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The Annals of Otology, Rhinology, and... Oct 2021Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been...
BACKGROUND
Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey's syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers.
MATERIALS AND METHODS
Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes.
RESULTS
Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey's syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site.
CONCLUSION
In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey's syndrome and preserved facial cosmesis in most patients.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Prospective Studies; Skin Transplantation; Surgical Flaps; Transplantation, Autologous; Young Adult
PubMed: 33657862
DOI: 10.1177/0003489421999542 -
Dento Maxillo Facial Radiology May 2022To provide a graded diagnosis of benign and malignant lesions in the parotid gland by conventional ultrasound, and thus to predict the probability of malignancy of the...
OBJECTIVES
To provide a graded diagnosis of benign and malignant lesions in the parotid gland by conventional ultrasound, and thus to predict the probability of malignancy of the lesions.
METHODS
Retrospective analysis of conventional ultrasound images of 150 patients with parotid lesions by two observers. Parotid lesions were classified into seven patterns and then categorised into eight grades: Grade 0, unsatisfied illustration on ultrasound; Grade 1, normal parotid gland; Grade 2, definitively benign; Grade 3, probably benign; Grade 4, indeterminate; Grade 5, probably malignant; Grade 6, highly suggestive malignant and Grade 7, already had malignant diagnosis. Combined with the pathological results, the conventional ultrasound diagnostic grade of parotid lesions was evaluated for predicting the probability of malignancy.
RESULTS
There was excellent interobserver agreement of both readers for patterns and grades ( = 0.89 and 0.90, < 0.01). The proportions of the malignancies in conventional ultrasound Grade 2, 3, 4, 5 and 6 according to the two readers 0 and 0, 0 and 0, 8.7% and 8.8%, 54.2% and 50%, 100% and 100%, respectively. The sensitivity, specificity and area under ROC curve were 64.0%, 91.2%, 0.809 and 64.0%, 89.6%, 0.802, respectively, using Grade 5 of the two readers as the best grade for diagnosing benign and malignant parotid lesions.
CONCLUSION
The conventional ultrasound diagnostic grade of parotid lesions can be used to evaluate the risk of malignancy and will be helpful to improve the imaging diagnosis and clinical treatment.
Topics: Diagnosis, Differential; Humans; Parotid Gland; Parotid Neoplasms; Pilot Projects; ROC Curve; Retrospective Studies; Sensitivity and Specificity; Ultrasonography
PubMed: 35113723
DOI: 10.1259/dmfr.20210484 -
Ultraschall in Der Medizin (Stuttgart,... Aug 2023Preoperative differentiation between benign parotid tumors (BPT) and malignant parotid tumors (MPT) is crucial for treatment decisions. The purpose of this study was to...
OBJECTIVES
Preoperative differentiation between benign parotid tumors (BPT) and malignant parotid tumors (MPT) is crucial for treatment decisions. The purpose of this study was to investigate the benefits of combining contrast-enhanced ultrasound (CEUS) and strain elastography (SE) for preoperative differentiation between BPT and MPT.
METHODS
A total of 115 patients with BPT (n=72) or MPT (n=43) who underwent ultrasound (US), SE, and CEUS were enrolled. US and CEUS features and the elasticity score were evaluated. Receiver operating characteristic curve (ROC) analysis was used to assess the diagnostic performance of SE, CEUS, and SE + CEUS with respect to identifying MPT from BPT.
RESULTS
Solitary presentation, larger diameter, irregular shape, ill-defined margin, heterogeneous echogenicity, and calcification on US and higher elasticity score on SE had a significant association with malignancy. MPT also presented an unclear margin, larger size after enhancement, and "fast-in and fast-out" pattern on CEUS. The combination of SE and CEUS was effective for differentiating MPT from BPT (AUC: 0.88, 0.80-0.95), with a sensitivity of 86.0%, specificity of 88.9%, and accuracy of 87.8%, which were significantly higher than the values for SE (AUC: 0.75, 0.66-0.85) and CEUS (AUC: 0.82, 0.73-0.91) alone.
CONCLUSION
The combination of CEUS and SE is valuable for distinguishing MPT from BPT.
Topics: Humans; Elasticity Imaging Techniques; Parotid Neoplasms; Sensitivity and Specificity; Contrast Media; Diagnosis, Differential; Ultrasonography
PubMed: 36731495
DOI: 10.1055/a-1866-4633 -
Cancer Medicine Jun 2024To investigate the added value of extracellular volume fraction (ECV) and arterial enhancement fraction (AEF) derived from enhanced CT to conventional image and clinical...
Discriminating atypical parotid carcinoma and pleomorphic adenoma utilizing extracellular volume fraction and arterial enhancement fraction derived from contrast-enhanced CT imaging: A multicenter study.
OBJECTIVES
To investigate the added value of extracellular volume fraction (ECV) and arterial enhancement fraction (AEF) derived from enhanced CT to conventional image and clinical features for differentiating between pleomorphic adenoma (PA) and atypical parotid adenocarcinoma (PCA) pre-operation.
METHODS
From January 2010 to October 2023, a total of 187 cases of parotid tumors were recruited, and divided into training cohort (102 PAs and 51 PCAs) and testing cohort (24 PAs and 10 atypical PCAs). Clinical and CT image features of tumor were assessed. Both enhanced CT-derived ECV and AEF were calculated. Univariate analysis identified variables with statistically significant differences between the two subgroups in the training cohort. Multivariate logistic regression analysis with the forward variable selection method was used to build four models (clinical model, clinical model+ECV, clinical model+AEF, and combined model). Diagnostic performances were evaluated using receiver operating characteristic (ROC) curve analyses. Delong's test compared model differences, and calibration curve and decision curve analysis (DCA) assessed calibration and clinical application.
RESULTS
Age and boundary were chosen to build clinical model, and to construct its ROC curve. Amalgamating the clinical model, ECV, and AEF to establish a combined model demonstrated superior diagnostic effectiveness compared to the clinical model in both the training and test cohorts (AUC = 0.888, 0.867). There was a significant statistical difference between the combined model and the clinical model in the training cohort (p = 0.0145).
CONCLUSIONS
ECV and AEF are helpful in differentiating PA and atypical PCA, and integrating clinical and CT image features can further improve the diagnostic performance.
Topics: Humans; Male; Female; Adenoma, Pleomorphic; Middle Aged; Parotid Neoplasms; Tomography, X-Ray Computed; Diagnosis, Differential; Aged; Adult; Contrast Media; ROC Curve; Retrospective Studies; Adenocarcinoma
PubMed: 38899534
DOI: 10.1002/cam4.7407 -
NMR in Biomedicine Jan 2021Various MRI sequences have shown their potential to discriminate parotid gland tumors, including but not limited to T -weighted, postcontrast T -weighted, and...
Various MRI sequences have shown their potential to discriminate parotid gland tumors, including but not limited to T -weighted, postcontrast T -weighted, and diffusion-weighted images. In this study, we present a fully automatic system for the diagnosis of parotid gland tumors by using deep learning methods trained on multimodal MRI images. We used a two-dimensional convolution neural network, U-Net, to segment and classify parotid gland tumors. The U-Net model was trained with transfer learning, and a specific design of the batch distribution optimized the model accuracy. We also selected five combinations of MRI contrasts as the input data of the neural network and compared the classification accuracy of parotid gland tumors. The results indicated that the deep learning model with diffusion-related parameters performed better than those with structural MR images. The performance results (n = 85) of the diffusion-based model were as follows: accuracy of 0.81, 0.76, and 0.71, sensitivity of 0.83, 0.63, and 0.33, and specificity of 0.80, 0.84, and 0.87 for Warthin tumors, pleomorphic adenomas, and malignant tumors, respectively. Combining diffusion-weighted and contrast-enhanced T -weighted images did not improve the prediction accuracy. In summary, the proposed deep learning model could classify Warthin tumor and pleomorphic adenoma tumor but not malignant tumor.
Topics: Deep Learning; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Parotid Gland; Parotid Neoplasms
PubMed: 32886955
DOI: 10.1002/nbm.4408 -
Cancer Cytopathology Jun 2022Mesenchymal neoplasms of the parotid gland (PG) and para-pharyngeal (PP) space are distinctly uncommon. Fine-needle aspiration (FNA) biopsy experience with nonlipomatous... (Review)
Review
BACKGROUND
Mesenchymal neoplasms of the parotid gland (PG) and para-pharyngeal (PP) space are distinctly uncommon. Fine-needle aspiration (FNA) biopsy experience with nonlipomatous neoplasms from this site is reviewed.
METHODS
Cytopathology and surgical pathology files were examined for mesenchymal PG and PP space neoplasms. FNA biopsy was performed using standard technique.
RESULTS
Twenty-two PG and/or PP aspirates from 20 adults (male:female = 1.1:1; age range, 19-84 years, mean age, 50 years) and a 10-week-old infant met inclusion criteria. Biopsy sites included PG (17, 77%) or PP space (5, 23%). Five of 6 malignant neoplasms (83%) were called malignant cytologically. Only 7 of 11 (63%) benign neoplasms were recognized as a benign neoplasm. None of 5 solitary fibrous tumor (SFT) cases were correctly recognized. Conversion to the Milan classification showed 8 (36%) FNA cases diagnosed as benign neoplasm, 6 (27%) malignant neoplasm, 4 (18%) neoplasm of uncertain malignant potential, 2 (9%) nondiagnostic, and single cases of suspicious for malignancy and nonneoplastic. There was 1 false-positive and no false-negative FNA diagnoses. Ancillary testing in 10 (45%) aspirates helped substantiate a correct specific diagnosis in 3 malignant and 3 benign cases.
CONCLUSIONS
FNA biopsy of nonlipomatous mesenchymal SG neoplasms is particularly challenging. Less than half (9 of 11, 41%) had specific FNA diagnoses that correctly matched the tissue diagnoses or clinical outcome. Accurate Milan categorization was superior for malignant neoplasms (5 of 6, 83%) in contrast to benign neoplasms (7 of 11, 63%), or neoplasms of uncertain malignant potential (SFT) (2 of 5, 40%).
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Female; Humans; Infant; Male; Middle Aged; Parapharyngeal Space; Parotid Gland; Retrospective Studies; Solitary Fibrous Tumors; Young Adult
PubMed: 35195952
DOI: 10.1002/cncy.22562 -
Oral Oncology Dec 2021Mucoepidermoid carcinoma (MEC) is one of the most common salivary gland malignancies. Our aim was to evaluate the prognostic impact of primary tumor site in patients...
UNLABELLED
Mucoepidermoid carcinoma (MEC) is one of the most common salivary gland malignancies. Our aim was to evaluate the prognostic impact of primary tumor site in patients with MEC.
MATERIAL AND METHODS
This cohort identified 308 patients with MEC who underwent primary surgery between 1985 and 2015. Survival outcomes were determined using the Kaplan-Meier method. Hazard ratios for primary site were determined using the Cox proportional-hazards model.
RESULTS
One hundred eighty (58%) patients were diagnosed with minor and 128 (42%) with major salivary gland cancer. Primary site in the minor salivary gland group included 137 (44%) oral cavity, 38 (12%) pharynx, 3 (0.9%) nasal cavity, and 2 (0.6%) trachea and larynx. The major salivary gland group included 118 (38%) parotid, 8 (3%) submandibular, and 2 (0.6%) sublingual. With a median follow-up of 73 months, 5-year overall survival and disease-specific survival were 84% and 91%, respectively. Patients with tumors located in the hard palate and retromolar trigone had the best survival, while patients with tumors located in the paranasal sinuses and submandibular gland had the poorest survival. After controlling for tumor grade and stage, MEC primary site was not predictive of survival or recurrence. On multivariate analysis, worse DSS was associated with stage III-IV tumors (HR: 7,11; 95% CI: 1.19-26.43; p = 0.0034) and high-grade tumors (HR: 19.12; 95% CI: 2.26-162.77; p = 0.0068).
CONCLUSIONS
While high grade and advanced overall stage were found to be independent predictors of worse survival, primary tumor site was not predictive of poor outcome.
Topics: Carcinoma, Mucoepidermoid; Humans; Neoplasm Staging; Prognosis; Retrospective Studies; Salivary Gland Neoplasms; Survival Rate
PubMed: 34768210
DOI: 10.1016/j.oraloncology.2021.105602 -
Journal of Personalized Medicine Oct 2022Extracapsular dissection (ECD) was introduced for the removal of superficial and small benign parotid tumors. According to a recent proposal, ECD is reserved for tumors...
Extracapsular dissection (ECD) was introduced for the removal of superficial and small benign parotid tumors. According to a recent proposal, ECD is reserved for tumors that are 3 cm or less, mobile, and close to the parotid borders in cases of pleomorphic adenoma. The aim of the study is to evaluate the effectiveness of ECD for treatment of benign parotid tumors also in cases of tumors that were larger than 3 cm and deeper. All ECD for benign parotid neoplasms conducted between 2007 and 2017 were reviewed. The lesions included were limited to primary parotid tumors and categorized by Quer proposal. Facial nerve monitoring was used in all cases. Facial nerve palsy and local recurrences were assessed. The 88 ECD performed met inclusion criteria. The mean lesion size was 4.26 cm. Of the tumors, 68 were less than 3 cm in diameter and 20 were larger, 64 were superficial, and 24 were deep. The most common lesion types were pleomorphic adenoma (88.6%). There was no significant difference in complication rates between the size of tumor ( = 0.9) and location ( = 0.91). Our results suggest that extracapsular dissection could be considered an option for first-time diagnosed benign parotid tumors, even in cases of large dimensions and deep lobe involvement.
PubMed: 36294780
DOI: 10.3390/jpm12101641 -
The Pan African Medical Journal 2022Tumors of the parotid gland can be challenging if left untreated. We report three cases of patients with initial clinical and therapeutic manifestations of neglected...
Tumors of the parotid gland can be challenging if left untreated. We report three cases of patients with initial clinical and therapeutic manifestations of neglected parotid tumours in Madagascar: two women and one man aged 42, 47 and 51 years, with tumours that had been developing for 4, 7 and 11 years respectively. One patient was suspected to have malignant tumour due to skin necrosis. The diagnosis was then confirmed by cytopuncture. After obtaining the informed consent, total parotidectomy was performed in all patients. Facial nerve sacrifice with cervical lymph node dissection was established in the patient with a malignant tumour. No intraoperative adverse events were reported. Parotid tumors can become cancerous without proper treatment. Socio-economic factors are involved in delayed consultation. However, early consultation in patients with parotid tumors would prevent management risks.
Topics: Male; Humans; Female; Parotid Neoplasms; Adenoma, Pleomorphic; Parotid Gland; Lymph Node Excision; Risk Management; Retrospective Studies
PubMed: 36915420
DOI: 10.11604/pamj.2022.43.184.29628 -
Computational and Mathematical Methods... 2021To investigate the correlation between sonographic and computed tomography and pathological features of basal cell adenomas (BCAs) of the parotid gland.
PURPOSE
To investigate the correlation between sonographic and computed tomography and pathological features of basal cell adenomas (BCAs) of the parotid gland.
METHODS
This retrospective study included 41 patients (43 tumors) with BCAs. The tumors were divided into three types based on their location in the parotid gland and their imaging features. The features of the tumors were analyzed.
RESULTS
Imaging manifestations and corresponding pathological results of most BCAs of the parotid glands resembled those of benign parotid gland tumors. Malignant transformation occurred in membranous BCAs and in those with extensive cribriform structures. Type-II and type-III tumors accounted for 82.93% of the total proportion. Thirteen tumors showed cystic degeneration with 30.23%, among which type-III tumors could easily develop cystic degeneration. These cystic areas might correspond to cystic degeneration or focal necrosis. Cystic change was not dependent on the tumor size. The pathological features of the tumors were correlated to their imaging manifestations.
CONCLUSION
Most BCAs of the parotid glands have imaging manifestations similar to those of benign parotid gland tumors. BCAs with extensive cribriform structures and of the membranous type can show malignant transformation and should be treated with caution in clinical practice.
Topics: Adenoma; Adult; Aged; Aged, 80 and over; Computational Biology; Female; Humans; Immunohistochemistry; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography; Young Adult
PubMed: 34912472
DOI: 10.1155/2021/7906058