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PubMed1980

Bilateral parotid neoplasms.

We are reporting what we believe to be the second case of bilateral parotid neoplasm occuring synchronously with differing histologies. We believe that this neoplasm may represent a specific propensity of parotid tissue in a given individual to develop neoplasia in a multipotential glandular organ subject to many neoplastic diseases. There also exists the possibility that this condition may represent an immune deficiency specific to the parotid gland. The case reports that have been reviewed demonstrate that a secondary neoplasm may arise from benign mixed tumors. We question whether this is an example of monistic origin of acinic cell tumor from a mixed-cell tumor or, perhaps, dualistic expression for this salivary gland to develop a multiplicity of anaplastic and metaplastic growth variants. In approaching a case with bilateral parotid involvement, the physician must be aware of the rare possibility that benign and malignant tumors may coexist. He must be prepared to proceed with more radical extirpation than simple superficial parotidectomy.

Adenocarcinoma↗

PubMed1980

Parotid tumors: a ten-year experience in a community hospital.

The results of 47 operations for parotid tumor in a community hospital are reviewed. The morbidity and recurrence rates are comparable to those of large published series and support the hypothesis that subtotal parotidectomy can be done safely in a general surgical group practice in which no single surgeon has a large experience.

Adolescent↗

PubMed1995

[Surgical treatment of lymphadenitis caused by non-tuberculous mycobacteria in children].

A retrospective study was made of 43 consecutive cases of children with the diagnosis of non-tuberculous mycobacterial lymphadenitis treated in our surgical department between 1976 and 1992. In 16 of the 42 children the diagnosis was initially missed and these children elsewhere underwent incision and drainage resulting in a chronic sinus. In 37 children the disease was localized in the head-and-neck area, while in the other 6 inguinal or axillary lymph nodes were involved. All 43 children underwent a regional lymph node dissection with a partial parotidectomy in three. In 5 children recurrent disease developed within 4 months after dissection. The recurrences were all successfully treated with additional surgery. In none of the children did the dissection result in permanent damage of nerves, especially not of the facial nerve. The cosmetic results were good but depended on the possibilities of entering the neck through a cosmetically ideal incision. Early recognition of the disease is of the utmost importance for an adequate surgical and cosmetically desirable result. An aggressive surgical therapy is advocated and will not result in permanent damage provided the surgeon has the technical skill required for neck dissections.

Child↗

PubMed1995

[Our experience with parotid cysts].

The cysts of the parotid gland are very rare lesions of congenital or acquired aetiopathogenesis. In most cases, the symptom is an unilateral painless swelling in the area of the parotid without any fixation to the overlying skin or any involvement of the facial nerve. These must be distinguished from neoplasms with a similar clinical presentation or neoplasms with a cystic component. Making the right preoperative diagnosis can be extremely difficult but the adequate therapy remains the superficial parotidectomy. However the final diagnosis is established histopathologically. The precise histological classification is often an elaborate task because of the similarities in the epithelial lining of the various cysts and the heterogeneity in their histogenic origin. In this study, the authors describe four cases of parotid cystis. They examine the clinical aspects, the preoperative diagnostic approach, the treatment and they analyse the histopathological findings. Finally, their results are compared with the data found in the international medical literature.

Adolescent↗

PubMed1995

[A cystic lymphoepithelial lesion of the parotid in HIV-1-infected patients].

Cystic lymphoepithelial lesion is an infrequent disorder involving the saliva glands mainly the parotid gland; however, its frequency has increased coinciding with the epidemics of HIV-1 infection. Three cases of parotid lymphoepithelial lesion in patients with HIV-1 infection, 2 of whom were hemophiliacs and one an ex-intravenous drug addict, are presented. In all the cases the lesion was a painless slow growth right submandibular mass, with no history of inflammation. Two of the patients had a contralateral tumor of the same characteristics which was not studied. Fine needle aspiration puncture was performed in the three patients although diagnosis was obtained by pathologic study following superficial parotidectomy. Cystic lymphoepithelial lesion is an entity to be taken into account on differential diagnosis of cervical masses in patients with HIV infection. In individuals with severe immunosuppression treatment should be conservative.

Acute Disease↗

PubMed1978

[Hemangiopericytoma of the parotid in the child (author's transl)].

A very rare case of localization in a large salivary gland (parotid) of a hemangiopericytoma in a 9 and 1/2 year old child. Detailed and discussed histopathological examinations resulted in a diagnosis of hemangiopericytoma (Nézelof, Gérard-Marchant). Despite wide excision by parotidectomy, there was a local recurrence two years later.

Child↗

PubMedDate not supplied

Lymphoepithelial cysts of salivary glands in HIV-infected patients: clinico-pathological and immunohistochemical features.

The parotidectomy specimens of 3 HIV-infected patients with lymphoepithelial cysts (CLL) have been used to study, with an immunohistochemical method, the expression of the following antigens in histopathological sections: Cytokeratins, CD3, CD20, CD35, CD68, MAC387, Kappa and Lambda light chains. The purpose of the study was to ascertain if CLL of salivary glands parallel the immunophenotype of extrasalivary systemic lymphadenopathy (LAS). The results of this study show that the epithelial lining of CLL does not derive from preexisting ducts and that the immunophenotype of CLL very closely resembles that of LAS. These features seem to suggest that CLL and LAS are tightly related diseases and that probably surgery is not the elective treatment for this lesion.

Adult↗

PubMed1995

An audit of surgery of the parotid gland.

The management of patients undergoing 50 surgical procedures to the parotid gland was reviewed. The overall accuracy of fine needle aspiration cytology was 87%, false-positive and false-negative rates for malignant disease both being 4%. The sensitivity, specificity and accuracy of fine needle cytology for malignant parotid tumours was 66%, 95%, and 91%, respectively, that of benign tumours (pleomorphic adenoma or Warthin's tumour) being 88%, 83% and 87%, respectively. Sensitivity, specificity and accuracy for the remaining (principally inflammatory) parotid diseases was 100%, 95% and 96%, respectively. The predictive value of a positive test for malignant tumours, benign tumours and inflammatory conditions was 66%, 94% and 75%, respectively. The negative predictive value for these conditions was 95%, 71% and 100%, respectively. Facial nerve weakness after parotidectomy occurred in three patients (8.8%), being permanent in two cases (both malignant). Although Frey's syndrome was not recorded in any of the notes, careful follow-up revealed two cases (6%). To date there have been no local recurrences after excision of either benign or primary malignant parotid masses. One patient with squamous cell carcinoma metastatic to the parotid gland died, despite block dissection of the neck and radiotherapy. This small series with a limited follow-up suggests that diseases of the parotid gland can be managed by general surgeons with an interest in this field. Although fine needle aspiration and ultrasonic scan may be helpful, the decision to operate should be made on clinical grounds.

Adolescent↗

PubMed1994

[Small-cell carcinoma of the parotid gland. Apropos of a case].

One case of primary small cell carcinoma of the left parotid gland is reported. A total parotidectomy with facial nerve preservation and left functional neck dissection was performed, with postoperative radiotherapy to the surgical area. A lymph node metastases appears 4 months later, and it needs radical neck dissection followed by chemotherapy. 18 months following initial surgery, our patient is free of disease. The ultrastructural and immunohistochemical studies does not suggest an origin neuroendocrine of the carcinoma. This tumor appears to have a better prognosis than small cell carcinoma of the lung, which it resembles histologically.

Carcinoma, Small Cell↗

PubMed1994

[Contribution of L lactate and amino-acid enzymatic biosensors for the analysis of Frey syndrome].

Twelve patients with Frey's syndrome after total parotidectomy for plemorphic adenoma were analysed using simultaneously 2 biosensors. Biosensors allowed for detection of L lactate and amino acid level on intact skin. The assay procedure and the results achieved with the simultaneous use of these 2 biosensors are presented. The L lactate biosensor appears to be an interesting tool for Frey's syndrome analysis. The sensibility of the amino acid biosensor is not sufficient enough to allow its use at time of Frey's syndrome analysis.

Amino Acids↗

PubMed1994

Clear cell sarcoma of the pre-parotid region: an initial case report.

An unusual case of clear cell sarcoma (CCS) found in the parotid region of a 75-year-old man with a long history of chronic lymphoid leukemia is reported. Treatment of the patient included a total parotidectomy with preservation of the facial nerve. The tumor was pathologically consistent with a clear cell sarcoma. Since CCS originates from the neural crest and is melanin producing, we suggest that this particular tumor originated from the superficial musculo-aponeurotic system (SMAS). To our knowledge, this is the first case of CCS that has been reported in the parotid region.

Aged↗

PubMedDate not supplied

[The surgical procedure in facial nerve injuries].

Nine patients with cancer of the parotid glands were operated on. Parotidectomies involved resection of the facial nerve. In 3 patients neuroplasty was simultaneously carried out: the nerve was epineurally sutured end-to-end. Facial nerve function recovered in these patients.

Adenoma, Pleomorphic↗

PubMed1994

[Surgical anatomy of the parotid region. Current concepts].

Three zones of the parotid region situated in the cervicofacial area were studied. The bilobular architecture of the parotid gland, the relations between the facial nerve and the parotid gland and the cover plans are described. On the posterior border of the parotid there is a cleavage interlobular point where the facial nerve penetrates and can be dissected. Thus the facial nerve has four parts designated as retro, inter, intra and preglandular. The parotid gland and is surrounding capsula is covered by a superficial musculoaponeurosis and the skin. The musculoaponeurosis is used in cervicofacial lifting procedures and palliative treatment of facial palsy. It can also be used in certain situations (primary tumours of moderate size without capsula involvement) to fill retromandibular depressions after total parotidectomy.

Dermatologic Surgical Procedures↗

PubMed1994

[Surgery of the infratemporal fossa. An improved cutaneous access technic].

UNLABELLED: Surgery in the infra-temporal area, formerly known as the pterygo-maxillary area, is not often performed and raises several problems including the route of access and indications and contraindications. Many procedures have been proposed by ENT or maxillo-facial surgeons dealing with cancer. ANATOMY: The infratemporal area is a basically pyramidal shaped, very deep region of the face. The base of the pyramid formed by the medial aspect of the ramus is triangular and the upper surface of the pyramid is the floor of the skull. The anteromedial aspect corresponds to the posterior aspect of the maxillary bone and the posteroinferior aspect to the pterygomaxillary fascia. INDICATIONS: This type of surgery is generally indicated for locoregional cancers and exceptionally for benign tumors originating in this area, e.g. angiomas, neurinomas of the dental or lingual nerve, either as single tumours or as part of a Recklinhausen disease. Most often, the surgeon is faced with the problem of infra-temporal invasion of a tumour originating outside the area: malignant tumour of the sinus (epidermoid epithelioma), salivary glands, bone tumours, etc. The main problem is naturally to determine the route of access, via the ramus, the parotid, the maxillary sinus or the submandibular region. In the author's opinion, the upper route via a coronal incision combined with a lifting incision on the same side is a particularly interesting approach. Different situations may arise: parotidectomy is required with preservation of the VIIth nerve, resection of the ramus or anterior section, making it possible to fold back the lateral part involved and thus provide sufficient access.

Ameloblastoma↗

PubMed1995

[Color Doppler ultrasound studies of parotid tumors].

BACKGROUND: Color-coded duplex sonography is being increasingly used in the head and neck as another method of diagnosis of, for example, stenosis of arteries or veins or of hemangioma. Moreover, it is of greatest interest in having the ability to differentiate benign from malignant tumors. Since the underlying type of tumor is directly responsible for the (operative) treatment recommended we have investigated histologically proven benign and malignant parotid tumors. PATIENTS: Thirty-six patients (20 women, 16 men, ages 32-66 years) with parotid tumors of unknown histology were examined by means of ultrasound and color-coded duplex sonography. Afterwards, tumors were treated by complete parotidectomy. Histological results were compared postoperatively to the data from the color-coded duplex sonography. MATERIALS AND METHODS: Ultrasound B sonography. All patients were examined with a "Sonoline SI-450" (Siemens), using a 7.5 MHz transducer. Color-coded sonography. The color-coded duplex sonograph used was the Quantum 2000 (Siemens). All investigations were carried out with a 7.5 MHz transducer. Criteria of color-coded duplex sonography. Criteria of the investigation were the qualitative range of color distribution as an indication of vascularization and measurement of perfusion velocity--as far as possible--with mean pulsatility indices. The mean pulsatility index represented peripheral resistance and was proportional to it. All data were collected from three areas in the center of the tumor and tumor margins, respectively. Tumors selected were 17 histologically proven pleomorphic adenomas, 15 adenolymphomas and 4 adenoid cystic carcinomas. RESULTS. In comparing perfusion velocity and mean pulsatility indices, no significant difference was detected between pleomorphic adenomas and adenolymphomas. A loss of perfusion and color was seen in both tumor types, although it occurred more often in the adenolymphomas. These cystic areas in most cases had already been clearly detected with normal B-scan sonography. In two of the four malignancies there were no obvious differences to the benign tumors. In the other two cases of malignancy a pronounced vasularization was detected and, therefore, an extended distribution of color. This finding together with decreased perfusion velocity and low mean pulsatility indices indicated low peripheral resistance. CONCLUSIONS: At this point it is not possible routinely to utilize color-coded duplex sonography as an accurate indicator of underlying pathology of parotid neoplasms. A differentiation among different types of benign tumors is not possible using the technique, nor can malignancies be recognized definitively by this method.

Adenolymphoma↗

PubMed1994

Malignant melanoma of cervical and parotid lymph nodes with an unknown primary site.

Forty-six patients with malignant melanoma metastatic to cervical or parotid lymph nodes with an unknown primary site were treated at UCLA Medical Center from 1964 through 1991. Treatment consisted of parotidectomy and/or neck dissection with or without adjuvant therapy. The initial presentation was a cervical mass in 74% and a parotid mass in 26% of patients. Metastasis distal to the head and neck nodal basins developed in 22% of patients. Involvement of more than four cervical or parotid nodes resulted in a significant increase in distant metastasis (P < .01). Adjuvant therapy was found to have no significant effect on survival rates. However, age at the time of diagnosis influenced the survival rates. The significance of the improved survival of these patients as compared to those with a known primary melanoma is discussed.

Adolescent↗

PubMed1994

Intraductal tetracycline therapy for the treatment of chronic recurrent parotitis.

Chronic recurrent parotitis (CRP) is recurrent parotid inflammation with non-obstructive sialectasis. Therapies which produce acinar atrophy or remove the acini are effective in treating CRP. Parotidectomy, tympanic neurectomy, duct ligation, and radiation therapy have either a low success rate or a high risk of morbidity. Intraductal antibiotic instillation has been proposed as a possible method of treatment. We hypothesized that the cytotoxic effects of tetracycline could produce acinar atrophy. A double-blind experiment of intraductal tetracycline instillation was performed in ten rabbits. Acinar atrophy and acute inflammation were found in 40% of the tetracycline treated glands; controls had a complete absence of these histologic changes. These results support the use of tetracycline instillation to produce acinar atrophy and therefore, intraductal tetracycline may be an effective, low-risk therapy for CRP. The clinical features of CRP will be reviewed and therapeutic implications discussed.

Adult↗

PubMed1994

[Salivary gland tumors. Clinical aspects and therapy].

Salivary gland tumors are rare. One-fifth are malignant. The parotid is the gland most often affected, particularly in adenomas. Adenomas and carcinomas are tumors that occur in adulthood; angiomas are the tumors that occur most frequently in childhood. Other than their localization, salivary gland tumors have few specific signs. In the clinical examination the locoregional and functional presentation is evaluated. Imaging studies refine or correct the clinical diagnosis, primarily by visualizing the deeper planes. Morphological diagnosis in benign lesions depends on resection results; in malignant lesions additional intraoperative frozen section is needed, and in questionable cases incisional biopsy. Fine-needle aspiration cytology may provide valuable knowledge when planning therapy. Limited parotid tumors are resected by lateral or subtotal parotidectomy. Carcinomas are resected as needed, with neck dissection added in case of lymph-node involvement. Small adenoid cystic carcinomas can be treated curatively by very wide resection. Aggressive and extensive tumors are irradiated postoperatively. Malignancies not operated upon are irradiated primarily. Facial nerve paralysis can be rehabilitated by different nerve repair or static surgical techniques.

Adult↗