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PubMed1980

Microvascular free dermis-fat flaps for reconstruction after ablative head and neck surgery.

Reconstruction of the head and neck region following radical parotidectomy with or without mandibulectomy may be a difficult procedure. Facial skin is usually preserved, but the underlying soft-tissue structures and bone are deficient. The challenge is to augment the facial defect while the overlying skin is preserved with a high success rate, minimal time, one operative stage, and reduced secondary deformity to the patient. In certain instances, a microvascular free flap is ideal. We have used a de-epithelialized microvascular free groin flap successfully to reconstruct large parotid-mandibular defects in nine patients. A small bridge of epithelium is left to relieve tension from edema and to monitor the flap postoperatively. The high success rate, minimal complications, and acceptable donor site defect make the microvascular free dermis-fat flap an ideal choice for this type of reconstruction.

Adolescent↗

PubMed1984

Malignant parotid tumors in patients under 20 years of age.

Since 1944, 26 patients with parotid cancer who were under 20 years of age have been seen and treated at the University of Texas M.D. Anderson Hospital and Tumor Institute at Houston by a single group of surgeons with a similar therapeutic approach. Follow-up data were obtained in all patients up to 26 years. Mucoepidermoid and adenocarcinomas were the most common histologic cell types. None of the 26 patients initially had either facial nerve paralysis or palpable nodal metastasis. Initial treatment for 21 of the 26 patients consisted of a parotidectomy and neck dissection. The overall absolute two-year survival and above-clavicle control was 88%. A poor prognosis correlated well with adverse tumor criteria such as poor differentiation histologically, nodal metastasis, nerve invasion, and locally invasive disease. Aggressive local-regional treatment is recommended since only two patients died of distant metastasis as the sole manifestation of their treatment failure. The use of postoperative irradiation must be carefully selected in these young patients since severe irradiation complications developed in three of the five long-term survivors.

Adenocarcinoma↗

PubMed1984

The cheek-neck rotation flap for closure of temporozygomatic-cheek wounds.

The head and neck surgeon is often consulted for evaluation and treatment of traumatic or neoplastic lesions of the lateral aspect of the face. Large malignant cutaneous lesions may require excision with wide margins, often parotidectomy, and possibly neck dissection. Traumatic lesions may involve notable soft-tissue loss, and parotid, facial nerve, or mandibular injury. Management of such planned or unplanned wounds challenges the surgeon due to the magnitude of the soft-tissue defect, cosmetic and functional considerations, and the need for soft-tissue protection and nourishment of repaired structures. Primary reconstruction with a large cheek-neck rotation flap provides the advantages of reliability, simplicity, excellent exposure, vital-structure protection, superior aesthetic results, and eliminates the need for a second operative site to harvest skin grafts or distant flaps. Four illustrative cases are reported, with a discussion to address parotid metastases from carcinoma of the lateral aspect of the face and initial treatment of shotgun injuries to the face.

Adolescent↗

PubMed1984

Parotid gland surgery using the Shaw Hemostatic Scalpel.

Twenty-five patients who underwent parotid gland surgery using the Shaw Hemostatic Scalpel (group 1) were compared with 25 patients who had similar surgery using conventional techniques (group 2). Overall, the patients in group 1 had less blood loss and shorter operative times. In patients who underwent superficial parotidectomy, the incidence of temporary partial facial nerve paralysis was 31% in the experimental group v 43% in the conventional group. The mean number of branch paralyses per patient was one in group 1 v 1.9 in group 2, and time to recovery of full function was 50% less in group 1. The Shaw Hemostatic Scalpel is a safe, efficacious instrument for use in parotid gland surgery.

Evaluation Studies as Topic↗

PubMed1985

Treatment and prognosis of mucoepidermoid carcinoma in the pediatric age group.

Although mucoepidermoid carcinoma is the most common malignant salivary neoplasm in adults, it occurs rarely in the pediatric age group. A retrospective study of 15 pediatric cases from 1954 to 1984 showed that 13 of the patients were 10 to 15 years old, and 11 were female. The parotid (11/15) and the palate (4/15) were the sites involved. Tumors were graded into three categories: well differentiated (grade I), moderately differentiated (grade II), and poorly differentiated (grade III). Tumor grade influenced the method and outcome of treatment. Wide local composite resection was used for palatal tumors, and total parotidectomy (with or without nerve resection) and nodal dissection was the technique selected for parotid tumors. No nodal or distant metastases were present in the poorly differentiated tumor category (2/15). A follow-up period of ten years or more was possible in 90% of the cases. The prognosis for those studied is excellent, and there have been no deaths attributable to the malignant process.

Adolescent↗

PubMed1988

Cystic parotid lesions in patients at risk for the acquired immunodeficiency syndrome.

Twenty-three patients at risk for the acquired immunodeficiency syndrome presented with cystic lesions of the parotid gland. Fourteen patients had unilateral parotid cysts and nine had bilateral enlargement. Ten patients were positive for antibodies to the human immunodeficiency virus (HIV), three were negative for antibodies to the human immunodeficiency virus, and ten refused testing. Fine-needle aspiration cytology and computed tomography were helpful in making the diagnosis of benign lymphoepithelial cyst. Superficial parotidectomy confirmed the diagnosis. Concurrent malignancy (Kaposi's sarcoma) was diagnosed in one patient from a parotid specimen. Follow-up has ranged from four months to five years.

Cysts↗

PubMed1992

Primary squamous cell carcinoma of the parotid gland.

We reviewed all cases of possible primary squamous cell carcinoma of the parotid gland treated at Mayo Clinic, Rochester, Minn, from 1960 through 1988. Eighteen cases of primary squamous cell carcinoma of the parotid gland were identified. We report the clinical behavior and results of treatment of these rare parotid gland neoplasms. The age at diagnosis ranged from 48 to 86 years; the majority of patients were aged 65 years or older. Half of the patients presented with an asymptomatic parotid gland mass; a painful mass occurred in 33% of patients. Facial paralysis was noted in 17%, and a neck was the presenting symptom in 11% of patients. All patients underwent parotidectomy, and all or part of the facial nerve was sacrificed in 66% of patients. A neck dissection was performed in 12 patients, five of whom had pathologic confirmation of neck metastasis. Adjunctive radiation therapy was performed in 55% of patients. The overall survival at 5 years was 50%. Deep fixation and facial nerve paralysis were associated with a poor prognosis. Most recurrences developed within 1 year of initial treatment. Regional recurrence was always associated with a rapid death. Our data suggest that aggressive treatment and early detection may result in a better prognosis than is commonly associated with these tumors.

Aged↗

PubMed1993

Predicting occult lymph node metastasis in parotid cancer.

To determine the factors predictive of occult cervical metastases, we retrospectively reviewed the charts of 99 previously untreated patients with a primary parotid malignancy who underwent elective neck dissection between 1960 and 1985. Univariate and multivariate analyses were performed to determine the predictive value of 11 factors. The univariate study found facial nerve paralysis, extraparotid extension, and perilymphatic invasion statistically significant. In the multivariate analysis of preoperative factors, facial nerve paralysis was most predictive of occult disease. If the variable pool was expanded to include a fine-needle biopsy, tumor grade became the most important preoperative variable. When the analysis was further expanded to include a parotidectomy, the most influential factors were patient age, perilymphatic invasion, and extraparotid tumor extension. This report identifies the variables predictive of occult neck disease in parotid cancer.

Adolescent↗

PubMed1975

Acinic cell carcinoma: collective review, including bilateral cases.

Bilateral acinic cell carcinoma of the parotid gland is rare. On the basis of one case and a review of 486 parotid acinic carcinomas, unilateral as well as bilateral, total parotidectomy seems to be the treatment of choice for this low-grade malignant neoplasm that recurs commonly following inadequate excision. If involved by tumor, the facial nerve must be taken. Metastases are more likely to lung and bone than to regional nodes. For this reason, radical neck dissection is not routinely indicated.

Adolescent↗

PubMedDate not supplied

Lymphoepithelial carcinoma of salivary glands.

BACKGROUND: Malignant lymphoepithelial lesions (MLEL) or lymphoepithelial carcinoma or undifferentiated carcinoma with lymphoid stroma, is a rare but unique malignancy of the major salivary glands. There is an exceptionally high incidence in Eskimos and native Greenlanders, but it has never been reported in the Arab population. We report the first case from Saudi Arabia in the native Arabs. These are unencapsulated tumors with a strong tendency to metastasize to the regional lymph nodes. METHODS: We reviewed English and Arabic literature and found the total number of reported cases of MLEL to be 103 with predominant involvement of the parotid gland. Parotidectomy followed by neck dissection and radiotherapy was performed, with a survey of the nasopharynx and EB virus titer. RESULTS: The patient underwent radical neck dissection followed by radiation after developing the neck metastasize. Three years to date he remains in remission with no distant or regional metastases. CONCLUSION: Malignant lymphoepithelial lesions of the salivary gland are unencapsulated tumors with poorly differentiated epithelial cells scattered throughout fibrolymphocytic stroma. They have a strong tendency to metastasize to the regional lymph nodes with predominant involvement of the parotid gland. They are commonly associated with Epstein-Barr virus infection. The majority of them are radiosensitive. Combination therapy with surgery and radiation is desirable to control the disease. We recommend complete surgical excision with neck dissection followed by postoperative radiotherapy to the local site as well as to the neck as treatment of choice.

Arabs↗

PubMed1998

Nodular fasciitis in the parotid region of a child.

BACKGROUND: Nodular fasciitis is a common pathologic entity in the limbs of adults but rare in the head and neck of children. It is defined by the World Health Organization as a benign and probably reactive fibroblastic growth extending as a solitary nodule from superficial fascia into subcutaneous tissue. Treatment is local excision, and recurrence is rare. METHOD: Case Report RESULTS: A 3.5-year-old boy was initially seen with a 1-year history of gradually enlarging but otherwise asymptomatic right facial mass. On examination, a firm nodule was palpable anterior to the right ear, and facial movement was symmetrical. Computed tomography showed a rounded, well-defined solid mass continuous with the parotid fascia. The patient underwent superficial parotidectomy without complication. The pathology was reported as nodular fasciitis, and the child has had no clinical recurrence over 2 years. CONCLUSION: Benign lesions in this region in children may present similarly to malignancies but require much more-conservative treatment.

Child, Preschool↗

PubMed1998

Ameloblastic carcinoma of the mandible.

BACKGROUND: Ameloblastic carcinoma is a rare, aggressive odontogenic neoplasm of the jaws in which the epithelial cells exhibit cytologic features of recognizable ameloblastoma and malignancy. Cases with metastasis have been infrequently reported. METHODS: A case of a 64-year-old white woman with mandibular ameloblastic carcinoma with documented distant metastasis is presented. The patient's presenting symptoms included facial asymmetry of the right jaw over 2 months and the development of moderate trismus. Clinical manifestations, pathology, treatment, and biologic behavior are discussed. The nomenclature and classification of odontogenic carcinomas are reviewed, including entities that should be considered in the differential diagnosis. RESULTS: The patient underwent surgical resection consisting of mandibulectomy, parotidectomy, and modified radical neck dissection followed by radiation to both necks and tumor bed. Postsurgically, the patient developed pulmonary metastasis at 11 months and expired with widespread metastatic disease at 28 months. CONCLUSIONS: This case demonstrated an unusual behavior pattern in that local recurrence and regional metastasis did not occur. Distant metastasis occurred despite apparent adequate control of the primary mandibular tumor. The ameloblastic carcinoma is a highly malignant neoplasm which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.

Female↗

PubMed1998

Sialadenosis: a presenting sign in bulimia.

BACKGROUND: Sialadenosis refers to noninflammatory, often recurrent, enlargement of the salivary glands, most frequently the parotids, which is almost always associated with an underlying systemic disorder. These include diabetes, alcoholism, malnutrition, anorexia nervosa, and bulimia. It is thought that the various causes of sialadenosis all result in a common pathogenetic effect in that they produce a peripheral autonomic neuropathy which is responsible for disordered metabolism and secretion, resulting in acinar enlargement. METHODS: This paper reports a case of sialadenosis as a presenting sign in bulimia and studies the histologic and electron microscopic features of this disease. RESULTS: Light microscopy showed acini which appeared to be larger than normal and which were composed of plump pyramidal cells containing prominent zymogen granules. There was less interstitial fat, and the ducts were widely dispersed. Electron microscopy showed the acinar cells to be packed with membrane-limited, dark secretory granules some of which showed moulding of their outlines. Cellular organelles and nuclei were inconspicuous. CONCLUSIONS: Management of sialadenosis depends upon identification of the underlying cause, which must then be corrected. In bulimia, the swellings may be refractory to standard treatment modalities, and parotidectomy may be considered as a last resort to improve the unacceptable aesthetics.

Adult↗

PubMed1999

Leiomyosarcoma of the parotid gland: a case report and review of the literature.

BACKGROUND: A primary leiomyosarcoma of the parotid gland has been reported only three times in the English literature. This type of tumor represents an extremely rare group of salivary gland neoplasm. METHODS: A 44 year old man was initially seen with a 5 cm right parotid mass which was resected with a total parotidectomy, preserving the facial nerve. The patient had no palpable cervical lymph nodes. RESULTS: The majority of the specimen was made up of a relatively well demarcated tumor 5 cm in diameter. The tumor was noted to contain moderate to poorly differentiated primary leiomyosarcoma of the parotid. CONCLUSIONS: A primary leiomyosarcoma of the parotid gland is an extremely rare existing entity. A review of the literature reveals that primary leiomyosarcoma and other sarcomas of the major salivary glands may share similar histogenesis and biologic behavior with their soft tissue counterparts.

Adult↗

PubMed1977

Acinic cell carcinoma: long-term survival after pulmonary metastases: light and electron microscopic study.

Metastatic pulmonary nodules discovered 6 years after superficial parotidectomy for an acinic cell carcinoma in a 61-year-old man were studied by light and electron microscopy. The lesions were composed of clear cells and darker, gland-forming cells with granular cytoplasm, which by electron microscopy demonstrated features of ductal and acinar serous cells, respectively. Cytologic evidence of malignancy, such as extensive necrosis, nuclear pleomorphism, significant mitotic activity, incomplete encapsulation, and perineural invasion was present. The patient is free of tumor 5 years after resection of the pulmonary lesions. In view of the indolent growth characteristics of this tumor, a more aggressive surgical approach to metastatic tumor foci is recommended.

Carcinoma↗

PubMed1977

Multicentric dermal-type cylindromas of the parotid glands in a patient with florid turban tumor.

Dermal-type cylindromas of parotid glands in a patient with turban tumor, and various adnexal tumors, represent a rare diathesis, apparently not reported previously. A Caucasian man, born in 1916, had a scalpectomy for turban tumor in 1957. In 1957, 1960, and 1974, dermal type cylindromas were excised from portions of both parotid glands, developing from intercalated and striated ducts; they were considered benign, based on long term followup. Adrexal tumors included multiple dermal cylindromas, trichoepitheliomas, eccrine spiradenomas, and Bowen's disease, and occurred on almost all skin surfaces. In November, 1976, a portion of a right parotidectomy included a 3.5 X 3-cm malignant tumor having the characteristics of an invasive poorly differentiated spindle cell epidermoid carcinoma, which showed no evidence of originating from a malignant basal cell tumor. Several encapsulated and developing benign basal cell tumors were included in the specimen. Dermal-type cyclindromas of the parotid gland are considered to be a variant of basal cell ademona, or monomorphic adenoma, basal cell type, since they consist of similar cell components, although of somewhat different arrangement and with prominent focal deposition of hyaline. Dermal-type cylindromas should be excised conservatively as they appear. They must be differentiated from adenoid cystic carcinoma, which is an infiltrating neoplasm and requires a radical surgical approach.

Adolescent↗

PubMed1978

Acinic cell carcinoma of salivary origin. A clinicopathologic study of 67 cases.

This study reviews a 30 year experience with acinic cell carcinoma. The tumor arose in the parotid gland in 64 patients, the submaxillary gland in one and minor salivary glands in two. In untreated patients with small tumors, clinical findings usually suggested a benign mixed tumor and a subtotal parotidectomy which spared the facial nerve was highly effective therapy. In contrast, local recurrence and death was the rule in those few who had locally extensive disease, regardless of how radical an operation was performed. Determine "cure" rates for the entire group were 76, 63 and 55% at 5, 10 and 15 years, respectively. Cervical lymph node metastasis occurred in 16% of the patients, and distant metastasis in 12%. Survival was most directly influenced by the clinical extent of the primary tumor, and also correlated with certain histologic features which are described.

Adolescent↗

PubMed1981

Irradiation of metastatic parotid carcinoma.

Acinic cell carcinomas of the parotid should be considered distinct malignancies despite descriptions of low-grade malignant potential and innocuous histologic patterns. Benign-appearing tumors frequently have a clinically malignant course. Blood-borne metastases may occur early despite gross and microscopic innocence. Indolent growth may be a characteristic of local disease, which may then be approached with less than radical parotidectomy and sacrifice of the facial nerve. These tumors prove to be radiosensitive. More aggressive postoperative irradiation and palliative irradiation is recommended. Two cases of successful palliation of spinal metastases are presented as examples of radiosensitivity of this tumor.

Adenocarcinoma↗