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PubMed2002

Stylomandibular tenotomy in the transcervical removal of large benign parapharyngeal tumours.

We used a simple modification of the transcervical approach in a selected group of nine patients with large benign parapharyngeal space tumours, all of whom met the following inclusion criteria: The tumour was benign on fine needle aspiration, the encapsulated tumour was not attached to skull base or great vessels in the parapharyngeal space on imaging. Adequate exposure was achieved by just dividing the stylomandibular ligament and retracting the mandible anteriorly. It was possible to remove the tumours successfully and safely in all nine patients without the need for mandibulotomy or superficial parotidectomy. In seven cases, the tumour crossed the midline. There were no major perioperative neurological or vascular complications. On subsequent follow up, there were no clinical or radiological signs of residual or recurrent tumour.

Humans↗

PubMed1997

The accuracy of clinical examination versus frozen section in the diagnosis of parotid masses.

PURPOSE: This study evaluated the role of clinical examination and frozen sections in the diagnosis and management of parotid masses. PATIENTS AND METHODS: One hundred seventy patients underwent parotidectomy. Of these, the data on 65 were analyzed, with emphasis on accuracy of the clinical diagnosis and frozen section results compared with the final histologic diagnosis. RESULTS: The results showed that the sensitivity of frozen sections for malignancy was 93.3%, and the specificity for a benign tumor was 95.74%, with a 4.2% false-negative rate and a 6.7% false-positive rate. Of the 65 patients, 58 patients had an explicit clinical diagnosis; 88.4% were correctly identified as benign tumors, and 78.6% were correctly diagnosed as malignancies. The false-positive and false-negative rates were 21.4% and 7.0%, respectively. CONCLUSIONS: The results of this study suggest that clinical examination can provide information that is not very reliable, and the surgical plan should be based on intraoperative frozen sections rather than the history and clinical features.

Adolescent↗

PubMed1976

Results of radical treatment of cancer of the parotid gland.

Twenty-five patients with different histological variants of malignant tumours of the parotid gland have been treated by parotidectomy combined with interstitial radiotherapy with delayed afterloading and dose fractionation during the operation. The indications for this therapeutic approach and the techniques used are described. The follow-up of the patients ranging from one to over five years showed only two local recurrences, although most of the patients were in an advanced stage locally. Complications due to the irradiation have not been observed.

Adolescent↗

PubMed1977

Haemangiomas of the parotid gland in children.

The authors present the case histories of 40 intraparotid haemangiomas, in 11 of which they achieved healing after radical surgical treatment (parotidectomy). Since 1971, the authors have adopted a conservative approach (not surgical), seeing that most of the cases involute spontaneously up to complete healing. None of the 29 cases treated conservatively has undergone exacerbations of the process, after the age of 6-9 months. No emergency surgical operations were required.

Child, Preschool↗

PubMed1999

Intraductal papillary carcinoma of the parotid gland with low malignancy.

A peculiar case of papillary carcinoma arising in the parotid gland is reported. A 68-year-old woman presented with a right, painless, parotid mass, measuring approximately 3 cm in greatest diameter. A conservative parotidectomy was performed. Histologically, the neoplasm showed exophytic papillary projections into a cavity. The cells were focally suggestive of epidermoidal differentiation, whereas a transitional differentiation was noted in other portions, as in bladder papilloma. Immunohistochemical studies showed strong positivity of the neoplastic cells for cytokeratin and weak positivity for PCNA and Mib-1. We classified this neoplasm among the papillary tumors with a low-grade of malignancy.

Aged↗

PubMed2003

Epithelial-myoepithelial carcinoma of the parotid gland.

We report a rare case of epithelial-myoepithelial carcinoma (EMC) of the parotid gland. A 70-year-old man presented with a 4-months-history of right-sided subauricular swelling. Computed tomographic scans revealed a well-defined mass with cystic lesion, measuring about 40 mm in diameter, in the right parotid gland. Because the tumor occupied superficial lobe, he underwent superficial parotidectomy with preservation of the facial nerve. On the basis of the histological and immunohistochemical findings, the tumor was diagnosed as EMC. His post-operative course was uneventful, and he is currently free from disease 6 months after surgery. Diagnosis, clinical behavior and treatment of EMC are reviewed from perusal of the literature.

Aged↗

PubMed2003

Malignant fibrous histiocytoma of the parotid gland.

Primary malignant fibrous histiocytoma (MFH) arising in a major salivary gland is rare. We encountered a case of MFH affecting the parotid gland. The patient was a 54-year-old man diagnosed as having pleomorphic type of MFH after extended total parotidectomy. Examination of the resected specimen revealed the tumor had not been completely removed. Accordingly treatment consisted in the resection of MFH and radiotherapy in combination with chemotherapy using carboplatin (CBDCA). This postoperative therapy was effective in controlling the growth of the remaining tumor tissue. As the patient showed no signs of local recurrence and distant metastasis for 5 years, plastic surgery was performed to improve the serious deformation of the face with a free anterolateral thigh flap. Our literature review yielded 17 cases of parotid MFH and the 2-year survival rate was 33%.

Antineoplastic Agents↗

PubMed2003

Clinicopathological study of undifferentiated carcinoma of the parotid gland.

OBJECTIVE: Undifferentiated carcinoma of the salivary gland is a rare malignant tumor, and is difficult to distinguish from other poorly differentiated types of carcinoma or sarcoma. The present study investigated clinical and pathological characteristics for undifferentiated carcinoma of the parotid gland. PATIENTS AND METHODS: Forty-four patients with previously untreated carcinoma of the major salivary glands were treated at our institution between 1986 and 1999. Of these, five patients (two males, three females) were diagnosed with undifferentiated carcinoma of the parotid gland and treated. For histological reinvestigation, multislices of resected specimens were made and diagnosed. RESULTS: Although all patients were treated by radical surgery (more than subtotal parotidectomy), all died of distant metastasis, including two patients with locoregional relapse. Tumors in these two patients included a small portion of poorly differentiated epidermoid or mucoepidermoid carcinoma. The remaining three patients did not show any differentiated portions, and histological findings demonstrated heterogeneous patterns of lymphoepithelial carcinoma, small cell carcinoma and unclassified (a pattern of malignant hemangiopericytoma), respectively. CONCLUSIONS: Investigation using multislice sections is needed to diagnose undifferentiated carcinoma of the salivary glands. Regarding prognosis, carcinoma that is too poorly differentiated but including slightly-differentiated portions should be considered undifferentiated carcinoma. All patients died of distant metastasis despite radical surgery, suggesting that chemotherapy is needed to improve patient outcomes.

Aged↗

PubMed1992

Tuberculosis of the parotid salivary gland.

An interesting and rare case of tuberculosis involving a parotid gland is discussed. Although pulmonary tuberculosis is not uncommon in Turkey, primary parotid gland involvement is rare. The patient was treated by parotidectomy and antituberculous chemotherapy.

Drug Therapy↗

PubMed1982

Malignant lymphoma of the parotid gland.

A case of malignant lymphoma of the parotid gland was described. A 15-year-old male developed a mass which was a firm and non-tender. The patient underwent a superficial parotidectomy with preservation of the facial nerve. The tumor was a grey, soft mass, 3 X 4 X 4 cm in size. On microscopic examination, the tumor was intraglandular lymph node with invasion of salivary gland tissue. The tumor cells were seen between acini and ducts. A diagnosis of lymphosarcoma, prolymphocytic, nodular type was made according to the WHO's classification system and the patient was refered for radiation therapy. Further investigations, including radio-isotope scanning of liver, spleen and bone and a biopsy of bone marrow revealed no sign of the disease. The patient was treated with 5380R of cobalt irradiation and in follow-up of a one year's duration there was no recurrence. Our case fulfilled the criteria which was represented by Hyman and Wolff and we reviewed the literature of this condition.

Adolescent↗

PubMed1996

A chronic organized masseter abscess causing trismus resolved by hemi-masseter myotomy.

We present a 62-year-old patient with a chronic organized abscess of the right masseter muscle that developed following parotidectomy. This patient's chronic abscess originated from an infection in the masticator space from the second molar. Cases of repeated parotitis should lead one to suspect a masticator space infection. In this case, the cicatricical masseter muscle produced severe trismus. Total eradication of the abscess and myotomy of the masseter resolved the problem completely. We should pay attention to the dental condition in case of masticator space infection, especially in case of masseter muscle infection mimicking parotitis.

Abscess↗

PubMed1999

Primary non-Hodgkin's lymphoma of brachial plexus.

We report the case of a 65-year-old man with non-Hodgkin's lymphoma (NHL) not only in the brachial plexus but also in the central nervous system and parotid gland. He was referred to our hospital for evaluation of a right parotid mass. He also presented with bilateral facial palsy and paralysis of the left superior limb. Computed tomography scan and magnetic resonance imaging revealed mass lesions in the right parapharyngeal space, the deep lobe of the right parotid gland. and the left brachial plexus. A gallium-67 citrate scan demonstrated abnormal uptake in the left brachial plexus. These symptoms and lesions improved during steroid therapy. However, the symptoms worsened again after steroid therapy was discontinued. We performed a right parotidectomy to confirm the diagnosis. Histopathological study revealed NHL. He was treated with combination chemotherapy, and most of the lesions and symptoms, except bilateral facial palsy, improved. Despite follow-up treatment, a brain metastasis occured, and he died 16 months after the onset of symptoms.

Aged↗

PubMed1990

Benign cysts of the parotid gland.

Benign cysts of the parotid gland are not frequently diagnosed. They occur in any portion of the parotid gland and may be difficult to diagnose. They present with considerable histological variation in their linings. Three cases are presented of unilocular benign cystic lesions of the parotid gland that have been treated by superficial parotidectomy. Two of them were lined by a single or pseudostratified layer of cuboidal epithelium and were diagnosed as retention cysts. The third was a lympho-epithelial cyst and was lined by stratified squamous and partially by pseudostratified ciliated columnar epithelium. A review of the relevant literature is also presented.

Adolescent↗

PubMed1993

Local capsular dissection of parotid pleomorphic adenomas.

Local capsular dissection as described by HANCOCK11 for the treatment of parotid pleomorphic adenomas is discussed. The results of 71 primary parotid pleomorphic adenomas are described, including a 5.6% recurrence rate. This method has the advantage that less facial nerve weakness and Frey's syndrome are seen than with superficial or complete parotidectomy. The recurrence rate appeared to be somewhat higher than with most other series.

Adenoma, Pleomorphic↗

PubMed1993

Acinic cell carcinoma arising in a parotid lymph node.

The case of a 37-year-old woman with primary acinic cell carcinoma arising in an intraparotid lymph node is presented. The patient is free of disease 20 months after superficial parotidectomy. This is probably the first histologically documented case of acinic cell carcinoma arising from intranodal salivary gland tissue. Awareness of possible malignant alteration of ectopic salivary gland tissue in lymph nodes is essential.

Adult↗

PubMed2003

Synchronous tumours of the unilateral parotid gland: rare or undetected?

INTRODUCTION: Multiple tumours of the parotid gland with the same histological appearance may occur as synchronous unilateral tumours, but bilaterality has also been reported. Synchronous multiple unilateral parotid tumours with different histology remain rare. METHODS: Between January 1988 and May 2002, a total of 341 patients underwent parotidectomy in our department. Medical charts were reviewed retrospectively for synchronous multiple unilateral tumours. RESULTS: Fourteen patients had two or more tumours within the same specimen. The combinations encountered were two to four adenolymphomas (n=9), adenolymphoma plus pleomorphic adenoma (n=3), adenolymphoma plus MALT lymphoma (n=1), and pleomorphic adenoma plus acinic cell carcinoma (n=1). The outcome was clinical freedom from signs of tumour recurrence in any patient (mean follow-up = 51 months). CONCLUSION: Synchronous multiple unilateral parotid tumours usually include two or more adenolymphomas and might occur more often than previously realized. The possibility of a concomitant carcinoma, and the prevention of recurrent tumours, may warrant a more radical surgical excision of the parotid gland, accurate intraoperative examination of the resected specimen, and routine histological evaluation of the entire specimen. Preoperative radiological investigation may further increase the chances of finding multiple parotid tumours.

Adenolymphoma↗

PubMed1991

Acinic cell carcinoma of the salivary glands. A review of 20 new cases.

Twenty patients with acinic cell carcinoma of the salivary glands are presented. Seventeen tumours were located in the parotid and three in minor salivary glands, one being considered intraosseous. According to the growth patterns, they were classified as solid-acinar in 8 patients, microcystic in 5 patients, follicular in 3 patients and papillocystic in 4 patients. 9 cases were considered high grade malignant tumours and among the 11 well-differentiated, 2 suffered dedifferentiation in local recurrences. Local recurrence appeared in 9 cases. Three cases had nodal disease on admission while 5 developed this during the course of the disease. Distant metastasis appeared in 2 cases. Local recurrence and nodal disease correlated with the degree of differentiation and state of the margins in the surgical specimen. We recommend an aggressive surgical approach followed by postoperative radiotherapy for the undifferentiated tumours and extensive ones. For the limited and better differentiated, a more limited excision, such as total parotidectomy preserving the facial nerve is suggested.

Adult↗

PubMed1993

Morphological study of the parotid lymph nodes.

The surgical resection of metastatic lesions of the parotid gland is controversial. The present anatomical study has been carried out to determine whether or not lymph nodes are present in the deep lobe of the gland and to assess their number in different age groups. We found a substantial number of lymph nodes in the deep lobe of the parotid gland independently of the subject's age. It can be concluded that from a strictly morphological point of view, superficial parotidectomy does not appear adequate when radical neck dissection including the parotid gland is to be done.

Adolescent↗