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PubMed1994

Bilateral gustatory sweating as a sign of diabetic neuropathy.

Gustatory sweating is a relatively common sequela to parotidectomy and is almost always unilateral in nature. This article presents a case of bilateral gustatory sweating in a patient with no history of facial trauma or surgery who was undergoing periodontal therapy. A thorough examination determined the cause of diaphoresis to be autonomic neuropathy as a result of a 26-year history of Type II diabetes mellitus. Few cases of this rare complication of diabetes have been described, and the current case represents the first report in the dental literature.

Aged↗

PubMed1993

Acinic cell carcinoma of the parotid gland in childhood.

A 13-year-old girl underwent surgery at the Ear Nose and Throat Department of the Children's Hospital and Scientific Research Institute, Bambino Gesù, Rome, because of an acinic cell carcinoma of the parotid gland. Two years after total parotidectomy with preservation of the facial nerve, metastasis occurred in a lateral cervical lymph node. Acinic cell tumors are uncommon in childhood; in children under the age of 16 years only 35 cases have been reported. There are too few acinar cell carcinomas occurring in children to yield an idea of their natural course. The neoplasm is also referred to as 'acinar cell tumor', in contrast to acinar cell carcinoma, because the neoplasm may be benign or malignant. Unfortunately, there are no histological distinguishing features that permit the pathologist to determine which neoplasm will behave in an aggressive fashion.

Adolescent↗

PubMed1990

Management of the parotid pleomorphic adenoma, the problem of exposing tumour tissue at operation. The logical pursuit of treatment policies.

The objective of treatment of a parotid pleomorphic adenoma is to remove all tumour cells with minimal short- and long-term morbidity and minimal recurrence rates. If an enucleation is carried out, the facial nerve may be put at risk and tumour fragments will inevitably be left in the wound. Most surgeons suggest that after enucleation, radiotherapy must be given to reduce the recurrence rate to an acceptable level. If during a formal superficial parotidectomy the tumour capsule is visualised, the objective of removing the tumour with an intact cuff of normal tissue has failed and the operation has in effect become an enucleation. This paper defines the problem and discusses its management.

Adenoma, Pleomorphic↗

PubMed1994

A clinicopathologic study of parotid gland tumors.

PURPOSE: A review of 121 parotid gland tumors over a 10-year period was carried out. METHODS: The clinical records were retrieved to analyze treatment modalities, history, pathology reports, and sex and age distribution. RESULTS: Pleomorphic adenoma was the most common benign tumor (88.2%), with adenoid cystic carcinoma being the most common malignant tumor (7.4%). Pleomorphic adenoma was more common in women than in men. Clinical signs and symptoms were of no value in distinguishing between malignant and benign tumors. Malignant tumors tended to be more common in the elderly. Subtotal or total parotidectomy was used as the method of treatment.

Adenocarcinoma↗

PubMed1991

Serum amylase of non-parotid and non-pancreatic origin increases on feeding in rats and may originate from the liver.

1. In order to evaluate possible non-salivary contributions to the content of salivary-type amylase in the circulation, parotid glands--the only salivary source of amylase in rats--have been totally removed and the effects on serum amylase have been assessed, after fasting and at different times after feeding. 2. Despite the parotidectomy the resting level of salivary-type amylase remained the same and an increase was still found to occur on feeding. 3. Isoelectric focusing has identified additional isoforms of amylase in serum and liver distinct from those occurring in parotid saliva. 4. The liver therefore may be contributing to the fasting levels of serum amylase and to the increases that occur on feeding, in rats.

Amylases↗

PubMed1985

Long-term results of local excision and radiotherapy in pleomorphic adenoma of the parotid.

Three hundred and eleven patients with primary pleomorphic salivary adenoma of the parotid gland seen between 1950 and 1971 are reviewed. All were managed by a combination of surgery, usually local excision, and irradiation. The minimum follow-up is 10 years. Recurrence rates at 0-5 years and 5-10 years were 1 and 1.5%, respectively, and all recurrences in this period were histologically or clinically benign. This recurrence rate is similar to those reported after superficial parotidectomy. After 10 years, however, the recurrence rate rose, becoming maximal at 15-20 years (4%) and yielding a cumulative risk of recurrence of 8.0% at 20 years. The late recurrences were predominantly malignant tumors. One tumor was probably radiation-induced; the remainder were compatible with spontaneous malignant transformation of benign pleomorphic adenoma, although radiation may have increased the incidence. In the absence of a comparable purely surgical series, this cannot be determined. The recommendation is made that the management of these tumors should be primarily surgical with irradiation reserved for patients presenting surgical difficulties. In addition, prolonged follow-up is necessary since there is a significant incidence of late recurrence and such recurrence may be more likely to be malignant regardless of the primary form of management.

Adenoma, Pleomorphic↗

PubMed1985

Parotid area lymph node metastases from carcinoma of the skin.

From January 1966 through April 1980, 38 patients with squamous cell carcinoma and one patient with basal cell carcinoma of the skin with lymphatic metastases to the parotid area were treated with curative intent at the University of Florida. Fourteen were initially treated with surgery, nine inoperable patients were treated primarily with radiation therapy, and 16 were treated with planned combined therapy, i.e., superficial or total parotidectomies with preoperative or postoperative radiation therapy. The ultimate parotid area control rate for the group treated with radiation alone was 50%; there were no failures at doses above 6500 rad. The parotid area control rate was 88% in the combined-treatment group with no failures when the surgical margins of resection were free; however, when gross residual disease was left behind, only 4 of 6 lesions were controlled. In the surgery-alone group, the ultimate parotid area and neck control rate was only 15%. The major sequela from combined therapy was sacrifice of the seventh nerve at surgery. Treatment methods are discussed.

Aged↗

PubMed1986

Radiation therapy for carcinoma of the pinna using iridium 192 wires: a series of 70 patients.

From January 1970 to November 1982, 70 patients with carcinoma of the pinna were treated by interstitial irradiation. An afterloading technique with Iridium 192 wires was used. One patient recurred and had a total pinnectomy followed by 60 Gy external radiation. This patient was alive without evidence of disease at 134 months. Three patients who had tumors greater than 4 cm in size at presentation developed late necrosis which required subsequent total pinnectomy. Cosmetic results were assessed in 55 patients and were good with few late sequelae (in 78% of cases (36/46) when the tumor measured less than 4 cm, but only in 1/9 when the tumor measured more than 4 cm). We advocate interstitial Iridium 192 irradiation for treatment of pinna tumors smaller than 4 cm. None of 39 patients with squamous cell carcinoma had biopsy proven cervical lymph node metastasis at the time of diagnosis. Four patients with squamous cell carcinoma (4/39: 10%) later developed a regional nodal metastasis after treatment of the pinna. All four relapsed in the parotid region and were managed by partial parotidectomy and neck dissection followed by external irradiation. One of these four patients died from uncontrolled cervical node disease. In our opinion, when regular follow-up is dependable, it is reasonable to save treatment of the cervical nodes for those patients who relapse with involved metastatic cervical nodes.

Adult↗

PubMed1990

Radiotherapy in epithelial tumors of the parotid gland: case presentation and literature review.

A group of 113 patients irradiated for parotid tumor was studied retrospectively. Sixty-two patients were irradiated after superficial parotidectomy or enucleation of a pleomorphic adenoma. None of them had a recurrence after 5-15 years. Sixteen patients were irradiated postoperatively after surgery for a recurrence of pleomorphic adenoma. Only one of them had developed a recurrent tumor. Thirty-five patients with a malignant parotid tumor were treated by irradiation, 22 after surgery and 13 after biopsy only. Patients with a low malignancy tumor (10/11) and adenoid cystic carcinoma (6/12) responded better than patients with a high malignancy carcinoma (2/12). A tumor larger than 4 cm, facial nerve palsy, lymph node metastasis, and inoperability indicate a poor prognosis. With high dose radiotherapy it is possible to treat inoperable tumors successfully. Adenoid cystic carcinomas can respond well to irradiation alone.

Adenoma, Pleomorphic↗

PubMed1990

Carcinoma of the major salivary glands treated by surgery or surgery plus postoperative radiotherapy.

From 1975 to 1987, 87 patients with carcinomas of the major salivary glands (70 parotid and 17 submandibular) were treated at our institution by either surgery or surgery followed by postoperative radiotherapy (RT). Surgical procedures included superficial (24%) or total (56%) parotidectomies and submandibular gland resection (20%). Postoperative RT usually began 2 to 4 weeks following surgery. Using 4 MV photons or, infrequently, 60Co, the majority of patients received 6000 cGy in 6 weeks to the parotid region (ranged from 4500 to 7000 cGy). Determinant actuarial survival was 74% at 5 years and 71% at 10 years. For patients with previously untreated disease, 5 of 19 (26%) treated by surgery alone experienced local recurrence, whereas only 2 of 50 (4%) recurred locally following surgery plus postoperative RT (p = 0.01). For patients presenting with recurrent disease, 4/4 (100%) failed locally following surgery as opposed to 3/14 (21%) following surgery plus postoperative RT (p = 0.01). The determinant 5-year actuarial survival for patients receiving postoperative RT was 75% versus 59% for surgery alone. Results were analyzed by multivariate methods using determinant survival or recurrence as endpoints. Five important prognostic factors were identified. (a) Facial nerve paresis was predictive of poor outcome (p less than 0.001) with 3-year relapse free survival of 13%. (b) Undifferentiated histology was associated with decreased survival (p = 0.002). (c) Male sex was associated with poor outcome (p = 0.008). (d) Skin invasion resulted in decreased survival (p = 0.012). (e) Radiotherapy was associated with improved survival (p = 0.014). In addition, postoperative RT was effective in preventing local recurrence (p less than 0.001). The data demonstrate the efficacy of postoperative RT in improving survival and local control for patients with carcinomas of the major salivary glands.

Adolescent↗

PubMed1992

Radiation therapy as a treatment for benign lymphoepithelial parotid cysts in patients infected with human immunodeficiency virus-1.

Patients who are infected with the human immunodeficiency virus (HIV) may develop benign lymphoepithelial cysts within the parotid gland that cause severe facial deformity. Standard treatment for this disorder has been superficial parotidectomy, repeated fine-needle aspirations or observation alone. These approaches are unsatisfactory because elective surgery in immunocompromised patients should be avoided, the cysts recur soon after aspiration, and observation alone for a treatable deforming facial process is unacceptable. Radiotherapy's proven effectiveness in treating other benign disorders of the parotid gland led us to evaluate its usefulness as a treatment for this disorder. Eight patients with parotid enlargement, who were seropositive for HIV, received 8-10 Gy to the parotids in 1 week. Five patients had complete response and three patients had partial response. All were very satisfied with the cosmetic result. Treatment-related toxicity was well tolerated and consisted of mild xerostomia and transient taste loss. In all cases, these side effects resolved within 1 month. Radiation therapy thus appears to be an effective and well-tolerated treatment for AIDS-related parotid enlargement.

Adult↗

PubMedDate not supplied

The diagnostic value of computed tomography in temporomandibular joint synovial chondromatosis.

Synovial chondromatosis of the temporomandibular joint was diagnosed and location of dens particles was assessed by means of computed tomography. Based upon the data collected, the joint was operated conservatively and most of the calcifications were removed leaving the patient symptom free. The importance of an accurate preoperative diagnosis of synovial chondromatosis by use of CT scan is stressed in view of numerous unnecessary condylectomies and parotidectomies reported in the literature.

Adult↗

PubMedDate not supplied

Metastatic neuroendocrine tumors of the parotid gland.

OBJECTIVES: To present 2 cases of neuroendocrine tumors of the parotid gland and to review the clinical presentation, histopathologic, and immunohistochemical findings and treatment of these rare tumors. STUDY DESIGN: Case series. METHODS: This study reviews 2 patients who both presented with firm masses in the parotid gland diagnosed as neuroendocrine carcinoma by histopathologic and immunohistochemical examination. The evaluation, diagnosis, and treatment are discussed. RESULTS: Both patients underwent complete tumor extirpation via a total or subtotal parotidectomy. Both patients received postoperative radiation therapy and chemotherapy. CONCLUSIONS: Neuroendocrine tumors of the parotid gland are uncommon lesions; however, they have a favorable prognosis as compared to their pulmonary counterparts with early diagnosis and aggressive treatment. Diagnosis is based on the immunohistochemical characteristics of the tumor. Appropriate treatment includes complete surgical excision with postoperative radiation therapy to the parotid bed with the addition of postoperative chemotherapy in patients suspected to have metastatic disease.

Aged↗

PubMedDate not supplied

Undifferentiated carcinoma arising from the Stensen's duct: a case report and review of the literature.

Primary carcinoma arising in Stensen's duct is an extremely rare and poorly understood tumor. A 38-year-old man was referred with a malignant lesion situated in the right cheek. The patient was treated by local resection, total parotidectomy, and modified radical neck dissection. Microscopic examination revealed tumor cells of basaloid pattern with squamous differentiation in some areas. The tumor showed a very aggressive behaviour with early local recurrence and metastatic disease. The histological and radiological findings suggest the origin from the Stensen's duct. Primary carcinoma of Stensen's duct should be histologically consistent with epidermoid, mucoepidermoid, or undifferentiated carcinoma. The diagnosis of true Stensen's duct carcinoma can be performed on the basis of clinical presentation, radiological findings, and tumor histology. Criteria for determination of origin in the duct are revised and compared with this case.

Adult↗

PubMedDate not supplied

Preoperative cytology in the management of parotid neoplasms.

BACKGROUND: This study evaluates the diagnostic role of preoperative cytology of parotid neoplasms. The method is particularly useful in the evaluation of the parotid diseases in which the same clinical features may be treated variously. Fine-needle aspiration biopsy is a simple and well-tolerated diagnostic tool, which provides accurate information for diagnosis and follow-up of the disease. The accuracy of the method partly depends on the operator skill. MATERIALS AND METHODS: From a series of 452 subjects who underwent parotidectomy, preoperative cytological evaluation was available in 310 and compared with histological diagnosis in a retrospective review. RESULTS: The agreement between histotype determination using fine-needle aspiration biopsy and final histological diagnosis was 79%, specificity was 100%, sensitivity was 83%, and diagnostic accuracy was 97%. CONCLUSION: These findings demonstrated that, given the low complication rate, preoperative cytology is particularly useful in diagnosing parotid disease and in planning the surgical strategy and approach.

Biopsy, Fine-Needle↗

PubMed2005

Recurrent pleomorphic adenoma of the parotid gland.

BACKGROUND: Surgery of recurrent pleomorphic adenoma presents an increased risk of facial nerve injury and a considerable re-recurrence rate. METHODS: A series of 33 patients with first recurrence of pleomorphic adenoma of the parotid gland was analyzed. The data were derived from medical records as well as from interviews and clinical examinations of all living patients. Histologic material of the initial and recurrent tumor were reviewed. RESULTS: Multifocal recurrence and carcinoma in pleomorphic adenoma were observed in 73% and 9% of patients, respectively. The incidence of permanent partial facial nerve injury after surgery was 23% in patients with initial enucleation and 14% in those with initial superficial parotidectomy (including 1 patient with facial nerve resection and 1 patient with a partial facial paresis before recurrence surgery). A subsequent recurrence occurred in 6 patients, all with initial enucleation after a mean time interval of 9 years. CONCLUSIONS: The preservation of the facial nerve was possible in all but 1 patient treated for the first recurrence with a relatively low rate of permanent partial facial paresis because of the use of the operating microscope and facial nerve monitor. To evaluate the re-recurrence rate, a follow-up of at least 10 years is necessary.

Adenoma, Pleomorphic↗

PubMed2004

Management of lipomas arising from deep lobe of the parotid gland.

OBJECTIVES: We would like to present our experience in management of lipomas arising in the deep lobe of the parotid gland, which were diagnosed and operated in our clinic from the point of complication/morbidity, and recurrence, in line with the literature. MATERIAL AND METHODS: Five patients with lipoma found in the deep lobe of the parotid gland, diagnosed and treated at our clinic in the 12-year period between March 1992 and March 2004, were included in this study. Limits of the tumors were determined by computed tomography (CT), and/or magnetic resonance imaging (MRI). Preoperative fine needle aspiration biopsy (FNAB) was also performed. Through a classic parotidectomy incision, the parotid gland was exposed. Full exposure of the facial nerve and its branches was performed. The removal of deep lobe parotid lipomas was achieved by enucleation in all cases. Postoperative complication/morbidity and recurrence were evaluated. RESULTS: The most common symptom was an otherwise asymptomatic mass on the parotid region and/or upper lateral neck. One of five patients was presented with medial displacement of the lateral pharyngeal wall, and tonsil as the additional physical finding. Preoperative radiologic evaluation results revealed that CT and/or MRI scans accurately localized 100% of the tumors in relation to the deep lobe of the parotid gland. FNAB did not enable us to make a diagnosis of lipoma in four of the cases. Total resection was achieved in all cases. Temporary facial nerve paralysis, due to the dissection of the facial nerve, did not occur in any cases. There was no recurrence of the tumors after a mean follow-up of 60 months. CONCLUSION: Assessment of the exact location of the tumor is an important consideration for selection of the appropriate surgical approach. Different from lipomas found in other locations, those observed in the parotid gland cannot be easily resected by simple dissection. Resection of these tumors requires full exposure of the facial nerve.

Adult↗

PubMed2005

Large cell neuroendocrine carcinoma of the parotid gland: case report and literature review.

A 74-year-old male presented with a large polinodular mass in the neck. Fine needle aspiration cytology (FNAC) showed an undifferentiated large cell carcinoma. Computed tomography (CT) showed a large parotid mass with multiple satelite nodules. The remaining radiological studies were normal. Radical parotidectomy was performed. The tumor was a large cell carcinoma with neuroendocrine features and positive immunostain for neuroendocrine markers. The patient received postoperative radiotherapy and was free of tumor eight months later. Only four cases of large cell neuroendocrine carcinoma (LCNEC) of the salivary gland have been communicated. All of them have involved the parotid gland. This tumor presents in elderly patients as a large infiltrating parotid mass. Fine needle aspiration cytology serves to recognize the carcinoma, but it fails in recognizing the neuroendocrine features of the tumor. The histopathological features of this tumor are the same as in other organs. Chromogranin and synaptophysin are useful immunohistochemical markers. A primary location of the tumor in another organ, specially the lung, should be ruled out. Surgery is the main treatment modality and can be complemented with postoperative radiotherapy. The prognosis seems to be poor. More studies are needed to better define the therapeutical alternatives and prognostic factors of these rare tumors.

Aged↗