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Head & Neck Dec 2023Several diagnostic modalities with various sensitivity and specificities can be used to evaluate a parotid mass. The aims of this project were to compare the diagnostic...
INTRODUCTION
Several diagnostic modalities with various sensitivity and specificities can be used to evaluate a parotid mass. The aims of this project were to compare the diagnostic actionability, accuracy, and ability to accurately predict extent of surgery for FNA and frozen section during the evaluation of a parotid mass.
METHODS
A retrospective chart review of patients who underwent parotidectomy for a parotid mass from January 1, 2015 to January 30, 2022 was conducted. Actionability was defined as a pathology diagnosis or the histologic grade of a lesion, as this provided clear and useful information for the surgeon to act upon. Diagnostic accuracy was determined by comparing FNA and frozen section results to final pathology. Accuracy of extent of surgery was determined by comparing predicted extent of surgery from the FNA or frozen section result to the extent of surgery predicted by the final pathology.
RESULTS
A total of 626 patients were included in this study. FNA was obtained in 396 (63%) patients, while all neoplasms were evaluated by frozen section analysis. FNA diagnosis was actionable in 318 (80%), while frozen section diagnosis was actionable in 616 (98%) patients. Exactly 294 (92.5%) FNA diagnoses were accurate compared with 600 (98%) frozen section diagnoses. The FNA diagnosis predicted appropriate extent of surgery in 294 (74%) while the frozen section diagnosis predicted appropriate extent of surgery in 600 (96%). Among the 396 patients with FNA, frozen section was significantly more likely to accurately predict appropriate extent of surgery compared with FNA (p < 0.001).
CONCLUSION
Frozen section is more likely to yield actionable and accurate results compared with FNA. Additionally, frozen section is better than FNA in predicting the appropriate extent of surgery.
Topics: Humans; Biopsy, Fine-Needle; Frozen Sections; Retrospective Studies; Sensitivity and Specificity
PubMed: 37752736
DOI: 10.1002/hed.27527 -
The British Journal of Oral &... May 2024Patients with cutaneous melanoma with metastatic deposits in the parotid gland have poor prognosis due to the high risk of developing distant metastasis. In the era of... (Review)
Review
Patients with cutaneous melanoma with metastatic deposits in the parotid gland have poor prognosis due to the high risk of developing distant metastasis. In the era of effective immunotherapy, there is no consensus amongst head and neck surgeons about the extent of neck dissection required for patients presenting with clinically apparent parotid metastasis. This review aims to determine the incidence and pattern of occult neck disease for patients with parotid metastasis reported in literature to help guide clinicians on the extent of neck dissection required. The systematic review search was conducted using PubMed, EMBASE and Medline, using PRISMA guidelines. The inclusion criteria include cases treated with parotidectomy and neck dissection for patients with parotid melanoma metastasis. A narrative synthesis was carried out due to heterogeneity of studies. A total of 14 studies was included. We found no study reporting on outcomes with surgery and adjuvant immunotherapy in this cohort of patients. The incidence of distant metastasis reported was variable but remains high for patients with parotid metastasis. Patients with parotid and neck involvement have poorer prognosis than patients with parotid only metastatic disease. The effect and extent of neck dissection in patients with clinically apparent parotid nodes remains unclear in the era of effective immunotherapy. There is a need for further well-designed studies evaluating the outcomes for such patients following surgery and adjuvant immunotherapy.
PubMed: 38945797
DOI: 10.1016/j.bjoms.2024.05.004 -
Otolaryngology--head and Neck Surgery :... Jan 2024To determine if ultrasound-guided (USG) radiofrequency ablation (RFA) of Parotid Warthin's tumor under local anesthesia is a safe and effective procedure.
OBJECTIVE
To determine if ultrasound-guided (USG) radiofrequency ablation (RFA) of Parotid Warthin's tumor under local anesthesia is a safe and effective procedure.
STUDY DESIGN
Safety and feasibility study.
SETTING
Tertiary academic medical center.
METHODS
This is an IDEAL phase 2a trial in a tertiary referral center. Twenty patients with Parotid Warthin's tumor were recruited. RFA was done between September and December 2021 for all 20 patients using a CoATherm AK-F200 machine with a disposable, 18G × 7 mm radiofrequency electrode. Results and follow-up statistics were compared with a historic sample of patients with parotid Warthin's tumor who underwent parotidectomy between 2019 and 2021 in the same center.
RESULTS
Nineteen patients were included in the analysis as 1 patient dropped out after 4 weeks of follow-up. The mean age for the RFA group was 67 years old with most of them being male smokers. At a median of 45 weeks (44-47 weeks) postprocedure there was a 7.48 mL (68.4%) volume reduction compared to baseline. Three patients had transient facial nerve (FN) paresis, 1 recovered within hours, and the other 2 by 12 weeks follow-up. Three patients had great auricular nerve numbness; 1 patient had infected hematoma treated in an out-patient manner. Compared to a historic cohort of parotidectomy patients for Warthin's tumor, there was no significant difference in FN paresis and other minor complications between the 2 treatment modalities.
CONCLUSION
The current analysis suggests that USG RFA of Warthin's Tumor is a safe alternative to parotidectomy with shorter operative time and length of stay.
Topics: Humans; Male; Aged; Female; Feasibility Studies; Parotid Neoplasms; Adenolymphoma; Ultrasonography, Interventional; Radiofrequency Ablation; Paresis
PubMed: 37435621
DOI: 10.1002/ohn.417 -
Indian Journal of Otolaryngology and... Sep 2023Although, instances of postoperative bleeding in ENT surgery are infrequent, sometimes they can be dreadful for both patient & surgeon. Here we are reporting 2 cases of...
Although, instances of postoperative bleeding in ENT surgery are infrequent, sometimes they can be dreadful for both patient & surgeon. Here we are reporting 2 cases of postoperative bleeding that we encountered recently. (1) Superficial temporal artery aneurysmal bleed- post parotidectomy (2) Left superior thyroid artery aneurysmal bleed- post tracheostomy.
PubMed: 37636682
DOI: 10.1007/s12070-023-03660-1 -
Ear, Nose, & Throat Journal Jun 2024Canalicular adenoma (CA) is a rare benign tumor of the salivary glands, predominantly affecting elderly females, with a strong predilection for the upper lip. While CA...
Canalicular adenoma (CA) is a rare benign tumor of the salivary glands, predominantly affecting elderly females, with a strong predilection for the upper lip. While CA commonly arises in the minor salivary glands, its occurrence in the parotid gland is exceptionally rare. In this report, we present a unique case of CA in the parotid gland, adding to the scant literature with only 8 documented instances. The patient, a 57-year-old Asian male, presented with a painless swelling in the left parotid gland that had been persisting for 8 years. Clinical examination and imaging studies identified a lobulated mass, prompting surgical intervention. The patient underwent a superficial parotidectomy, and pathological examination of the excised tissue confirmed the diagnosis of CA, with no signs of malignancy. This case illustrates the diagnostic and management challenges associated with CA, particularly given its rare presentation in the parotid gland. Accurate diagnosis is reliant on surgical biopsy, and careful surgical planning is imperative, especially considering the proximity of the facial nerve. Our case underscores the need for heightened awareness of CA's unique presentations, particularly within the Asian population. Given the potential for recurrence, long-term follow-up is essential. Further research is needed to elucidate the biological behavior of CA and to refine management strategies for optimal patient outcomes.
PubMed: 38881446
DOI: 10.1177/01455613241262652 -
European Archives of... Dec 2023To investigate the anatomical relationships between the structures adjacent to the cartilaginous portion of the ear canal in children with Work type I congenital...
PURPOSE
To investigate the anatomical relationships between the structures adjacent to the cartilaginous portion of the ear canal in children with Work type I congenital branchial cleft anomalies (CFBCAs) and to develop new classifications and surgical strategies.
METHODS
Retrospective analysis was performed on 50 children with Work type I CFBCAs admitted between December 2018 and December 2022.
RESULTS
Among the 50 children, total parotidectomy was performed on 49 sides. In 44 cases (88%), the main body of the lesion was closely associated with the cartilage of the inferior ear canal wall. Among these cases, the lesions in 40 cases occurred within the space enclosed by the dorsal inferior wall cartilage, mastoid process, and parotid gland, while in the remaining four cases, the lesions were located between the anterior inferior wall cartilage and parotid gland. Based on the preoperative imaging observations, clinical manifestations, and intraoperative findings, the cases were classified into 6 subtypes (a to f) including 21 cases (42%) of Type Ia (inferior wall of EAC), 7 cases (14%) of Type Ib (bottom wall of EAC), 12 cases (24%) of Type Ic (posterior-inferior wall of EAC), 4 cases (8%) of Type Id (anterior-inferior wall of EAC), 4 cases (8%) of Type Ie (anterior ear wall of EAC), and 2 cases (4%) of Type If (isolated from parotid).
CONCLUSION
Surgical intervention is the only treatment for first branchial cleft anomalies and a comprehensive understanding of the classifications will help with the precise localisation and excision of the lesions.
Topics: Child; Humans; Retrospective Studies; Craniofacial Abnormalities; Pharyngeal Diseases; Ear Canal; Branchial Region
PubMed: 37505262
DOI: 10.1007/s00405-023-08140-4 -
Current Medical Imaging Aug 2023Sebaceous lymphadenoma is a rare parotid gland neoplasm. Up to now, there have been several studies that have discussed the imaging manifestations of salivary sebaceous...
INTRODUCTION/BACKGROUND
Sebaceous lymphadenoma is a rare parotid gland neoplasm. Up to now, there have been several studies that have discussed the imaging manifestations of salivary sebaceous lymphadenoma. In this paper, we have reported a case of multiple parotid sebaceous lymphadenoma demonstrated by ultrasound, CT scan, and MRI examinations, including diffusion-weighted imaging. To the best of our knowledge, this report is the first one on DWI findings of sebaceous lymphadenomas, and also the first report on multiple lesions in unilateral parotid gland.
CASE PRESENTATION
A 41-year-old woman presented with a nodule in the left parotid region. The lesion has grown slowly for 2 months and was not associated with any discomfort. Ultrasound, CT scan, and MRI examinations, including diffusion-weighted imaging, showed multiple nodules in the left parotid gland of a 41-year-old woman. These nodules were heterogeneous on CT scan and MRI examinations, and intratumorally multifocal fat and cystic areas were detected. On ultrasound examination images, these lesions were heterogeneous hypoechoic echotexture with multifocal irregular hyperechogenic areas, without significant blood flow. The patient underwent a left parotidectomy. Histopathologic sections showed nests of sebocytes distributed in lymphoid follicles and lymphocyte background, with obvious cystic changes. The patient recovered after receiving left parotidectomy. The microscopy diagnosis was parotid sebaceous lymphadenoma.
CONCLUSION
This case highlights the main imaging feature of parotid sebaceous lymphadenomas, namely an intraparotid heterogeneous nodule containing multifocal fat and cystic areas, and its possible origination from an intraparotid lymph node. This case also indicates that this rare lesion may occur at multiple sites.
PubMed: 37622554
DOI: 10.2174/1573405620666230825113417 -
Journal of Telemedicine and Telecare May 2024We examined the suitability of using a video visit platform to perform postoperative parotidectomy evaluation at a tertiary care, multiple-surgeon otolaryngology center.
INTRODUCTION
We examined the suitability of using a video visit platform to perform postoperative parotidectomy evaluation at a tertiary care, multiple-surgeon otolaryngology center.
METHODS
A retrospective case review was conducted of patients who underwent parotidectomy and postoperative video visits between November 2019 and December 2020. Success of video visit, plan if applicable, and post-visit outcomes were reviewed. Video visits were designated as successful if the physician could assess for complications in the postoperative course (e.g. first bite pain, Frey syndrome, ear numbness, unplanned visits to the emergency department, unplanned return to the operating room), perform examination of facial nerve function, and formulate care recommendations per clinical judgement without deferment of recommendations for a subsequent in-person visit.
RESULTS
There were 96 postoperative video visits with 91 unique parotidectomy patients. Demographics: 28/63 male/female; average age, 54y. All video visits were suitable for successful postoperative parotidectomy patient evaluation. Eight visits (8.3%) consisted of patients presenting with common postoperative complications (e.g. eye dryness, first bite pain) and warranted care recommendations. In only two cases did the patient require further in-person procedural (hematoma evacuation, seroma aspiration) follow-ups. For the other 91.7% of visits (n = 88), no additional recommendations were required as patients experienced uncomplicated postoperative courses. Of all the patients, 26.1% (n = 23) were instructed to follow-up for routine surveillance. All other patients, 73.9% (n = 65) were instructed to follow-up as needed.
CONCLUSION
Postoperative parotidectomy evaluation is highly amenable to being performed by video. A telemedicine option offers convenience for patients in the majority of cases without compromising clinical assessment and judgment for the physician.
Topics: Humans; Male; Female; Middle Aged; Follow-Up Studies; Retrospective Studies; Tertiary Healthcare; Telemedicine; Surgeons; Pain; Otolaryngology
PubMed: 35549759
DOI: 10.1177/1357633X221095319 -
Head & Neck Jun 2024Anatomic landmarks such as the tympanomastoid suture line, posterior belly of the digastric muscle, tragal pointer, and styloid process can assist the parotid surgeon in...
BACKGROUND
Anatomic landmarks such as the tympanomastoid suture line, posterior belly of the digastric muscle, tragal pointer, and styloid process can assist the parotid surgeon in identifying and preserving the facial nerve. Vascular structures such as the posterior auricular artery and its branch, the stylomastoid artery, lay in close proximity to the facial nerve and have been proposed as landmarks for the identification of the facial nerve. In this case report, we describe an anatomic variation in which the stylomastoid artery has fenestrated the main trunk of the facial nerve, dividing it in two.
METHODS
Two patients underwent parotidectomy (one for a pleomorphic adenoma, the second for a parotid cyst) through a standard anterograde approach with identification of the usual facial nerve landmarks.
RESULTS
The appearance of the main trunk of the facial nerve was unusual in both patients due to its being fenestrated by the stylomastoid artery. The stylomastoid artery was divided, and the remainder of the facial nerve dissection was performed uneventfully with subsequent resection of the parotid mass in both patients.
CONCLUSIONS
In rare instances, the stylomastoid artery can penetrate through the common trunk of the facial nerve. This is an important anatomic variant for the parotid surgeon to be aware of, as it can increase the difficulty of facial nerve dissection.
Topics: Humans; Facial Nerve; Parotid Gland; Parotid Neoplasms; Male; Female; Adenoma, Pleomorphic; Middle Aged; Anatomic Variation; Dissection; Anatomic Landmarks; Adult; Temporal Bone
PubMed: 38610123
DOI: 10.1002/hed.27775 -
European Archives of... Jun 2024Among the complications of parotid surgery, facial palsy is frequent and burdened by high functional and social impact for the patient. There are few data on the...
OBJECTIVES
Among the complications of parotid surgery, facial palsy is frequent and burdened by high functional and social impact for the patient. There are few data on the efficacy of facial neuromuscular retraining (FNR) in patients with facial palsy after parotid surgery, and no data exist on its impact in timing and extent of recovery.
MATERIAL AND METHODS
A retrospective study was conducted on patients undergoing FN sparing parotid surgery and suffering from postoperative facial palsy. Among 400 patients undergoing surgery between July 2016 and May 2023, those with the preservation of the FN and onset of facial palsy were selected. Nerve function was evaluated during 2 years follow up using the House-Brackman (H&Bs) and Sunnybrook scales (SBs).
RESULTS
A total of 46 patients undergoing partial or total parotidectomy were included. At discharge 18 patients (39,1%) had IV to VI grade paralysis according to the H&Bs and the mean SBs value was 54. At 2 and 6 months after surgery, the average value of Sunnybrook increased to 76.5 and 95.4 respectively. After 12 months no patients with IV to VI grade paralysis were represent in our cohort. Two years after surgery, only five patients (10.9%) had persistent grade II paralysis according to HBs.
CONCLUSIONS
Our study supports the efficacy of FNR in the rehabilitation of facial paralysis after nerve-sparing parotidectomy. The greater functional improvement is achieved within the first 6 months of rehabilitation. A significant improvement is detected still after 18 months, supporting the importance of long rehabilitation for patients without complete recovery after the first year.
PubMed: 38914817
DOI: 10.1007/s00405-024-08758-y