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Head & Neck Jul 2021The aim was to identify prognostic factors and test three prognostic scoring models that predicted the risk of recurrence in patients with parotid gland carcinoma.
BACKGROUND
The aim was to identify prognostic factors and test three prognostic scoring models that predicted the risk of recurrence in patients with parotid gland carcinoma.
METHODS
All Danish patients with parotid gland carcinoma, treated with curative intent, from 1990 to 2015 (n = 726) were included. Potential prognostic factors were evaluated using Cox regression and competing risk analyses. The concordance of each prognostic model was estimated using Harrel's C index.
RESULTS
The study population consisted of 344 men and 382 women, with a median age of 63 years. Age above 60 years, high grade histology, T3/T4 tumor, regional lymph node metastases, and involved surgical margins were all associated with a significant reduction in recurrence-free survival. The prognostic model that agreed best with actual outcomes had a C-index of 0.76.
CONCLUSION
Prognostic scoring models may improve individualized follow-up strategies after curatively intended treatment for patients with parotid gland carcinoma.
Topics: Carcinoma; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Gland; Parotid Neoplasms; Prognosis; Retrospective Studies
PubMed: 33734517
DOI: 10.1002/hed.26672 -
Kathmandu University Medical Journal...Basal Cell Adenoma (BCA) known as monomorphic adenoma is a rare type of benign epithelial salivary neoplasm that mostly occurs in the parotid gland. Clinically BCA... (Review)
Review
Basal Cell Adenoma (BCA) known as monomorphic adenoma is a rare type of benign epithelial salivary neoplasm that mostly occurs in the parotid gland. Clinically BCA appears as a firm, mobile, slow-growing mass and is usually diagnosed during the histopathological examination of the resected surgical specimen. Histological differential diagnosis ranges from benign to malignant neoplasms such as pleomorphic adenoma, basal cell adenocarcinoma, adenoid cystic carcinoma and basaloid squamous cell carcinoma. The treatment of BCA is surgical excision, due to its varied prognosis with the different histological subtypes; a regular long term follow up of the patient postoperatively is mandatory. We report a rare and interesting case of basal cell adenoma of the parotid gland in a 52 year old female. We review the literature; discuss the diagnosis and management of this rare histological entity.
Topics: Adenoma; Adenoma, Pleomorphic; Carcinoma, Adenoid Cystic; Female; Humans; Middle Aged; Parotid Gland; Parotid Neoplasms
PubMed: 34165108
DOI: No ID Found -
Journal of Computer Assisted TomographyA prediction model of benign and malignant differentiation was established by magnetic resonance signs of parotid gland tumors to provide an important basis for the...
OBJECTIVE
A prediction model of benign and malignant differentiation was established by magnetic resonance signs of parotid gland tumors to provide an important basis for the preoperative diagnosis and treatment of parotid gland tumor patients.
METHODS
The data from 138 patients (modeling group) who were diagnosed based on a pathologic evaluation in the Department of Stomatology of Jilin University from June 2019 to August 2021 were retrospectively analyzed. The independent factors influencing benign and malignant differentiation of parotid tumors were selected by logistic regression analysis, and a mathematical prediction model for benign and malignant tumors was established. The data from 35 patients (validation group) who were diagnosed based on pathologic evaluation from September 2021 to February 2022 were collected for verification.
RESULTS
Univariate and multivariate logistic regression analysis showed that tumor morphology, tumor boundary, tumor signal, and tumor apparent diffusion coefficient (ADC) were independent risk factors for predicting benign and malignant parotid gland tumors ( P < 0.05). Based on multivariate logistic regression analysis of the modeling group, a mathematical prediction model was established as follows: Y = the ex/(1 + ex) and X = 0.385 + (1.416 × tumor morphology) + (1.473 × tumor border) + (1.306 × tumor signal) + (2.312 × tumor ADC value). The results showed that the area under the receiver operating characteristic curve of the model was 0.832 (95% confidence interval, 0.75-0.91), the sensitivity was 82.6%, and the specificity was 70.65%. The validity of the model was verified using validation group data, for which the sensitivity was 85.71%, the specificity was 96.4%, and the correct rate was 94.3%. The results showed that the area under receiver operating characteristic curve was 0.936 (95% confidence interval, 0.83-0.98).
CONCLUSIONS
Combined with tumor morphology, tumor ADC, tumor boundary, and tumor signal, the established prediction model provides an important reference for preoperative diagnosis of benign and malignant parotid gland tumors.
Topics: Humans; Parotid Neoplasms; Retrospective Studies; Nomograms; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Sensitivity and Specificity; Parotid Gland
PubMed: 37551140
DOI: 10.1097/RCT.0000000000001522 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Oct 2021Parotid gland tumors are usually solitary tumors, and multiple tumors of the parotid gland are extremely rare. We present a highly unusual case of bilateral and... (Review)
Review
Parotid gland tumors are usually solitary tumors, and multiple tumors of the parotid gland are extremely rare. We present a highly unusual case of bilateral and simultaneous pleomorphic adenoma and basal cell adenoma of the parotid gland. We review the literature and discuss the clinical manifestations, diagnosis, and treatment of these two rare tumors.
Topics: Adenoma, Pleomorphic; Humans; Parotid Gland; Parotid Neoplasms
PubMed: 34636212
DOI: 10.7518/hxkq.2021.05.018 -
Head & Neck Nov 2021The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis... (Meta-Analysis)
Meta-Analysis Review
The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.
Topics: Bayes Theorem; Humans; Neoplasm Recurrence, Local; Network Meta-Analysis; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 34288212
DOI: 10.1002/hed.26813 -
The Annals of Otology, Rhinology, and... Jul 2019To identify and evaluate patients with parotid bed malignancy demonstrating radiographic findings of auriculotemporal (AT) nerve involvement.
OBJECTIVE
To identify and evaluate patients with parotid bed malignancy demonstrating radiographic findings of auriculotemporal (AT) nerve involvement.
METHODS
A retrospective review of patients with parotid bed malignancy was performed to identify patients with imaging findings of AT nerve involvement and record associated clinical findings, symptoms, and pathology information. Independent, blinded review of radiographic images by a senior neuroradiologist was performed to identify imaging characteristics and categorize patients into highly likely or possible involvement groups.
RESULTS
Of 547 patients identified with parotid bed malignancy, 23 patients exhibited radiographic findings suggestive of AT nerve involvement. Thirteen patients met criteria for highly likely involvement, and 10 patients met criteria for possible involvement. Cutaneous malignancy with metastasis to the parotid bed accounted for 11 of 23 patients, and the most common histology was squamous cell carcinoma (9 patients). Primary parotid malignancy accounted for 12 of 23 patients, and the most common histology was salivary ductal carcinoma (3 patients). All 13 highly likely patients reported periauricular pain, and 11 of 13 demonstrated facial weakness. Features suggesting advanced disease included radiographic findings of intracranial involvement (10/23 patients), nonsurgical primary treatment (13/23 patients), and positive margins on pathology report (7/10 patients).
CONCLUSION
AT nerve involvement is an uncommon but important phenomenon that often occurs in the setting of advanced disease and is commonly associated with periauricular pain and coexisting facial weakness. Awareness of the associated clinical features and imaging patterns can allow for appropriate identification of this pattern of spread and help to optimize treatment planning.
Topics: Carcinoma, Ductal; Head and Neck Neoplasms; Humans; Magnetic Resonance Imaging; Mandibular Nerve; Parotid Neoplasms; Positron-Emission Tomography; Retrospective Studies; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck
PubMed: 30894024
DOI: 10.1177/0003489419837574 -
Head & Neck Apr 2023The surgical approach to a parotid neoplasm has traditionally been taught through a modified-Blair incision. This approach results in a visible scar in the preauricular,...
The surgical approach to a parotid neoplasm has traditionally been taught through a modified-Blair incision. This approach results in a visible scar in the preauricular, retromandibular, and upper neck skin. Various modifications have been undertaken which aim to improve cosmesis either by decreasing overall incision length and/or relocation of the incision to the hairline via what is commonly described as a "facelift approach". We describe a novel minimally invasive parotidectomy approach which utilizes a single retroauricular incision. This approach eliminates both the preauricular scar as well as the extended incision in the hairline and additional skin flap elevation which accompanies it. Sixteen patients underwent parotidectomy using this minimally invasive incision and the excellent clinical outcomes are reviewed. The minimally invasive retroauricular approach to parotidectomy provides excellent exposure with no visible incision/scar in appropriately selected patients.
Topics: Humans; Cicatrix; Parotid Neoplasms; Neck; Surgical Flaps; Rhytidoplasty; Parotid Gland
PubMed: 36808673
DOI: 10.1002/hed.27306 -
HNO Apr 2023Due to the rarity of primary parotid malignancies, there are currently only limited clinical study data on the optimal surgical therapy. Parotid malignancies encompass... (Review)
Review
BACKGROUND
Due to the rarity of primary parotid malignancies, there are currently only limited clinical study data on the optimal surgical therapy. Parotid malignancies encompass a broad spectrum of more than 20 different histological subtypes with varying biology, which thus represents a challenge for even experienced pathologists and head and neck surgeons with proven expertise in salivary gland surgery.
OBJECTIVE
The aim of this review article is to provide an overview of the current literature on surgical therapy of the primary tumor and the cN0 neck as well as treatment of the facial nerve, and to shed light on the various controversial aspects of this topic.
RESULTS
In salivary gland oncology there is a trend towards safe (R0) but more conservative surgery. Currently, less-invasive surgical approaches could potentially be applied in a small subgroup with carefully selected caudally located and R0-resected "low-grade tumors" in stages T1-T2 and cN0 in relatively young patients with high compliance and more in the context of structured clinical studies. Elective neck dissection in the case of cN0 status should be carried out if risk factors for occult cervical lymph node metastasis (T3-T4a, "high-grade subtypes," advanced age, lymphangitic carcinomatosis) are present. In cases of small "low-grade parotid carcinomas," narrow resection margins or even microscopic tumor residues on the facial nerve can potentially be adequately compensated with adjuvant radiation therapy. However, due to the lack of solid data, the significance of the actual effect of the radiation in this situation should be viewed with great caution.
Topics: Humans; Parotid Neoplasms; Parotid Gland; Neoplasm Staging; Neck Dissection; Lymph Nodes; Retrospective Studies
PubMed: 35579674
DOI: 10.1007/s00106-022-01182-w -
Annals of the Royal College of Surgeons... Jan 2021Parotid masses causing facial palsy are highly indicative of malignancy. A significant number of cases describing benign parotid disease causing facial palsy have been...
INTRODUCTION
Parotid masses causing facial palsy are highly indicative of malignancy. A significant number of cases describing benign parotid disease causing facial palsy have been reported.
MATERIALS AND METHODS
We performed a systematic review of the literature to establish the aetiology, clinical features, investigations and management undertaken during these presentations to assess how these factors differed from malignant presentations and to establish an evidence-based algorithm for their management.
RESULTS
A total of 85 cases were identified from 78 articles. Cystadenolymphomas were the most common histopathological type ( = 0.034). Mean facial palsy recovery duration in neoplastic aetiology was longer than for infective aetiology ( = 0.033). A significant association existed between uncommon infective organisms and development of facial palsy ( = <0.0001).
CONCLUSION
Uncommon benign aetiologies are associated with facial palsy. Investigations and management should be guided by patients' clinical presentations, avoiding excessive treatment. Complete facial palsy recovery rates are high, although not immediate.
Topics: Algorithms; Cystadenoma; Diagnosis, Differential; Evidence-Based Medicine; Facial Paralysis; Humans; Lymphoma; Parotid Gland; Parotid Neoplasms
PubMed: 32969265
DOI: 10.1308/rcsann.2020.0194 -
Surgical Infections Jun 2023
Topics: Humans; Parotid Neoplasms; Tuberculosis; Parotid Diseases
PubMed: 36720003
DOI: 10.1089/sur.2022.332