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PubMed1985

[Rare cervicofacial cysts and fistulas in children].

Among the various congenital cervicofacial swellings observed in children, three types are rarely encountered in general practice: auriculobranchial cysts and fistulae, thymic cysts and cystic lymphangiomas. To resolve diagnostic and therapeutic problems related to these rare lesions it is essential that their etiopathogenic bases be understood. Auriculobranchial cysts and fistulae present clinical symptoms (cervical, parotid, auricular) that are only poorly evidenced and are related mainly to infection. Surgical excision requires a wide approach route of the parotidectomy type with preliminary isolation of the facial nerve. Thymic cysts result from embryogenic anomalies leading to remnants from the 3rd endobranchial pouch and/or degenerative disorders of Hassal's corpuscles. Of mainly perioperative detection their exeresis requires investigation of possible inferior mediastinal prolongations and preservation of healthy thymic parenchyma. Cystic lymphangiomas arise from dysembryoplasia of the lymphatic system, two opposing pathogenic theories existing to explain their origin. They are serious lesions because of their dissecting tendencies and their inexorable growth in the vast majority of cases. Two forms of lymphangioma, from the embryologic, diagnostic and therapeutic points of view, can be distinguished: those of extraparotid origin and those developing from the parotid.

Branchioma↗

PubMed1979

Osteoradionecrosis of the temporal bone.

Six cases of osteoradionecrosis of the temporal bone are described. Persistent symptoms of otitis externa refractory to local treatment measures should alert the physician to the possibility of underlying osteoradionecrosis. Treatment of superficial parotidectomy and partial temporal bone resection with preservation of the facial nerve is indicated if local aggressive conservative measures fail to control the disease. Benign mixed tumors of the parotid gland should be treated surgically with avoidance of radiotherapy.

Adult↗

PubMed1979

[Anatomo-clinical considerations on surgery of the deep lobe of the parotid gland].

In the light of their first-hand experience in actual clinical cases, the authors review the problems of surgical anatomy of the deep lobe of the parotid gland in malignancy. After discussing certain differences between normal and surgical anatomy of the region, they explore therapeutic possibilities and conclude that also in malignancies involving only the deep lobe of the gland the treatment of first choice is still total parotidectomy with preservation of the facial nerve.

Humans↗

PubMed1979

[2 cases of adenolymphoma of the parotid gland].

Starting from two cases of adenolymphoma of the parotid gland they had under observation, the Authors underline their doubts regarding the histogenesis, discuss the clinical approach and show their attitude towards the therapy. It consists of an enucleation or nucleoresection of the tumour in case only the superficial part of the gland is affected; a total parotidectomy with facial nerve preservation and without any radiotherapy, in case of a radical operation; with complementary radiotherapy if the operation has not been radical for certain.

Adenolymphoma↗

PubMed1968

Salivary gland tumors and sialadenitis in children. Experience at Childrens Hospital of Los Angeles.

Parotitis, hemangio-endothelioma and mixed tumors are the most common salivary gland lesions in the pediatric age group. Carcinoma and sarcoma are uncommon. Rapid growth of a tumor and pain suggest malignant change.A conservative non-operative approach is stressed for most cases of chronic parotitis. Scout x-ray films and sialangiographic examination are useful in differentiating an inflammatory lesion from a neoplastic growth. Total parotidectomy is advised if operation is indicated.A case of spontaneous resolution of a hemangioma of the parotid gland is presented. A less aggressive temporizing plan should be considered with these lesions, as the risk of seventh nerve injury in children is considerable. The treatment of choice for a non-inflammatory tumor is surgical excision, for most parotid tumors are radioresistant. Small masses should be completely excised for pathological evaluation. Incisional biopsy may occasionally be indicated in the case of a large diffuse lesion, for it may be inflammatory and total excision unnecessary. Most patients with chronic parotitis came to medical attention because of a non-tender asymptomatic parotid lump or diffuse swelling.

Child↗

PubMed1984

[Mucoepidermoid carcinoma of the parotid gland in a child].

We report a case of parotid mucoepidermoid carcinoma in a 6-year-old boy. After nerve-sparing subtotal parotidectomy, he remains free of disease 15 months later. We review the former experience on this unusual childhood neoplasia through a review of nearly 300 cases from the literature.

Age Factors↗

PubMed1978

[Basal cell carcinoma developing in a preauricular fistula (author's transl)].

Malignant neoplasms in lateral cervical cysts and fistulae have been frequently described in the literature. In the following case, a tumor is reported which was found in the unusual localization of a preauricular fistula. The histologic diagnosis was basal cell carcinoma. In this 41-year-old male patient the tumor led to local recurrent inflammatory symptoms. Therapy consisted first of excision of the fistula. After final diagnosis was made, total parotidectomy and an additional excision of the skin were carried out.

Adult↗

PubMed1984

Facial squamous carcinoma with parotid metastasis--closure with cheek-neck rotation.

Because squamous carcinoma of the face is usually recognized and treated early, regional metastasis occurs infrequently. However, due to neglect or initial treatment failure, aggressive lesions of the temporal-zygomatic area may metastasize to parotid nodes. These tumors are most effectively treated with en bloc primary excision and regional node dissection, which includes superficial parotidectomy with or without neck dissection. Closure of such large defects presents a technical challenge and often skin grafts are utilized. This report deals with our experience with a large lateral facial squamous carcinoma with parotid metastasis. Surgical options and a method of primary closure with cheek-neck rotation flap are discussed. Controversy exists regarding elective neck dissection and/or postoperative irradiation. Postoperative irradiation is advised for pathological evidence of perineural invasion, multiple positive nodes, extranodal spread, or questionable margins.

Aged↗

PubMed1983

Lymphoscintigraphy for malignant melanoma. Surgical considerations.

Lymphoscintigraphy using technetium-99m atimony sulfur colloid was performed in 22 patients with melanoma referred to Duke University Comprehensive Cancer Center in an attempt to identify patterns of regional lymphatic drainage. Scans from six patients revealed lower extremity lesions with three located below the knee, one in the popliteal space, and two others proximal to the knee joint. Despite the location of the primary, all scans but one showed initial drainage to the inguinal nodes bypassing the popliteal lymph node group. Of the three patients who had primary melanoma of the posterior scalp, the lymphatic drainage was directed to the posterior cervical nodes. No drainage to the parotid nodes or anterior neck nodes was visualized. The knowledge gained from lymphoscintigraphy resulted in posterior neck dissections instead of the standard anterior neck dissection and superficial parotidectomy. In areas of ambiguous lymphatic drainage from the trunk, radiocolloid scanning can identify areas at risk for developing metastatic disease. Six lesions within 5 cm of the midline demonstrated bilateral axillary or groin drainage in 83 per cent of the patients. For two lesions near Sappey's line colloidal uptake to the ipsilateral axilla and groin was the rule. After a 3-year follow-up, during which time 70 to 90 per cent of lymph node metastases are predicted to occur, no nodal metastases were ever documented in areas that did not show colloidal uptake. No correlation was found between amount of radiolabel in positive compared to negative nodes, although those nodes that were completely replaced by tumor contained no 99mTc activity and were negative on scanning.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1983

[Ligation of the external carotid in the parotid space. Its surgical significance].

The classical procedure of external carotid artery ligature in the carotid sulcus presents certain difficulties: The subdiagastric lymph nodes and branches of farabeuf's venous trunk must be avoided, and major nerves and vessels, including the hypoglossal nerve, internal carotid artery, and internal jugular vein, identified and protected. An approach to the external carotid artery at its entry into the parotid space, as employed in parotidectomy, avoids such problems due to major anatomical elements. This technique appears to be simpler, less restrictive, and more rapidly accomplished than the classical method of ligature, when its objective, the most frequent one, is arrest or prevent ion of hemorrhage in the region supplies by the internal maxillary artery.

Carotid Artery, External↗

PubMed1983

[Melanoma developing from a cellular blue nevus].

A rare observation of melanoma developing in the presence of the cellular blue nevus of the ear lobe with a comparatively favourable course is presented. Melanoma metastases appeared in the right parotid salivary gland and lymph nodes 25 years after removal of the primary tumor and 7 years of survival after parotidectomy and fascial dissection of the cervical adipose tissue.

Adult↗

PubMedDate not supplied

The ultrasonic scalpel in head and neck surgery.

The Cavitron ultrasonic surgical aspiration system (CUSA) is a new surgical tool that has received little attention in head and neck surgery. The device fragments and aspirates tissues with mechanical energy delivered by direct contact with the tip of a transducer vibrating at 23,000 Hz. The potential of the CUSA system was evaluated in several laboratory exercises: superficial parotidectomies on fresh cadavers, subtotal sialadenectomies on cats, and direct application to the brachial plexus in cats to assess effects on peripheral nerves. The CUSA quickly etched away salivary gland parenchyma while grossly preserving nerve, vessel, and fibrous elements, allowing virtually bloodless dissection. Small vessels could be cauterized directly. Direct application of CUSA to peripheral nerves for limited periods produced no significant clinical deficits, although worrisome histologic findings were noted.

Animals↗

PubMed1981

[Parotid cyst with branchiogenic part as remains of the first cleft and equivalent of a neck- ear-fistula (author's transl)].

Report on a rarity, consisting in the anatomic connexion of a parotid cyst with serous fluid and a congenital dysontogenesis near the ear. The latter will reduced to remains of the ectoderm of the first branchial cleft, remaining during the migration of the ear-"anlage" to the upper dorsal direction and interpreted as equivalent of a neck-ear-fistula. During embryogenesis apparently happens a collision between the remains of ectoderm and the ducts of the parotid-"anlage", developing from the buccal cavity. Clinical aspects, diagnosis, differential diagnosis and treatment were discussed. The management comprises exstirpation of the cyst after parotidectomy with preservation of the facial nerve.

Adult↗

PubMed1981

[Lesion of the parotid, still known as Godwin's syndrome. A case report (author's transl)].

Parotidectomy with conservation of the facial nerve, followed by radiotherapy to lymph glands, was employed to treat a benign lympho-epithelial lesion in the parotid. Clinical characteristics, therapy, and prognosis of this rare affection are described though diagnosis is difficult, the presence of such a lesion should be considered in all cases of parotid tumours.

Aged↗

PubMed1982

[Cysts of the parotid gland. Apropos of 4 cases].

The authors report 4 cases of parotid cyst seen in the department of maxillo-facial surgery (Pr Crépy): -one cystic lymphangioma, -one dermoid cyst, -two lympho-epithelial cysts. They stress the hazards of needle puncture and the essential value of exploratory parotidectomy.

Adolescent↗

PubMed1981

[Auriculotemporal syndrome].

After a survey of the literature about etiological and physiopathological data or hypothesis, the different therapeutic possibilities are quoted. According to our experience we describe the occurrence of the Auriculotemporal Syndrome in a total of 157 parotidectomies performed in our clinic during the past seven years. One single post-traumatic case is commented. About 30% of our post-parotidectomic patients were incommodated by the syndrome, more specifically as an aggravating transpiration in the temporal region during meals. The greater number of patients experienced a distinct improvement applying a simple Scopolamin-salve; as a result we prefer this conservative therapy to a more aggressive treatment. However, whether we could prevent the appearance of the syndrome by using a more subtle surgical technique particularly in the region of the preauricular blood vessels, remains an open question.

Aged↗

PubMed1982

[Pathogenesis of chronic recurrent parotitis (author's transl)].

A combination of several factors is of importance in the pathogenesis of sialectatic parotitis. Stenson's duct is relatively long and its orifice is narrow. The flow of the saliva may be impaired, especially when mastication is abnormal or when the ductal lumen is scarred because of infection or trauma. Dental or oral mucosal disease may increase the number of pathogenic organisms which might then lead to a retrograde ascending infection. This is followed by epithelial desquamation and subsequent ductal obstruction. Allergic, genetic an racial factors in sialectatic parotitis are also discussed. The four characteristic progressive histologic stages of sialectatic parotitis are: a periductal inflammatory reaction, a diffuse lymphocytic sialadenitis with dilated ducts, fully developed sialectatic parotitis and, finally, fibrosis of the parotid gland. Conservative treatment will lead to an improvement of the clinical symptoms as well as the histopathological features in the first two stages, but in the two final stages total parotidectomy, with preservation of the facial nerve, is the treatment of choice.

Adolescent↗

PubMed1978

[Repeated recurrences after operations of non-malignant parotid tumours (author's transl)].

Recurrences of 222 operated on parotid tumours (1961--1975) are analysed. Recurrences and repeated recurrences of benigh parotid tumours are based on not corresponded praeoperations (without nerve preparation). The half of cases of first-recurrences (mixed tumours) will become further recurrences. In repeated parotid-recurrences should be done total parotidectomy with careful treatment of facial nerve.

Adenoma↗