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Journal of Oral Pathology & Medicine :... Feb 2021To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and extent of elective neck dissection in these neoplasms.
METHODS
Medline, Embase, Web of Science, Cochrane Library and Scopus were searched until August 31, 2020, to identify studies reporting the use of elective neck dissection in the management of malignant parotid tumours. The PRISMA checklist was used. A single arm meta-analysis was then made to determine the pooled rate of occult lymph node metastases. Risk of bias of the included studies was assessed through the ROBINS-E tool.
RESULTS
The initial search returned 20 541 articles, of which twelve met the inclusion criteria and were included in the meta-analysis. They comprised 1310 patients with parotid carcinoma, of whom 542 cN0 underwent elective neck dissection, which led to the diagnosis of lymph node metastasis (pN+/cN0) in 113 cases. Meta-analysis of the results of elective neck dissection showed an overall rate of occult metastases of 0.22 (99% CI: 0.14-0.30). Locally advanced or high-grade tumours were the commonest indications for elective neck dissection in the included studies. The most dissected lymph node levels were I-II-III, and level II was the commonest site of occult nodal metastases.
CONCLUSIONS
An occult metastasis rate of 0.22 (99% CI: 0.14-0.30) represents a not negligible percentage value, which should encourage further research to outline the most appropriate elective neck management in cN0 patients with parotid carcinomas.
Topics: Carcinoma; Humans; Lymph Nodes; Lymphatic Metastasis; Neck Dissection; Neoplasm Staging; Parotid Neoplasms; Retrospective Studies
PubMed: 33222323
DOI: 10.1111/jop.13137 -
Auris, Nasus, Larynx Aug 2022To evaluate surgical approaches and outcomes of pleomorphic adenoma of parotid gland in pediatric population. (Review)
Review
OBJECTIVES
To evaluate surgical approaches and outcomes of pleomorphic adenoma of parotid gland in pediatric population.
METHODS
A systematic search of PubMed and EMBASE was performed to identify articles reporting surgical treatment of pleomorphic adenoma of the parotid gland in children. A qualitative analysis on results was conducted.
RESULTS
Our search included 23 retrospective studies. The number of children with pleomorphic adenoma underwent surgical treatment were 330. Superficial parotidectomy is the most reported type of surgery, total parotidectomy is performed when the tumor occurs in the deep lobe or in revision surgery and limited excisions in selected case of small lesions mainly in the tail of parotid gland. The rate of recurrences after surgery ranged from 0% to 44.4%. Revision surgery was performed in all cases of recurrences. Considering major complications, transient facial paralysis was observed from 0% to 50% of cases after primary and/or revision surgery; Frey's syndrome from 0% to 14.3% of cases regardless of the type of surgeries.
CONCLUSION
Surgical treatment of pleomorphic adenoma of parotid gland in children requires a tailored approach based on the location and extent of the tumor with the main aim of complete excision of the neoplasm. Appropriate surgical approach results in a decrease of recurrence rate and morbidity. Surgical skill is needed to reduce complication rates especially in children.
Topics: Adenoma, Pleomorphic; Child; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Recurrence; Retrospective Studies
PubMed: 35101285
DOI: 10.1016/j.anl.2022.01.013 -
ANZ Journal of Surgery Mar 2023Accessory parotid tumours are rare, accounting for less than 10% of parotid neoplasms. Although similar tumours affect both the accessory parotid and parotid, accessory... (Review)
Review
Accessory parotid tumours are rare, accounting for less than 10% of parotid neoplasms. Although similar tumours affect both the accessory parotid and parotid, accessory parotid tumours are associated with higher rates of malignancy. Surgery is first line management. Standard surgical management involves a similar approach to superficial parotidectomy, despite the anterior location of these lesions. This approach requires extensive subcutaneous access and facial nerve dissection and therefore, poses significant risk. It can also result in poor cosmetic result due to scarring and Frey's Syndrome. On the contrary, a transoral approach to reduces the risk of cosmetic deformity, reduces recovery time and does not increase risk to the facial nerve. We present a case series of patients with accessory parotid masses, which have been successfully excised transoral and without endoscopic assistance.
Topics: Humans; Parotid Neoplasms; Parotid Gland; Sweating, Gustatory; Endoscopy; Dissection; Postoperative Complications
PubMed: 36754593
DOI: 10.1111/ans.18310 -
JPMA. the Journal of the Pakistan... Feb 2020To analyse the clinical and histopathological characteristics of parotid gland masses at a tertiary referral centre and to compare the results with those cited in...
OBJECTIVE
To analyse the clinical and histopathological characteristics of parotid gland masses at a tertiary referral centre and to compare the results with those cited in literature.
METHODS
The retrospective study was conducted at Adana Numune Training and Research Hospital, Adana, Turkey, and comprised data of patients undergoing parotid surgery between January 2011 and December 2016. They were evaluated in terms of age, gender, surgery method, fine-needle aspiration biopsy results, specimen reports and complications after the surgery for one year. SPSS 20 was used for data analysis.
RESULTS
Of 170 parotidectomies, 97(57.1%) had been performed on males and 73(42.9%) on females. There were 145(85.3%) benign and 25(14.7%) malignant tumours. Pleomorphic adenoma 67(39.4%) and Warthin's tumour 56(32.9%) were the two most common benign tumours. Mucoepidermoid carcinoma 7(4.1%) and adenoid cystic carcinoma 6(3.5%) were the two most prevalent malignant tumours. Superficial parotidectomy 133(78.2%) was the main type of surgical intervention. The sensitivity of fine needle aspiration cytology for identifying malignant tumours was 64.71%, the specificity was 100% and overall accuracy of the procedure was 94.92%.
CONCLUSIONS
Repeated aspirations for sampling different parts of the lesion should be performed on suspicion of malignancy, especially if fine needle aspiration cytology reported pleomorphic adenoma.
Topics: Adenolymphoma; Adenoma, Pleomorphic; Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Carcinoma, Adenoid Cystic; Carcinoma, Mucoepidermoid; Child; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Parotid Diseases; Parotid Neoplasms; Retrospective Studies; Sialadenitis; Tertiary Care Centers; Turkey; Young Adult
PubMed: 32063626
DOI: 10.5455/JPMA.17185 -
Head & Neck Mar 2021The prognostic importance of intraparotid lymph node metastasis (P+) in patients with primary parotid gland carcinoma is unclear. (Review)
Review
BACKGROUND
The prognostic importance of intraparotid lymph node metastasis (P+) in patients with primary parotid gland carcinoma is unclear.
METHODS
Nineteen retrospective and noncomparative cohort studies, published between 1992 and 2020, met the inclusion criteria and included 2202 patients for this systematic review.
RESULTS
The pooled prevalence of the P in adult patients in the unselected studies was 24.10% (95% confidence interval = 17.95-30.25). The number of P+ lymph nodes per patient was counted in only three studies and ranged from 1 to 11. The 5-year recurrence-free survival rate based on Kaplan-Meier analysis varied from 83% to 88% in P- patients compared to 36% to 54% in P+ patients. The average hazard ratio for tumor recurrence in patients with P+ compared to P- was 2.67 ± 0.58.
CONCLUSIONS
P+ is an independent negative prognostic factor in primary parotid gland cancer and should be included into the treatment planning.
Topics: Adult; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Neoplasms; Prognosis; Retrospective Studies
PubMed: 33169420
DOI: 10.1002/hed.26541 -
Auris, Nasus, Larynx Dec 2023Sialocele that develops after parotid surgery often prolongs the treatment period and stresses both the surgeon and patient. The extent of surgery and tumor size are...
OBJECTIVE
Sialocele that develops after parotid surgery often prolongs the treatment period and stresses both the surgeon and patient. The extent of surgery and tumor size are known to be associated with sialocele occurrence. We investigated the incidence of post-parotidectomy sialocele and the associated risk factors, with a focus on tumor size.
METHODS
We retrospectively reviewed the medical records of 172 patients who underwent parotidectomy between January 2013 and May 2020 at Haeundae Paik Hospital, Inje University of Korea. We stratified patients into those with and without sialocele (fluid collection in the operative bed). We compared clinical data, patient demographics, and surgical details; we identified risk factors for sialocele development after parotid surgery.
RESULTS
Seventeen patients were diagnosed with post-parotidectomy sialocele (9.88%; 17/172). Univariate logistic regression revealed that the male sex, deep lobe tumor location, and large tumor size were significantly associated with postoperative sialocele (p = 0.015, 0.009, and 0.016, respectively). We subjected these parameters to multivariate analyses; the odds ratios were 3.70, 3.58, and 2.34, respectively. Receiver operating characteristic curve analyses showed that a tumor size > 2.50 cm was the optimal cutoff in terms of predicting post-parotidectomy sialocele.
CONCLUSION
Male sex, a tumor in the deep lobe, and large tumor size were strongly associated with increased risk for sialocele after parotidectomy. Tumor size > 2.50 cm serves as the cutoff identifying patients likely to experience sialocele after parotid surgery.
Topics: Humans; Male; Parotid Neoplasms; Retrospective Studies; Parotid Gland; Cysts; Risk Factors; Salivary Gland Diseases; Postoperative Complications
PubMed: 36922283
DOI: 10.1016/j.anl.2023.02.006 -
Auris, Nasus, Larynx Jun 2022Objective; Neoplasm of accessory parotid glands are very rare, accounting for only 1% to 7.7% of all parotid gland tumors. External appproaches including parotidectomy...
UNLABELLED
Objective; Neoplasm of accessory parotid glands are very rare, accounting for only 1% to 7.7% of all parotid gland tumors. External appproaches including parotidectomy or facelift incision are the recommended treatment, allowing a good control over the anterior facial nerve's branches and Stensen's duct, but they require a large flap elevation and leave an external scar.
METHODS
We report the case of a 76-year-old woman presented with a chief complaint of swelling in the right cheek. The patient underwent ultrasonography, FNAC and MRI which identified a subcutaneous mass over the anterior border of the masseter muscle.
RESULTS
An endoscopic-assisted transoral resection was performed, no postoperative complications were recorded. Final histology was consistent with pleomorphic adenoma.
CONCLUSION
In selected cases, the endoscope-assisted transoral approach allow accessory parotid mass excision with better cosmetic results if compared to the transcutaneous approach. Although not negligible, the risk of facial nerve injury is minimized under endoscopic magnification.
Topics: Adenoma, Pleomorphic; Aged; Cheek; Female; Humans; Parotid Gland; Parotid Neoplasms; Salivary Ducts
PubMed: 33168293
DOI: 10.1016/j.anl.2020.10.004 -
The Laryngoscope Feb 2023To design a deep learning model based on multimodal magnetic resonance image (MRI) sequences for automatic parotid neoplasm classification, and to improve the diagnostic...
OBJECTIVE
To design a deep learning model based on multimodal magnetic resonance image (MRI) sequences for automatic parotid neoplasm classification, and to improve the diagnostic decision-making in clinical settings.
METHODS
First, multimodal MRI sequences were collected from 266 patients with parotid neoplasms, and an artificial intelligence (AI)-based deep learning model was designed from scratch, combining the image classification network of Resnet and the Transformer network of Natural language processing. Second, the effectiveness of the deep learning model was improved through the multi-modality fusion of MRI sequences, and the fusion strategy of various MRI sequences was optimized. In addition, we compared the effectiveness of the model in the parotid neoplasm classification with experienced radiologists.
RESULTS
The deep learning model delivered reliable outcomes in differentiating benign and malignant parotid neoplasms. The model, which was trained by the fusion of T2-weighted, postcontrast T1-weighted, and diffusion-weighted imaging (b = 1000 s/mm ), produced the best result, with an accuracy score of 0.85, an area under the receiver operator characteristic (ROC) curve of 0.96, a sensitivity score of 0.90, and a specificity score of 0.84. In addition, the multi-modal paradigm exhibited reliable outcomes in diagnosing the pleomorphic adenoma and the Warthin tumor, but not in the identification of the basal cell adenoma.
CONCLUSION
An accurate and efficient AI based classification model was produced to classify parotid neoplasms, resulting from the fusion of multimodal MRI sequences. The effectiveness certainly outperformed the model with single MRI images or single MRI sequences as input, and potentially, experienced radiologists.
LEVEL OF EVIDENCE
3 Laryngoscope, 133:327-335, 2023.
Topics: Humans; Parotid Neoplasms; Artificial Intelligence; Deep Learning; Sensitivity and Specificity; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 35575610
DOI: 10.1002/lary.30154 -
Ear, Nose, & Throat Journal Jun 2021Infantile hemangiomas (IHs) are the most common tumor of the parotid gland in children; however, there is no standard protocol for the treatment of IH. The generally...
INTRODUCTION
Infantile hemangiomas (IHs) are the most common tumor of the parotid gland in children; however, there is no standard protocol for the treatment of IH. The generally accepted practice is to begin the patient on β-blocker therapy if there are no contraindications.
OBJECTIVE
The purpose of this study is to better understand the challenges and successes of management of pediatric patients with parotid IH.
METHODS
This retrospective study analyzed 15 patients diagnosed with parotid IH from 2009 to 2016 who were cared for at a tertiary care center. Demographic information, lesion characteristics, and treatment course were obtained through patient chart review.
RESULTS
Fifteen pediatric patients with parotid IH were evaluated. The female:male ratio was 4:1; the average age of diagnosis was 8.75 months. Most lesions were greater than 3 cm in their widest dimension (73.3%), and 13 patients underwent imaging to further clarify the parotid mass in their clinical workup. Fourteen patients began treatment with propranolol; 10 patients saw complete resolution of their IH (66.7%) and 3 had a partial response to β-blocker therapy (20%). After discontinuation of propranolol, 2 patients had regrowth 2 to 3 months later after regression and were restarted on therapy. The average duration of treatment was 9.9 ± 8.45 months. The known adverse effects of propranolol-hypoglycemia, hypotension, bradycardia, and bronchospasm-were not observed in any patient.
CONCLUSION
In the treatment of parotid IH, propranolol is the generally accepted first-line therapy, as compared to corticosteroid or interferon α injections of years past. Parotid hemangiomas, however, have a lower response rate to propranolol and a similar recurrence rate compared to IH at other sites. The treatment duration necessary tends to be longer. Future studies will aim at identifying and evaluating potential predictors of outcomes to help inform the management of parotid hemangiomas.
Topics: Adrenal Cortex Hormones; Drug Administration Schedule; Female; Hemangioma; Hemangioma, Capillary; Humans; Infant; Male; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Propranolol; Retrospective Studies; Treatment Outcome
PubMed: 31565986
DOI: 10.1177/0145561319877760 -
JAAPA : Official Journal of the... Sep 2022Salivary gland tumors are rare, accounting for 6% to 8% of head and neck tumors. Detecting them in primary care is important so that adequate treatment can be provided....
Salivary gland tumors are rare, accounting for 6% to 8% of head and neck tumors. Detecting them in primary care is important so that adequate treatment can be provided. This case report describes a 58-year-old woman whose unilateral pulsatile tinnitus and ear fullness led to the diagnosis of a salivary gland tumor, specifically a pleomorphic adenoma of the parotid gland.
Topics: Adenoma, Pleomorphic; Female; Humans; Middle Aged; Parotid Gland; Parotid Neoplasms
PubMed: 36007120
DOI: 10.1097/01.JAA.0000854504.04227.cf