nerve. A superiorly based muscle flap from the sternocleidomastoid muscle was developed to cover the operative wound after either partial or complete parotidectomy. Results in 35 patients with such a muscle flap were compared with those in 35 control patients for the presence of absence of the Frey syndrome; the muscle flap was shown to be ineffective in preventing occurrence of gustatory sweating. Moreover, gustatory sweating to varying degrees was present in 34 patients with the muscle flap and in 33 control patients. Also, only 23 of the 70 patients had subjective complaints related to the syndrome, none of whom was incapacitated ore required additional measures for care.

Humans↗

PubMed1978

Squamous cell carcinoma of the skin metastatic to parotid nodes.

Preauricular masses may represent metastases to parotid nodes from carcinoma of the skin of the face, scalp, and neck. At the University of Florida from January 1966 to March 1977, a total of 20 patients were treated whose first evidence of metastasis was a preauricular mass ranging in size from 1 to 6 cm. All had been treated from two weeks to five years previously for at least one ipsilateral squamous cell carcinoma of the face or scalp. In no patient has a mucosal primary site of the head and neck subsequently developed. Treatment consisted of surgery or irradiation of both. The results suggest that superficial parotidectomy is usually inadequate for complete removal of these nodes, since the nodes lie lateral to the posterior facial vein and not the facial nerve. Surgery followed by irradiation appears to result in better survival than either modality alone.

Carcinoma, Squamous Cell↗

PubMed1980

Pleomorphic adenoma manifesting as aural polyp. Report of a case.

We report the sixth known case of a pleomorphic adenoma of the external auditory canal. It manifested as an aural polyp, and the diagnosis was made only after microscopic pathologic examination. Complete removal was accomplished after a total parotidectomy (with preservation of the facial nerve) provided access to the parapharyngeal space surrounding the internal carotid artery, where it is postulated that the tumor originated. A thorough knowledge of the developmental anatomy of this area greatly enhances operative success.

Adult↗