SEARCH · PubMed Health

Results for “parotidectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources

PubMed2004

Surgical anatomy of the parotid duct with emphasis on the major tributaries forming the duct and the relationship of the facial nerve to the duct.

Although there is a great amount in the literature to describe the anatomy of the parotid gland as a whole, little attention is given to the parotid duct. The purpose of this study is to examine the surgical anatomy of the parotid duct with special emphasis placed on the major tributaries forming the parotid duct and the relationship of the facial nerve to the duct. Twenty-nine fresh cadaver halves were dissected and the branching pattern of the ducts, position within the parotid, and their relationship to the facial nerve were studied. Of the complete heads studied, the parotid duct had the same pattern in 78.6% on the right and left sides. The parotid ducts in 31.0% of the half heads presented as a single discernible duct from parotid papilla to within the gland. In 62.1% of the half heads, the ducts were formed by a branching pattern within the gland. In the ducts with a branching pattern, 48.3% displayed a bifurcated pattern, 6.9% were trifurcated, and 6.9% had multiple branches. In 6.9% of the half heads studied, the parotid ducts bifurcated distal to the parotid gland. In all cases, the deep lobe of the parotid enveloped the parotid duct; only small ductules connected the superficial lobe with the duct. The facial nerve and its branches were always observed lateral to the parotid duct. Because one dissects lateral to the facial nerve during a superficial parotidectomy, generally the parotid duct remains intact and potential complications such as facial paralysis, sialoceles, and fistulizations are thereby minimized.

Cadaver↗

PubMed2003

Fine-needle aspiration biopsy of a cystic pleomorphic adenoma with extensive adnexa-like differentiation: differential diagnostic pitfall with mucoepidermoid carcinoma.

Although fine-needle aspiration biopsy (FNAB) is a highly accurate tool for the diagnosis of pleomorphic adenomas, even this common salivary gland neoplasm can be diagnostically challenging and cause pitfalls in cytodiagnosis. In particular, the presence of either cystic degeneration or squamous and mucinous metaplasia can lead to a false positive diagnosis of malignancy. Here we present the case of a 16-year-old female who presented with a painless, slowly growing mass in the superficial lobe of the right parotid gland. Magnetic resonance imaging of the parotid demonstrated a mass with heterogeneous postcontrast enhancement and a central, nonenhancing area suggestive of necrosis. FNAB of the lesion yielded proteinaceous debris and numerous whorls of keratin, small cohesive clusters of basaloid and squamoid epithelial cells, and many vacuolated and foamy cells. Initially and after consultation at an outside institution, the FNAB was reported as an "atypical neoplasm, cannot exclude mucoepidermoid carcinoma." A total, nerve-sparing parotidectomy and level II neck dissection revealed a pleomorphic adenoma with central cystic degeneration and extensive mixed appendageal differentiation. While foci of squamous metaplastic changes may occur in pleomorphic adenomas, the combination of cystic degeneration and extensive appendageal differentiation with numerous keratotic cysts is rare, and it presents the potential for misinterpretation of the FNAB as indicative of malignancy in general, and mucoepidermoid carcinoma in particular.

Adenoma, Pleomorphic↗

PubMed2005

Fine-needle aspiration biopsy of cystic pleomorphic adenoma with adnexa-like differentiation mimicking mucoepidermoid carcinoma: a case report.

Although pleomorphic adenomas (PAs) usually can be diagnosed very accurately with fine-needle aspiration biopsy (FNAB), even this common salivary gland neoplasm can be diagnostically challenging and cause pitfalls in cytodiagnosis. In particular, the presence of either cystic changes or squamous, mucinous, or sebaceous metaplasia can lead to a false positive diagnosis of mucoepidermoid carcinoma (MEC). Here, we present a case of a 70-yr-old man with an asymptomatic left deep lobe parotid mass for which CT-guided FNAB was performed. The FNAB cytology revealed cohesive clusters of squamous epithelial cells, sebaceous cells, oncocytes, macrophages, and rare myoepithelial cells. Characteristic metachromatic fibrillar chondromyxoid stroma, which usually is seen in PAs, was not seen in the aspirate. Although cytodiagnosis of PAs was suggested based on the presence of other cellular components, resection was recommended. The subsequent parotidectomy specimen revealed an encapsulated cystic PA with mixed appendageal differentiation including areas of squamous, mucinous, sebaceous, and oncocytic metaplasia. Chondromyxoid stroma was only focally present. Presence of squamous, mucinous, and/or sebaceous metaplasia, especially in the absence of chondromyxoid stroma, presents the potential for misinterpretation of the FNAB as indicative of malignancy in general and MEC in particular.

Adenoma, Pleomorphic↗

PubMed2005

Spontaneous infarction of a pleomorphic adenoma in parotid gland: diagnostic problems and review.

Although infarction of parotid gland pleomorphic adenoma (PA) following fine-needle aspiration (FNA) has been well-documented, spontaneous infarction of PA has remained as an uncommon entity in the literature. To our knowledge, we report the second case of spontaneous infarction occurring in a parotid gland PA. A 44-yr-old man presented with a 2-yr history of slowly enlarging right parotid mass, which had become painful 1 mo before performing FNA biopsy. Smears revealed abundant necrotic debris, atypical squamous cells, and small cells with dark nuclei suggestive of a carcinoma. Histologic examination of the tissue fragments demonstrated degenerated clusters of cells and chondromyxoid matrix. The parotidectomy specimen had features consistent with those of an infarcted PA. Although appears to be rare, spontaneous infarction of PA should be considered in the differential diagnosis, since necrosis may mimic carcinoma and cause misinterpretation of necrosis as an indication of malignancy, in an otherwise benign salivary gland neoplasm.

Adenoma, Pleomorphic↗

PubMed2002

Desmoplastic neurotropic melanoma of the head and neck: the role of radiation therapy.

BACKGROUND: Desmoplastic neurotropic melanoma (DNM) is an uncommon cutaneous melanoma variant with pronounced neurotropism. In contrast to ordinary melanomas, locoregional recurrences are common and distant metastasis are uncommon in patients with DNM. Local control with surgery and radiation therapy may assume a more important role in this variant of melanoma. We present a case of an unresectable skull base recurrence of DNM that was controlled using radiation therapy alone and review the literature. METHODS: Case report with 36-month follow-up. RESULTS: The patient is a 68-year-old with multiple recurrences of a DNM that originated on the forehead. After extensive surgery, including total parotidectomy and temporal bone resection, the patient had an unresectable recurrence of the skull base develop. This was treated with definitive radiation therapy, resulting in a complete response. The patient has had no evidence of recurrence at 3 years. CONCLUSIONS: DNM is a locally aggressive type of melanoma with a high risk of local recurrence that can be radioresponsive. The incidence of distant metastasis is low, so aggressive treatment to control local disease is warranted. This may include surgery plus adjuvant radiation therapy or definitive radiotherapy for unresectable recurrences.

Aged↗

PubMed2003

Treatment of gustatory sweating (Frey's syndrome) with botulinum toxin A.

BACKGROUND: Gustatory sweating is a common complication of parotid surgery. Injection of botulinum toxin A has been reported as a safe and effective treatment option for patients with Frey's syndrome. PATIENTS AND METHODS: A total of 69 patients who had undergone superficial parotidectomy because of adenoma were evaluated with respect to the incidence of Frey's syndrome and treatment interest. Minor's iodine starch test was used to detect the affected skin area. Affected skin areas were documented using a digital camera; skin areas were evaluated morphometrically. A single injection of Botox per 1 cm(2) skin field was administered to those patients interested in treatment. RESULTS: Of 43 patients (62%) with gustatory sweating, 33 patients requested treatment. The affected skin area varied from 16 cm(2) to 81 cm(2). The individual Botox dosage ranged from 16 to 80 IU. All relevant clinical symptoms of sweating disappeared within 1 week after a single injection. Treatment was well tolerated with no side effects. CONCLUSION: Botox A injection is a safe and effective treatment with long-lasting effects for patients with extensive gustatory sweating.

Adenoma↗

PubMed2003

Benign metastasizing pleomorphic adenoma of the parotid gland: a clinicopathologic puzzle.

BACKGROUND: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgical treatment (lateral or total parotidectomy) has been described in 1% to 5% of cases. Malignant degeneration has been reported in 2% to 9% of cases of pleomorphic adenoma of salivary gland origin. Metastasizing pleomorphic adenomas without histologic evidence of malignancy have rarely been reported. Metastatic lesions have been discovered in bone, lymph nodes, the lung, oral cavity, pharynx, skin, liver, retroperitoneum, kidney, calvarium, and central nervous system. To the best of our knowledge, we hereby report the first case of pleomorphic adenoma of the parotid gland metastasizing to the ipsilateral maxilla. METHODS: We simultaneously examined apoptosis-related protein expression and markers of cell-proliferation activity in our case of benign pleomorphic adenoma metastasis and compared outcome with a control group of primary parotid pleomorphic adenomas. RESULTS: Analysis of p53, Bcl-2, MIB1, CD 105, p27, and p21 expression did not reveal significant differences between metastasizing pleomorphic adenoma of the salivary gland and the control group of primary parotid pleomorphic adenomas. CONCLUSIONS: Clinical rather than pathologic evidence seems to justify inclusion of metastasizing salivary pleomorphic adenoma in the group of low-grade malignant salivary tumors.

Adenoma, Pleomorphic↗

PubMed2004

Acinic cell carcinoma of the parotid gland presenting as an external auditory canal mass.

BACKGROUND: The fissures of Santorini have long been known as a gateway for disease to pass from the external auditory canal to the periparotid and neck spaces. Although anatomically understandable, description of disease that originates in the parotid gland and extends through the fissures to the external auditory canal is rare. This is, in fact,the first presentation of such a patient at our institution in a previously untreated patient. METHODS: A 43-year-old woman was seen with a mass in her right external auditory canal. Further evaluation found this to be the presenting finding of a parotid neoplasm. The patient also had a right marginal mandibular paresis. Biopsy of the external auditory canal mass provided a diagnosis of an acinic cell adenocarcinoma. She underwent a right lateral temporal bone resection, type III modified neck dissection, and radical parotidectomy with facial nerve sacrifice and rectus abdominus reconstruction with facial nerve grafting. RESULTS: Pathologic examination of the specimen revealed an acinic cell carcinoma of the right parotid gland with focal dedifferentiation into a high-grade adenocarcinoma. CONCLUSIONS: Care should be taken with auditory canal masses to remember the possibility that disease is extending from the parotid through the fissures of Santorini, and evaluation and management should proceed accordingly.

Adult↗

PubMed2005

A case of mucormycosis limited to the parotid gland.

BACKGROUND: Mucormycosis is a rare fungal infection commonly affecting structures in the head and neck such as air sinuses, orbits, and the brain. Common predisposing factors include diabetes and immunosuppression. To date, only one case of mucormycosis involving the parotid gland has been reported, and this infection was associated with a fatal outcome. METHODS: We report a case of parotid gland mucormycosis in a 45-year-old woman with type 2 diabetes, who was successfully treated with a superficial parotidectomy and intravenous amphotericin B. RESULTS: After initial surgical and antifungal therapy, the patient was left with a residual facial nerve palsy for which multiple sling procedures were performed. She is currently alive and well 6 years after the diagnosis of mucormycosis. CONCLUSIONS: Mucormycosis of the parotid gland is a rare form of this often-fatal infection. In this case, infection remained isolated to the parotid gland and was diagnosed soon after presentation. The patient most likely survived because of the early diagnosis, successful surgical removal of all infected tissue, use of intravenous amphotericin therapy, and the aggressive management of comorbidities such as her diabetes.

Amphotericin B↗

PubMed2006

Effect of immunocompromise on metastatic cutaneous squamous cell carcinoma in the parotid and neck.

BACKGROUND: Our aim was to examine the effect of a compromised immune state on the outcomes in patients treated for metastatic cutaneous squamous cell carcinoma (SCC). METHODS: A retrospective analysis of patients with metastatic cutaneous SCC to the parotid and neck treated at Greenlane Hospital between 1992 and 2002 was conducted. Outcomes were compared between immune-competent and immunocompromised patients. A logistic regression analysis of likely risk factors for poor outcome was done. RESULTS: Forty-nine patients were identified, nine of whom were immunocompromised. All patients were treated by parotidectomy and/or neck dissection. The facial nerve was sacrificed in 42% of the patients. Thirty-seven patients underwent postoperative radiotherapy (76%). Recurrence was significantly more common in the immunocompromised group (56% vs 28%), with higher rates of local and distant recurrence. Survival at 1 and 2 years was reduced. CONCLUSION: Immunocompromise has a significant impact on the outcome of metastatic cutaneous SCC to the parotid and neck, affecting recurrence and survival.

Aged↗

PubMed2006

Squamous cell carcinoma of the parotid gland.

BACKGROUND: Our objective was to evaluate the outcome of patients treated for squamous cell carcinoma (SCC) of the parotid gland. METHODS: We conducted a retrospective chart review of the tumor registry from 1982 through 2003 at a tertiary referral medical center. Patients with SCC of the parotid gland were identified and followed for a minimum of 2 years after therapy. RESULTS: SCC involving the parotid was identified in 66 patients. The tumor was a metastasis from a known primary site in 41 patients (62%). In 16 patients (24%), no other primary site was identified, and the tumor may have originated in the parotid gland. Nine patients (14%) were undetermined. Therapy frequently included surgery. The integrity of the facial nerve was preserved in 92% of surgical patients. Only eight patients initially had clinical evidence of cervical metastasis; however, cervical metastasis was identified in 25 patients (44%), changing the course of therapy. CONCLUSION: SCC of the parotid gland was metastatic from a known primary tumor in more than half of the patients. The most common site of the primary tumor was a cutaneous malignancy of the head and neck. The high incidence of cervical lymph node involvement underscores the diagnostic and therapeutic importance of neck dissection with parotidectomy.

Adult↗

PubMed2006

Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck.

BACKGROUND: Among patients with cutaneous squamous cell carcinoma (SCC) of the head and neck, recent studies have shown that those with involvement of the parotid gland also have a high incidence of neck node involvement. Treatment of the neck by either surgery or radiotherapy is therefore recommended among patients with parotid SCC, even if clinical examination is negative. The aim of this study was first to analyze patterns of metastatic spread in the parotid and cervical lymph nodes and then to correlate the pattern of involved nodes with the primary cutaneous site in order to guide the appropriate extent of surgery, should neck dissection be used to treat the neck in patients with parotid SCC. METHODS: A cohort of 209 patients with cutaneous SCC of the head and neck and clinically evident regional metastatic disease was reviewed retrospectively from 3 Australian institutions. The distribution of involved nodes was obtained from pathology reports; the anatomic sites of primary cutaneous cancers were then correlated with these findings. RESULTS: Among 209 patients, 171 (82%) had clinical parotid involvement. Of these, 28 had clinical neck disease, whereas 143 had parotid disease alone. Thirty-eight (18%) patients had neck disease only. A total of 199 patients were treated surgically, whereas 10 received radiotherapy alone. Surgery included 172 parotidectomies and 151 neck dissections (93 of which were elective). Primary sites were cheek (21.7%), pinna (20.4%), temple (15.8%), forehead (15.8%), postauricular region (5.9%), neck (5.3%), anterior scalp (5.3%), posterior scalp (3.3%), periorbital (3.3%), nose (2.6%), and chin (0.6%). Among pathologically positive necks, level II was most frequently involved (79%). Level IV (13%) and level V (17%) were only involved in extensive lymph node disease, the exception being for isolated level V metastases from the posterior scalp. CONCLUSIONS: Primary sites were mainly localized to the lateral aspect of the head. Among patients with cutaneous SCC involving the parotid and neck, level II was the most commonly involved neck level. The distribution of involved nodes suggests that in a patient with parotid involvement and a clinically negative neck with an anterolateral primary, a supraomohyoid neck dissection, always including the external jugular lymph node(s) would be appropriate. In the case of a posterior primary, level V should be dissected as well. In patients with parotid SCC and a clinically positive neck, a comprehensive neck dissection is recommended.

Adult↗

PubMed2006

Permanent unilateral hearing loss after radiotherapy for parotid gland tumors.

BACKGROUND: The purpose of this retrospective study was to determine the long-term effects of radiotherapy on hearing function in patients who underwent parotidectomy and postoperative radiotherapy for unilateral tumors of the parotid gland. METHODS: An extensive set of tests was used to measure hearing loss. The mean dose on middle ear, cochlea, and Eustachian tube was estimated with a CT-planning system. RESULTS: A hearing loss of > or = 15 dB in 3 frequencies was found in 32% of the 52 patients included in the study. Patients with an asymmetrical hearing loss received a higher mean dose on the hearing structures (p < .002). The threshold dose for clinically relevant hearing loss was found at 50 Gy on the cochlea and Eustachian tube. CONCLUSIONS: Radiation-induced hearing loss is a common complication. A mean dose of > 50 Gy on the cochlea should be avoided.

Adult↗

PubMed2006

Malignant blue nevus of the parotid gland: A case report.

BACKGROUND: Malignant blue nevus is a highly aggressive tumor arising from a background of benign blue nevus. Extensive review of the medical literature revealed a few reported cases of this transformation from cutaneous origin. We report the first case of blue nevus of the parotid gland and its malignant transformation within this gland. METHODS: A 62-year-old woman presented to our clinic with sudden onset parotid mass. After a superficial parotidectomy, histologic examination of the specimen was performed. Features compatible with blue nevus with focal region of atypical mitotic activity were evident. The diagnosis of malignant blue nevus was confirmed by immunohistochemical studies. RESULTS: We report the first case of malignant transformation of blue nevus within the parotid gland. CONCLUSIONS: We found this lesion to be highly aggressive and to have metastasized shortly after diagnosis.

Antigens, Neoplasm↗

PubMedDate not supplied

Carcinosarcoma (malignant mixed tumor) of the parotid: report of a case with a pure rhabdomyosarcoma component.

BACKGROUND: Carcinosarcoma or true malignant mixed tumor of the parotid gland is extremely rare, accounting for < 1% of all salivary gland malignancies. METHODS: A 63-year-old woman presented with a 5-cm right parotid mass which was resected with a radical parotidectomy and infratemporal fossa dissection. RESULTS: The tumor contained two distinctive histologic patterns, that of a poorly differentiated ductal carcinoma and a pleomorphic rhabdomyosarcoma. Additionally, a residual focus of pleomorphic adenoma was present peripherally. Immunohistochemical and electron microscopic studies confirmed the skeletal muscle differentiation. CONCLUSIONS: The pattern of combined rhabdomyosarcoma and ductal carcinoma has not been previously reported and adds further evidence to the myoepithelial derivation of these tumors.

Carcinosarcoma↗

PubMedDate not supplied

Benign parotid adenomas: a review of the Princess Margaret Hospital experience.

BACKGROUND: The morbidity of treating benign parotid tumors is an important issue because the majority of patients are young. We therefore undertook this study to evaluate the outcome for these patients treated at the Princess Margaret Hospital. METHODS: A retrospective review was conducted on all patients registered with benign parotid tumors between 1970 and 1987. RESULTS: Seventy-six patients were included in this review; postoperative radiotherapy (XRT) was administered to 55 patients. Median follow-up time was 12.5 years. Postoperative XRT was particularly important for patients with recurrent disease. The risk of both temporary and permanent facial nerve paralyses increased with each operation. No patients in this study developed a malignancy. CONCLUSIONS: We recommend that all patients with benign parotid tumors be treated with a complete parotidectomy with preservation of the facial nerve. Consideration to postoperative XRT should be given to patients in whom there was tumor spillage, residual disease, or recurrences.

Adenoma↗

PubMedDate not supplied

Radical, modified, and selective neck dissection for cutaneous malignant melanoma.

BACKGROUND: The roles of modified and selective neck dissections in treating patients with clinical metastatic melanoma and the place of adjuvant radiotherapy are unclear. In the elective setting, the efficacy of various selective dissections also requires clarification. METHODS: The prospectively documented experience of the senior author (COB) was analyzed. A total of 175 patients had 183 neck dissections and 92 parotidectomies in 6 years. There were 75 therapeutic and 108 elective operations. Modified or selective neck dissections were performed in 58% of patients with clinical neck metastases. Ali but two elective operations were modified or selective dissections. Postoperative radiotherapy was given to 27 dissected necks. Minimum follow-up was 12 months, and 86% of patients were followed up for 2 years or to neck recurrence. RESULTS: Nodes were histologically positive in 80 dissections. The cumulative rate of control of metastatic melanoma in the neck was 86% at 5 years. Neck recurrence developed in 14% of radical dissections, 0% of modified, and 23% of selective dissections performed for clinical disease. Neck recurrence occurred after 5% of elective dissections. Recurrence was 7% among irradiated necks compared to 23% in nonirradiated (p-value not significant). The 5-year survival rate was 50%, and this was significantly worsened by increasing node involvement. CONCLUSIONS: Modified radical neck dissection is highly effective in controlling metastatic melanoma in selected patients. Selective dissections are less effective and need further study. Adjuvant radiotherapy appears to decrease the risk of neck recurrence. In the elective setting, recurrence is uncommon following the selective neck dissections described.

Adolescent↗

PubMedDate not supplied

Melanoma of the conjunctiva--a rational approach to management.

Eleven of 12 patients treated for invasive melanomas of the conjunctiva at the UCLA Hospitals from 1955 to 1976 revealed data sufficient for evaluation. Of these 11 cases, 4 died from 3 to 13 years after treatment as a result of the disease. The plan presented for surgical management of melanosis is based on histologic criteria and on the anatomic location of the tumor. In this series, such management ranged from local excision of noninvasive melanotic lesions to orbital exenteration with parotidectomy and radical neck dissection for invasive melanomas that involved the palpebral conjunctiva or caruncle. Extended follow-up is needed in all patients.

Adult↗