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Journal of Indian Association of... 2023Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children...
CONTEXT
Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children have different characteristics from those that occur in adults. When they occur in the pediatric age group, malignancy has to be ruled out.
SUBJECTS AND METHODS
This is a retrospective study of children who presented to our institute, a tertiary care referral hospital for children <12 years, with parotid swellings during the 5-year period between April 2018 and March 2023. The children who underwent surgical management for parotid lesions, in the form of parotidectomy, were included in the study. Children who were treated by nonoperative management were excluded from the study.
RESULTS
Twelve children were included. Of the 12 children, three (25.0%) children had malignancy, four (33.33%) children had benign tumors, three (25.0%) children had vascular malformations, and the remaining two (16.67%) children had inflammatory etiology. All children underwent superficial/total parotidectomy, depending on the involvement of superficial and/or deep lobe. Of the three malignant parotid tumors, two were of mucoepidermoid carcinoma and one was myoepithelial carcinoma. One of the children with mucoepidermoid carcinoma had recurrence.
CONCLUSIONS
Facial nerve-sparing parotidectomy is the treatment for neoplastic and inflammatory lesions. Initially, lymphovascular tumors were treated aggressively with parotidectomy. Neck node dissection should be performed only in children with fine-needle aspiration cytology-confirmed nodal metastases during primary surgery. Adjuvant treatment may be required in selected cases.
PubMed: 37842213
DOI: 10.4103/jiaps.jiaps_100_23 -
Head and Neck Pathology Sep 2023A 67-year-old female with a history of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) presented with right sided otalgia and a 2-3 cm firm, tender...
A 67-year-old female with a history of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) presented with right sided otalgia and a 2-3 cm firm, tender right posterior parotid mass. Fine needle aspiration biopsy (FNAB) established a diagnosis of acinic cell carcinoma (AciCC). Further workup demonstrated lung nodules which were confirmed by FNAB to represent metastatic AciCC. A right radical parotidectomy with sacrifice of the facial nerve, segmental mandibulectomy, and selective neck dissection (levels II-IV) was performed. Microscopically, the tumor displayed an infiltrative border with a solid multinodular growth pattern and fibrosclerotic septation. The tumor was composed mainly of uniform cells with abundant eosinophilic granular cytoplasm with round nuclei with prominent nucleoli. Nuclei were fairly monomorphic, mitotic counts were 3-4 per 2mm and there was no necrosis despite the aggressive growth pattern. An anti-mitochondrial immunohistochemical stain showed strong reactivity in the tumor cells, with an internal positive control of adjacent striated ducts. An immunohistochemical stain for NR4A3 demonstrated strong nuclear reactivity in the tumor cells. Electron microscopy highlighted the tumor cells with numerous mitochondria and distinctive electron dense intramitochondrial inclusions. Concurrent CLL/SLL was identified on histologic examination of the lymph nodes, but they were free of AciCC. After eight weeks of follow-up, she tolerated the surgery well and is currently receiving radiation therapy to the parotid and neck. In this illustrative case, we justify the oncocytic designation of AciCC by morphology, immunohistochemistry, and electron microscopy.
Topics: Female; Humans; Aged; Carcinoma, Acinar Cell; Leukemia, Lymphocytic, Chronic, B-Cell; Salivary Glands; Biopsy, Fine-Needle; Cell Nucleus
PubMed: 37541995
DOI: 10.1007/s12105-023-01578-2 -
Minerva Surgery Dec 2023Basal cell adenoma (BCA) and pleomorphic adenoma (PA) are among the most common benign neoplasms of the salivary glands. The aim of this study was to analyze and compare...
BACKGROUND
Basal cell adenoma (BCA) and pleomorphic adenoma (PA) are among the most common benign neoplasms of the salivary glands. The aim of this study was to analyze and compare the diagnosis, treatment, and recurrence rate of these two different types of parotid benign tumors.
METHODS
A retrospective analysis of all cases of parotid gland BCA and PA surgically treated between January 1, 1990, and December 31, 2019, was performed at our university.
RESULTS
A total of 349 patients were enrolled in the present study, 311 of which (89.1%) were affected by PA, and 38 patients (10.9%) by BCA. The most frequently performed surgery was partial parotidectomy for both groups (85.9% in PA and 65.8% in BCA). Perioperative complications - often transient and of short duration - occurred within 48 hours of surgery and were observed in 30.6% of PA patients and in 18.4% of BCA patients; furthermore, recurrences were noticed in 19 PA patients (6.2%) and in 3 BCA patients (7.9%) (rates in range with the available literature data).
CONCLUSIONS
To the best of our knowledge, this study is one of the largest single-center series in the literature comparing diagnosis, treatment, recurrence rate and clinical-pathological features of two different types of benign parotid gland tumors, BCA, and PA.
Topics: Humans; Adenoma, Pleomorphic; Parotid Gland; Retrospective Studies; Adenoma; Salivary Gland Neoplasms; Parotid Neoplasms
PubMed: 37530711
DOI: 10.23736/S2724-5691.23.09876-3 -
Journal of Clinical Medicine Apr 2024: Parotidectomies are indicated for a variety of reasons. Regardless of the indication for surgery, facial reanimation may be required because of facial nerve sacrifice...
: Parotidectomies are indicated for a variety of reasons. Regardless of the indication for surgery, facial reanimation may be required because of facial nerve sacrifice or iatrogenic damage. In these cases, facial restoration performed concurrently with ablative surgery is considered the gold standard, and delayed reanimation is usually not attempted. A retrospective review of all patients who underwent parotidectomies from 2009 to 2022 in a single institution was performed. Indications, surgical techniques, and outcomes of an algorithmic template were applied to these cases using the Sunnybrook, Terzis scores, and Smile Index. A comparison was made between immediate vs. late repairs. Of a total of 90 patients who underwent parotidectomy, 17 (15.3%) had a radical parotidectomy, and 73 (84.7%) had a total or superficial parotidectomy. Among those who underwent complete removal of the gland and nerve sacrifice, eight patients (47.1%) had facial restoration. There were four patients each in the immediate ( = 4) and late repair (n = 4) groups. Surgical techniques ranged from cable grafts to vascularized cross facial nerve grafts (sural communicating nerve flap as per the Koshima procedure) and vascularized nerve flaps (chimeric vastus lateralis and anterolateral thigh flaps, and superficial circumflex perforator flap with lateral femoral cutaneous nerve). The algorithm between one technique and another should take into consideration age, comorbidities, soft tissue defects, presence of facial nerve branches for reinnervation, and donor site morbidity. While immediate facial nerve repair is ideal, there is still benefit in performing a delayed repair in this algorithm.
PubMed: 38673542
DOI: 10.3390/jcm13082269 -
Midface microvascular reconstruction after maxillary complex tumor resection: A retrospective study.Journal of Cranio-maxillo-facial... Jan 2024The study purpose is to review the surgical approach and evaluate the results in managing patients with advanced midface and maxillary complex tumors. The most common...
The study purpose is to review the surgical approach and evaluate the results in managing patients with advanced midface and maxillary complex tumors. The most common anatomical site of the primary tumor was the maxilla, sometimes with extension to the orbit and anterior fossa, parotid and middle ear or even the lip. Surgical resection included maxillectomy in the majority of cases, combined with orbital exenteration or orbitectomy and anterior fossa resection. Parotidectomy and mastoidectomy/core petrosectomy were also performed. Reconstruction was performed with radial forearm osteocutaneous free flap, latissimus dorsi myocutaneous flap with scapular bone flap, lengthening temporalis myoplasty, rectus abdominis free flap, anterolateral thigh flap, in combination with temporalis and vastus lateralis, as well as pectoralis major myocutaneous flap. A total of 36 midface tumor excisions were performed, followed by the appropriate reconstruction. The average follow-up period was 15 years. To date, 23 patients are disease free, while 6 patients presented disease recurrence and 7 patients died during the 15-year follow-up period. Surgical resection remains the gold standard for midface tumors management. When safely performed, combined with microvascular and dynamic face reconstruction, surgery can offer improvement in quality of life and prolong the overall survival.
PubMed: 38185536
DOI: 10.1016/j.jcms.2024.01.002 -
Journal of Oral and Maxillofacial... Aug 2023During the preoperative evaluation of parotid gland tumors, one of the main concerns is to determine the location of the tumors in relation to the facial nerve. This...
PURPOSE
During the preoperative evaluation of parotid gland tumors, one of the main concerns is to determine the location of the tumors in relation to the facial nerve. This study aims to assess the value of ultrasound for determining the location of parotid gland tumors in relation to the facial nerve using Stensen's duct.
METHODS
This is a retrospective cross-sectional study at a single institute. The subjects who underwent preoperative ultrasound and parotidectomy for parotid gland tumors were included. The subjects with incomplete operative records or no reference standard for the location of parotid gland tumor were excluded. The primary predictor was ultrasound tumor location, which was defined as the location of parotid gland tumors determined by preoperative ultrasound as to whether the tumors were superficial or deep to the facial nerve. The operative records were used as the reference standard for the location of parotid gland tumors. The primary outcome was diagnostic performances of preoperative ultrasound in predicting the location of parotid gland tumors, which were calculated by comparing ultrasound tumor location to the reference standard. Covariates were sex, age, type of surgery, tumor size, and tumor histology. Data analysis involved descriptive and analytic statistics; P < .05 was considered statistically significant.
RESULTS
One hundred and two of 140 eligible subjects met inclusion and exclusion criteria. There were 50 male and 52 female, with a mean age of 53.3 years. Ultrasound tumor location was classified as deep in 29 subjects, superficial in 50, and indeterminate in 23. The reference standard was deep in 32 subjects and superficial in 70. Indeterminate ultrasound tumor location results were grouped as either deep or superficial to make every possible cross table in which ultrasound tumor location results were presented as a dichotomy. The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the ultrasound to predict the deep location of parotid tumors were 87.5, 82.1, 70.2, 93.6, and 83.8%, respectively.
CONCLUSIONS
Stensen's duct on ultrasound can be a useful criterion to determine the location of parotid gland tumor relative to the facial nerve.
Topics: Humans; Male; Female; Middle Aged; Parotid Neoplasms; Parotid Gland; Facial Nerve; Salivary Ducts; Retrospective Studies; Cross-Sectional Studies
PubMed: 37301226
DOI: 10.1016/j.joms.2023.05.012 -
Indian Journal of Otolaryngology and... Dec 2023Fine needle aspiration cytology (FNAC) is an integral part of the preoperative work-up of parotid tumours.
BACKGROUND
Fine needle aspiration cytology (FNAC) is an integral part of the preoperative work-up of parotid tumours.
AIM
To determine the rate of concordance between FNAC and histology following parotidectomy.
METHODS
A review of records of patients who had parotidectomy which was preceded FNAC was done. Data collected included patients' demography, presenting symptoms and clinical signs; cytology and post-operative histology results.
RESULTS
Seventy-seven records were found and 14 were excluded. Forty-five (71%: 45/63) of the tumours were benign, 21% (13/63) malignant and 8% (5/63) inflammatory lesions. Forty-one (91.1%: 41/45) of the benign tumours had concordance between FNAC and final histology. Seven (63.6%: 7/11) of FNAC diagnosed malignancies were confirmed on histology.
CONCLUSION
Around 71% of parotid masses were benign. Painful masses are more likely to be malignant and FNAC is more reliable for the diagnosis of pleomorphic adenoma than rare benign and malignant tumours of the parotid gland.
PubMed: 38027536
DOI: 10.1007/s12070-023-03685-6 -
The Laryngoscope Apr 2024To define a novel classification of first branchial cleft anomalies (FBCAs) based on the relationship between lesions and the facial nerve in terms of radiographic...
OBJECTIVE
To define a novel classification of first branchial cleft anomalies (FBCAs) based on the relationship between lesions and the facial nerve in terms of radiographic imaging findings and to introduce the corresponding surgical managements.
METHODS
The clinical data were retrospectively reviewed. Novel classification was proposed according to the head-neck MRI findings and surgical records. FBCAs limited in the cartilaginous segment of external auditory canal (EAC) or superficial parotid gland capsule were classified as type A. Lesions close to the FN and(or) involved into the parotid gland with no scar formation and no previous parotidectomy were classified as type B. FBCAs adhered to the FN and(or) invaded the parotid gland with scar formation due to previous surgery were classified as type C. Appropriate surgery approaches was also described, which was correlated with classification.
RESULTS
Fifty-one patients were included, and one patient suffered from bilateral lesions. Thirty-one, twelve, and nine lesions were classified as type A, type B, and type C FBCAs, respectively. One type A patient (1.92%) suffered from recurrence during follow-up. Temporary facial palsy (House-Brackmann II) was identified in 2 type C patients (3.85%) after surgery and recovered to normal within 2 months. One type B patient (1.92%) suffered from facial paralysis due to the FN injury and underwent facial nerve graft simultaneously. No patients with type C complained of hearing loss postoperatively.
CONCLUSION
This novel classification clearly illustrates definitely relationship between lesion and the facial nerve and appropriate surgical strategies were proposed based on the novel classification.
LEVEL OF EVIDENCE
4 Laryngoscope, 2024.
PubMed: 38676459
DOI: 10.1002/lary.31477 -
NeuroRehabilitation 2024Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients.
BACKGROUND
Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients.
OBJECTIVE
To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms.
METHODS
Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with moderate or severe facial dysfunctions.
RESULTS
Benign and malignant groups had a statistically significant improvement in mS-FGS (p < 0.001 and p = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome.
CONCLUSION
Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required.
Topics: Adult; Humans; Middle Aged; Facial Nerve; Parotid Gland; Prospective Studies; Postoperative Complications; Parotid Neoplasms; Retrospective Studies; Facial Paralysis
PubMed: 38306064
DOI: 10.3233/NRE-230220 -
Indian Journal of Otolaryngology and... Sep 2023Mucosa-associated lymphoid tissue(MALT) lymphoma is a distinct subtype of lymphoma, presenting as a diffuse gland involvement or a discrete mass. Pre-operative diagnosis...
Mucosa-associated lymphoid tissue(MALT) lymphoma is a distinct subtype of lymphoma, presenting as a diffuse gland involvement or a discrete mass. Pre-operative diagnosis is a challenge as Fine Needle Aspiration Cytology is often inconclusive and presently no radiological investigation is confirmatory, therefore final diagnosis is made after surgical resection and immunohistopathology. We report a case of MALT lymphoma, which clinically presented as a unilateral large diffuse swelling of the parotid gland with a diagnostic dilemma eventually underwent total parotidectomy to be finally diagnosed as MALT lymphoma of parotid gland and received field radiotherapy with complete cure and no recurrence in a 2-year follow-up.
PubMed: 37636800
DOI: 10.1007/s12070-023-03811-4