-
Cureus Feb 2024Facial nerve palsy (FNP) is a well-recognized complication following parotidectomy, with varying reported incidence rates in the literature. Understanding the incidence...
Facial nerve palsy (FNP) is a well-recognized complication following parotidectomy, with varying reported incidence rates in the literature. Understanding the incidence and factors contributing to FNP is crucial for optimizing patient care and surgical outcomes. A retrospective analysis was conducted on 78 patients who underwent parotidectomy at a tertiary care institution (Hospital de Especialidades Carlos Andrade Marin, Quito) over a 36-month period. Demographic data, preoperative pathology reports, surgical details, and postoperative outcomes, including FNP incidence and severity, were analyzed. The mean age of the cohort was 53 years, with a male-to-female ratio of 0.8:1. Fine needle aspiration revealed benign pathology in 70.5% of cases, with superficial parotidectomy being the most common surgical approach (84.6%). Postoperatively, FNP was observed in 51.2% of cases, with transient paralysis in 62.5% and persistent paralysis in 37.5%. The majority of FNP cases were classified as grade II and III according to the House-Brackmann grading system. A tumor size larger than 4 cm was associated with a higher incidence of FNP (57.5%). This study provides valuable insights into the incidence and severity of FNP following parotidectomy. Despite efforts to standardize surgical techniques, persistent paralysis remains a significant concern.
PubMed: 38550429
DOI: 10.7759/cureus.55045 -
A new modified limited incision for superficial parotidectomy compared to modified Blair's incision.Annals of Medicine and Surgery (2012) Sep 2023Many incisions have been used to perform parotidectomy, but they result in a visible scar on the neck and may cause patient dissatisfaction by producing disfigurement...
BACKGROUND
Many incisions have been used to perform parotidectomy, but they result in a visible scar on the neck and may cause patient dissatisfaction by producing disfigurement sometimes.
AIM OF STUDY
The aim of this study is to use a modified limited incision for superficial parotidectomy as an alternative to the classical incision, with no obvious scarring and without affecting the identification of the facial nerve, resulting in better cosmesis.
PATIENTS AND METHODS
A prospective comparative study on 100 patients has undergone superficial parotidectomy using a modified limited incision and another 100 patients who have undergone superficial parotidectomy using the modified Blair's incision (control group) for variant benign pathologies. The surgeries were conducted in four hospitals (three private and one public) in Baghdad, Iraq, from January 2016 to September 2022. In both groups, the patients were followed up through outpatient visits to assess the cosmetic result of the incision and detect postoperative complications.
RESULTS
All tumors were removed with no need for extending the skin incision. The cosmetic result of the incision was very satisfactory and only a nominal scar could be seen 6 months after surgery. Five percent of patients only developed postoperative complications.
CONCLUSION
A modified limited incision for superficial parotidectomy provides better patient satisfaction compared to a modified Blair's incision. The modified limited incision can be performed safely with a better cosmetic appearance of the surgical scar compared to the standard incision.
PubMed: 37663706
DOI: 10.1097/MS9.0000000000001123 -
Clinical Oral Investigations Dec 2023Surgical management of parotid pleomorphic adenoma ranges from total parotidectomy to extracapsular dissection (ECD). Minimalistic techniques aim to preserve function...
OBJECTIVES
Surgical management of parotid pleomorphic adenoma ranges from total parotidectomy to extracapsular dissection (ECD). Minimalistic techniques aim to preserve function and minimize the rate of recurrence. This study assesses functional, aesthetic, and disease control outcomes post-ECD through a sole transverse cervical incision for parotid pleomorphic adenoma.
MATERIALS AND METHODS
This longitudinal analysis enrolled 36 consecutive patients with pleomorphic adenoma who underwent ECD via a single cervical incision. Complications, satisfaction, salivary function, and tumor recurrence were evaluated. Salivary gland function was assessed using scintigraphy at 6 months post-surgery.
RESULTS
Tumors occurred in superficial (83%) or deep (17%) parotid inferior parts according to the European Salivary Gland Society level classification. The median tumor size was 2.8 cm (1.8-6.0 cm); the median operation time was 42 min (30-65 min). No tumor spillage or facial nerve injuries occurred. Facial nerve paralysis was only temporary in two (6%) patients, with minimal other complications. Operated parotid gland function matched the unoperated side. No recurrence was found during the median follow-up of 44 months (24-60 months).
CONCLUSIONS
ECD via a single transverse cervical incision is a safe approach for benign parotid tumors, yielding excellent functional and disease control outcomes.
CLINICAL RELEVANCE
These findings can provide clinically meaningful minimally invasive recommendations to treat pleomorphic adenoma with minimal complications.
Topics: Humans; Adenoma, Pleomorphic; Postoperative Complications; Neoplasm Recurrence, Local; Retrospective Studies; Esthetics, Dental; Parotid Neoplasms; Parotid Gland
PubMed: 38151592
DOI: 10.1007/s00784-023-05420-5 -
Indian Journal of Otolaryngology and... Sep 2023Salivary gland tumors represent 3-10% of all head and neck neoplasms. Most of the tumours are benign with parotid gland being most commonly affected. Surgical...
Salivary gland tumors represent 3-10% of all head and neck neoplasms. Most of the tumours are benign with parotid gland being most commonly affected. Surgical intervention in the form of parotidectomy forms the mainstay of treatment. Among the various postoperative complications that may occur after parotidectomy, facial nerve weakness is the most dreaded one for both the surgeon as well as the patient. In the literature, the incidence of transient facial weakness after parotid surgery ranges from 10 to 68%, and long-term dysfunction ranges from 0 to 19%. Apart from injury mechanisms such as nerve division, stretch, thermal injuries, ischemia, several other risk factors such as tumour size, disease duration etc. have also been identified for post parotidectomy facial nerve dysfunction which vary considerably from study to study. Thus, facial nerve injury despite being a common and dreaded complication is also a preventable one. We in our institute conducted a retrospective study from January 2018 to December 2021 to evaluate the incidence of facial nerve weakness and possible predictive factors among 60 patients who underwent superficial parotidectomy for benign tumours and found that when it comes to benign tumours surgical technique rather than tumour factors are more important in preventing nerve injury. Undertaking this study was important in order to emphasize the importance of extensive preoperative planning and better surgical practices among budding head and neck surgeons in our country.
PubMed: 37636740
DOI: 10.1007/s12070-023-03690-9 -
Otolaryngologia Polska = the Polish... Jun 2024<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of...
<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of 10 years.</br> <b><br>Aim:</b> The aim of this study was to evaluate the therapeutic results and prognostic factors.</br> <b><br>Materials and methods:</b> This is a retrospective study of patients with parotid cancer treated with radiotherapy between 2008 and 2017 at the National Institute of Oncology in Rabat. Patients who received adjuvant or exclusive radiotherapy were included in this study. We performed a multivariate analysis for the factors related to locoregional control and overall survival.</br> <b><br>Results:</b> Initially, 74 patients (45 men and 29 women), at a median age of 57 years. were identified. At the time of diagnosis, 10 (13.6%), 36 (48.6%), and 28 (37.8%) patients were in stage II, III, and IVab, respectively. Sixty patients received adjuvant radiotherapy after parotidectomy and 14 patients received exclusive radiotherapy for an unresectable tumor. At 5 years, the rate of locoregional control and overall survival were 68.2% and 53.7%, respectively. Surgical resection and negative margins were significantly correlated with locoregional control. Lymph node involvement, unresectable tumors, high-grade histological types, and cystic adenoid carcinoma were significantly correlated with poor overall survival.</br> <b><br>Conclusions:</b> Acceptable long-term results are obtained with surgery combined with radiotherapy. Surgical resection remains essential for parotid cancer, given the disappointing results of treatment with radiotherapy alone.</br>.
Topics: Humans; Parotid Neoplasms; Male; Female; Middle Aged; Retrospective Studies; Aged; Adult; Radiotherapy, Adjuvant; Treatment Outcome; Neoplasm Staging; Prognosis; Aged, 80 and over
PubMed: 38808641
DOI: No ID Found -
Ear, Nose, & Throat Journal May 2024This study aimed to determine the prevalence of complications after parotidectomy and identify factors associated with these complications. Data from patients who...
This study aimed to determine the prevalence of complications after parotidectomy and identify factors associated with these complications. Data from patients who underwent parotidectomy for neoplasms in 2 tertiary centers were analyzed. Patient characteristics and postoperative complications were collected. Demographics, diabetes, and smoking status were evaluated using descriptive statistics. The prevalence of complications was determined and associations with smoking, surgical type, preoperative facial nerve involvement, final pathology, and Milan category were examined using chi-squared and correlation analyses. Majority of patients were male (59.5%), falling within the age range of 31 to 50 years (42.7%). The most common complication was facial nerve weakness (23.6%), followed by seroma (19.1%), ear numbness (17.3%), and tumor recurrence (8.7%). Xerostomia demonstrated a correlation with smoking, while more invasive types of surgery showed associations with surgical site infection and tumor recurrence. Malignant disease on the final pathology and higher Milan category exhibited links with salivary fistula. No clear associations were found between preoperative facial nerve involvement and any of the complications. Age and body mass index (BMI) did not demonstrate significant correlations with complications. This study highlights the prevalence and associations of postparotidectomy complication. Facial nerve weakness was the most common followed by seroma and ear numbness. Smoking was correlated with xerostomia, while more invasive type of surgery was correlated with infection and recurrence. Age and BMI did not have associations. Personalized approaches and understanding factors for effective management are important. Further research is recommended to validate the outcome and understand the recovery from parotidectomy.
PubMed: 38721821
DOI: 10.1177/01455613241244656 -
Ear, Nose, & Throat Journal Apr 2024Warthin's tumors of the parotid gland can be safely observed. Definitive treatment usually requires parotidectomy under general anesthesia. The decision to operate on... (Review)
Review
Warthin's tumors of the parotid gland can be safely observed. Definitive treatment usually requires parotidectomy under general anesthesia. The decision to operate on Warthin's tumors of the parotid gland can be complicated in patients who wish to avoid risks of surgery and general anesthesia. This systematic review explores the potential of radiofrequency ablation (RFA) as a minimally invasive alternative. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model was used to collect 3 relevant studies that focused on RFA treatment for Warthin's tumors. The cumulative averages for tumor size and cosmetic scores were then quantified for patients with Warthin's tumors who underwent RFA therapy. The PRISMA systematic review method was employed to the PubMed and EMBASE databases. The comprehensive search term "Warthin Tumor Treatment" yielded 1299 articles from the years 1955 to 2023, 3 of which met inclusion criteria and were then selected. The 3 quantitative studies collectively assessed 37 patients with Warthin's tumors treated with RFA. Patients experienced an average tumor size reduction of 85.03% at 12 months post-RFA. There were minimal complications associated with RFA in these patients. This study suggests that RFA is an alternative to parotidectomy for the symptomatic treatment of Warthin's tumors. RFA procedures demonstrated substantial tumor size reduction with few complications. However, further meta-analysis and comparison with alternative treatments is warranted to establish RFA's role in treatment of Warthin's tumors. The study is limited by its reliance on only 2 databases and a lack of comprehensive examination of different RFA settings.
PubMed: 38647239
DOI: 10.1177/01455613241248119 -
Journal of Medical Case Reports Jan 2024Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic... (Review)
Review
BACKGROUND
Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic carcinoma with chondrosarcoma to the best of our knowledge. They consist of distinct carcinomatous and sarcomatous components and may arise de novo or from a preexisting pleomorphic adenoma.
CASE PRESENTATION
Herein we present a case of an 80-year-old white female who presented with progressively increasing left facial swelling over 6 weeks. Magnetic Resonance Imagining revealed a mass (3.4 cm) in the parotid gland with a predominant cystic/necrotic component. The cytology was atypical (Milan3) and a total parotidectomy and selective lymph node dissection was done. The resection showed extensive necrosis with high grade sarcomatous (chondrosarcoma) areas. The epithelial component was adenoid cystic carcinoma with perineural invasion. The patient is currently undergoing radiotherapy of the tumor bed and skull base due to propensity of perineural invasion of the adenoid cystic component. The most common carcinomas in carcinosarcomas of salivary glands are adenocarcinoma and squamous cell carcinoma.
CONCLUSION
Carcinosarcoma is a high-grade aggressive lesion with a poor prognosis and should be treated aggressively. More studies are needed to understand the origin of these tumors.
Topics: Humans; Female; Aged, 80 and over; Parotid Gland; Parotid Neoplasms; Carcinoma, Adenoid Cystic; Carcinosarcoma; Chondrosarcoma; Bone Neoplasms
PubMed: 38243328
DOI: 10.1186/s13256-023-04280-7 -
Ear, Nose, & Throat Journal Jul 2024Hemangiomas account for only 0.4% to 0.6% of all parotid tumors, making them extremely rare in adults. Unlike pediatric parotid hemangiomas, those in adults typically...
Hemangiomas account for only 0.4% to 0.6% of all parotid tumors, making them extremely rare in adults. Unlike pediatric parotid hemangiomas, those in adults typically present as asymptomatic swellings of the parotid, have no skin discoloration, and usually do not regress spontaneously. Therefore, an accurate diagnosis of parotid hemangiomas in adults before surgical excision is generally challenging. Herein, we present 3 cases of adult parotid hemangiomas. The patients all received parotidectomies with tumor resection. Histopathological analysis of the resected specimens revealed numerous dilated, thin- or thick-walled (small, large, or variably sized) vessels lined with flattened endothelial cells. A diagnosis of cavernous hemangioma of the parotid gland was established only after the histopathological analysis. Parotid cavernous hemangiomas in adults are rare and often misdiagnosed before surgical resection. Clinical presentation and imaging features on ultrasonography, computed tomography, magnetic resonance imaging, and angiography may support an accurate preoperative diagnosis. Surgical resection proved a suitable treatment approach for our 3 cases.
Topics: Humans; Parotid Neoplasms; Female; Male; Hemangioma, Cavernous; Adult; Middle Aged; Parotid Gland; Magnetic Resonance Imaging; Medical Illustration; Hemangioma
PubMed: 34904445
DOI: 10.1177/01455613211067834 -
World Journal of Clinical Cases Mar 2024Frey syndrome, also known as ototemporal nerve syndrome or gustatory sweating syndrome, is one of the most common complications of parotid gland surgery. This condition...
BACKGROUND
Frey syndrome, also known as ototemporal nerve syndrome or gustatory sweating syndrome, is one of the most common complications of parotid gland surgery. This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes, visual stimuli, or eating.
AIM
To investigate the preventive effect of acellular dermal matrix (ADM) on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection.
METHODS
Retrospective data from 82 patients were analyzed to assess the correlation between sex, age, resection sample size, operation time, operation mode, ADM usage, and occurrence of postoperative Frey syndrome.
RESULTS
Among the 82 patients, the incidence of Frey syndrome was 56.1%. There were no significant differences in sex, age, or operation time between the two groups ( > 0.05). However, there was a significant difference between ADM implantation and occurrence of Frey syndrome ( < 0.05). ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes.
CONCLUSION
ADM can effectively prevent Frey syndrome and delay its onset.
PubMed: 38576730
DOI: 10.12998/wjcc.v12.i9.1578