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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 -
Medical Archives (Sarajevo, Bosnia and... Jun 2022While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed...
BACKGROUND
While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed in the US each year, about 1300 to 1600 cases. The salivary gland cancer rate is 0.9 per 10000. The frequency of salivary gland tumors varies according to localization.
OBJECTIVE
In our study, we aimed to evaluate retrospectively the histopathological results, incidence, surgical treatment modalities and complications of parotid tumors operated in our clinic.
METHODS
We examined the patients who were operated for parotid gland tumor. The files of 136 patients who were admitted to the Otorhinolaryngology department of Dicle University Medical Faculty Hospital between January 2010 and April 2020 due to a parotid mass and underwent parotidectomy and whose pathology results were reported as benign or malignant parotid tumors were retrospectively scanned and included in the study. Patients' age, gender, FNAB cytology result, type of surgery, histopathological results after surgery and complications after surgical treatment were recorded.
RESULTS
A total of 136 patients, 73 (53.7%) male and 63 (46.3%) female, were included in the study. The mean age of the patients was 48.26±17.37 (min=14, max=83) years. Superficial parotidectomy was performed in 108 (79.4%) patients and total parotidectomy was performed in 28 (20.6%) patients. According to the histopathological results after surgery, 108 (79.4%) benign tumors and 28 (20.6%) malignant tumors were diagnosed. Accordingly, pleomorphic adenoma (47.8%) was the second most common with 65 patients, followed by Whartin tumor (25.7%) with 35 patients. The sensitivity (sensitivity) of FNAB was 85.2%, and the specificity (specificity) was 96.2%. The accuracy of FNAB was found to be 94.0%.
CONCLUSION
Good identification of the parotid mass preoperatively, together with both FNAB and radiological imaging methods, gains much more value in differentiating malignant and benign pathologies. While superficial parotidectomy is mostly sufficient in benign tumors, total parotidectomy-radical parotidectomy in malignant tumors and neck dissection should be considered in high-grade tumors even if there is no neck metastasis. Patients should be evaluated for RT and CT according to the tumor type after surgery.
Topics: Adenoma, Pleomorphic; Aged, 80 and over; Female; Humans; Male; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Salivary Gland Neoplasms
PubMed: 36200113
DOI: 10.5455/medarh.2022.76.170-174 -
STAR Protocols Mar 2022The murine parotid salivary glands develop postnatally, shaping oral mucosal immunity in early and adult life. This protocol details the surgical removal of the parotid...
The murine parotid salivary glands develop postnatally, shaping oral mucosal immunity in early and adult life. This protocol details the surgical removal of the parotid glands (parotidectomy) of mice. We also describe a protocol for saliva collection to enable manipulation and measurement of physiological and immunological salivary functions. Our saliva collection approach has been modified from published protocols to enable saliva collection from young mice, which can be challenging. For complete details on the use and execution of this protocol, please refer to Koren et al. (2020).
Topics: Animals; Mice; Parotid Gland; Saliva; Salivary Glands
PubMed: 34977687
DOI: 10.1016/j.xpro.2021.101048 -
European Annals of Otorhinolaryngology,... May 2022Posterior parotid lithiasis may in some cases require a combined surgical approach associating sialendoscopy to an external intraoral or transfacial approach. This...
Posterior parotid lithiasis may in some cases require a combined surgical approach associating sialendoscopy to an external intraoral or transfacial approach. This single-center retrospective study describes the surgical technique for parotid lithiasis extraction by a combined external and sialendoscopic approach with the help of CT-navigation. Five patients were included between November 2014 and July 2020. The sialolith was extracted in 100% of cases. Navigation and transillumination localizations matched consistently. No patients showed postoperative facial paresis. At 2 to 21 months' follow-up, there was no recurrence of sialolithiasis. Navigation can be a complement to transillumination, improving surgical comfort and safety, but does not replace first-line sialendoscopy. Visual control is required whenever possible after extraction. In combined procedures, it enables accurate identification of parotid sialoliths. In case of impassable stenosis, it could be a therapeutic alternative to parotidectomy.
Topics: Endoscopy; Humans; Lithiasis; Parotid Diseases; Retrospective Studies; Salivary Gland Calculi; Surgery, Computer-Assisted
PubMed: 34538758
DOI: 10.1016/j.anorl.2021.08.009 -
The Surgeon : Journal of the Royal... Aug 2022Sialocele and salivary fistula are recognised complications of parotid surgery and have been reported to be more common with less extensive parotidectomy. We...
PURPOSE
Sialocele and salivary fistula are recognised complications of parotid surgery and have been reported to be more common with less extensive parotidectomy. We investigated the efficacy of tissue sealant(Cunniffe et al., 2019) as an alternative to surgical drainage in terms of length of hospital stay (LOS), cost, and incidence of wound complications.
METHODS
The study comprised a retrospective review of a prospectively maintained parotidectomy database at a single tertiary Head and Neck referral centre between 2009 and 2020. Cases undergoing concomitant neck dissection or major skin resection were excluded. Patients were divided into Group 1 (without tissue sealant), and Group 2 (with tissue sealant). Patients were also divided based on extent of surgery 1) Extracapsular dissection/Partial superficial parotidectomy 2) Superficial/total parotidectomy.
RESULTS
Of 202 included patients, there were 146 in Group 1 (143 with drain), and 56 in Group 2 (7 with drain). Compared to Group 1, Group 2 had a significantly shorter LOS (mean 1.4 ± 0.98 versus 3.1 ± 1.29 days, p < 0.05) and estimated cost (€1386 versus €2736). There was no significant difference in the complication rates (15.8% Group 1 versus 10.7% Group 2, p = 0.50). Group 1 showed a higher incidence of complications in patients undergoing less extensive parotidectomy (19/70 versus 4/76, p = 0.02), whereas in Group 2, the difference was not significant (5/30 versus 1/26, p = 0.20).
CONCLUSION
The use of tissue sealant as an alternative to surgical drains after parotidectomy facilitates reduced LOS and cost savings without increase in morbidity.
Topics: Drainage; Humans; Length of Stay; Parotid Gland; Postoperative Complications; Retrospective Studies
PubMed: 34103269
DOI: 10.1016/j.surge.2021.05.001 -
Cureus Feb 2023The sternocleidomastoid (SCM) flap has been used for a long time in protective coverage of major vessels, reconstruction of intraoral pharyngeal, closure of... (Review)
Review
The sternocleidomastoid (SCM) flap has been used for a long time in protective coverage of major vessels, reconstruction of intraoral pharyngeal, closure of pharyngo-cutaneous fistulas, and augmentation of soft tissue defects in the oral and maxillofacial region. However, this flap is not yet commonly used due to doubtful blood supply to the flap. This flap offers favorable esthetic results, combined flap, rich vascularization, and the possibility of shifting the two heads of the muscle. Thus, this flap has been used broadly in the maxillofacial region to reconstruct the defects of the post-parotidectomy, mandible, pharynx, and floor of the mouth defects. Previous studies discussed the use of a SCM flap following parotidectomy. However, few studies explained the use of SCMs in facial reconstruction. This study aims to review published articles discussing the use of SCMs for facial reconstruction.
PubMed: 36883082
DOI: 10.7759/cureus.34575 -
European Annals of Otorhinolaryngology,... May 2023To describe the key technical points for preserving the great auricular nerve during parotidectomy for tumor, and to discuss the literature regarding the benefits,...
To describe the key technical points for preserving the great auricular nerve during parotidectomy for tumor, and to discuss the literature regarding the benefits, limitations and indications for nerve-sparing surgery. Data suggested that great auricular nerve preservation should be discussed in the preoperative consultation, attempted intraoperatively and mentioned in the operative report once parotidectomy completed.
Topics: Humans; Parotid Gland; Parotid Neoplasms; Quality of Life; Postoperative Complications
PubMed: 35902353
DOI: 10.1016/j.anorl.2022.07.005 -
Oncology Letters Jul 2022The aim of the present study was to analyze the clinical characteristics, surgical treatments and clinical outcome of patients with parotid gland tumors and to compare...
The aim of the present study was to analyze the clinical characteristics, surgical treatments and clinical outcome of patients with parotid gland tumors and to compare the results with those cited in the literature. A retrospective study was conducted in 140 patients (male, n=77; female, n=63) with parotid gland tumors who underwent parotidectomy at Hokuto Hospital Department of Otolaryngology-Head and Neck Surgery (Obihiro, Japan) between April 2007 and December 2021. Of the 140 patients enrolled, 118 (84.3%) patients had benign tumors, including 63 (45%) patients with pleomorphic adenomas and 43 (30.7%) patients with Warthin tumors, and 22 patients (15.7%) had parotid carcinoma. Comparison of the three groups of patients with parotid gland tumors indicated that pack years as an indicator of smoking status were significantly higher in patients with Warthin tumors than in those with parotid carcinomas (P=0.011) or pleomorphic adenoma (P<0.001). Fine-needle aspiration cytology (FNAC) was non-diagnostic for only 6 (4.3%) of 140 patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC by both conventional smear and liquid-based cytology (LBC) for parotid carcinomas were 70, 99, 93.3, 94.4 and 82.9%, respectively. Among the 22 patients with parotid carcinoma, extended total/total and superficial parotidectomy were performed in 10 (45%) and 11 (50%) cases, respectively. Total and selective neck dissection of the area from level II to I, II and III were performed in 6 (24%) and 7 (32%) patients, respectively. Postoperative radiotherapy (50 Gy) was performed in 15 (68%) patients. The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 51.5 and 76.4%, respectively. Univariate analysis revealed that age >65 years was significantly associated with poorer 5-year OS (P<0.001) and DFS (P<0.001). Multivariate analysis revealed that an age of more than 65 years combined with high-grade histologic malignancy was associated with worse DFS (P=0.02; hazard ratio, 3.628; 95% confidence interval, 1.283-9.514). In conclusion, the clinical characteristics and treatment outcomes of parotid gland tumors were consistent with the results of previous reports. Smoking may be closely related to the pathogenesis of Warthin tumors. LBC potentially provides improved accuracy in FNAC.
PubMed: 35720490
DOI: 10.3892/ol.2022.13328 -
Life (Basel, Switzerland) Dec 2022The parotid gland contains intra-glandular lymph nodes, the distribution of which is crucial for understanding the pathogenesis of intra-parotid lymph node metastases of... (Review)
Review
The parotid gland contains intra-glandular lymph nodes, the distribution of which is crucial for understanding the pathogenesis of intra-parotid lymph node metastases of parotid carcinoma and other head and neck carcinomas. Positive intra-parotid lymph node metastasis predicts the risk of positive cervical nodal metastasis. It is important to establish whether prophylactic neck dissection, including intra-parotid lymph nodes, contributes to treatment outcomes. The presence or absence of intra-parotid lymph nodes or metastasis-positive lymph nodes warrants further study. A preoperative diagnosis by imaging and fine-needle aspiration cytology of intra-parotid lymph nodes is difficult. Although intraoperative frozen section biopsy is performed during surgery, it is challenging to identify intra-parotid lymph nodes. The number of lymph nodes was the largest (47%) in the lower half of the superficial lobe, with 35% of nodes being concentrated in the inferior part of the cervicofacial branch, i.e., the lower pole of the parotid gland. Therefore, superficial parotidectomy and lower pole lobectomy need to be performed in cases in which a malignant tumor localizes to the superficial lobe or a lower pole. When intra-parotid lymph node metastases are detected during surgery, selective neck dissection (at least levels II and III) needs to be simultaneously performed.
PubMed: 36556418
DOI: 10.3390/life12122053 -
Frontiers in Oncology 2021The goal of this review was to introduce endoscopic/robotic parotidectomy (EP/RP) and compare EP/RP against conventional parotidectomy (CP) regarding the intraoperative...
BACKGROUND
The goal of this review was to introduce endoscopic/robotic parotidectomy (EP/RP) and compare EP/RP against conventional parotidectomy (CP) regarding the intraoperative and postoperative parameters in the treatment of parotid tumors.
METHODS
A systematic literature search of medical databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed from inception to November 2020 to generate relevant studies.
RESULTS
A total of 13 eligible studies (572 patients) were included for systematic review, and 7 out of 13 comparable studies for the quantitative synthesis of outcomes. Patients who underwent EP were characterized by less intraoperative bleeding volume, shorter incision length, and higher satisfaction postoperatively (WMD, 95% CI, -42.80; - 58.23 to -27.37; p < 0.01; WMD, 95% CI, -5.64; -7.88 to -3.39; p < 0.01; SMD, 95% CI, 1.88; 1.46 to 2.31; p < 0.01, respectively). However, operative time and risk of facial palsy exhibited no significant differences (WMD, 95% CI, -11.17; -26.71 to 4.34; p = 0.16; OR, 95% CI,0.71; 0.39 to 1.32; p = 0.28, respectively).
CONCLUSIONS
Our findings suggest that the current evidence does not adequately support EP is equally safe and effective as CP. In certain selected cases, endoscopic technology has its unique advantages. For patients with strong cosmetic needs, endoscopic or robotic techniques may be an alternative through adequate preoperative evaluations.
SYSTEMATIC REVIEW REGISTRATION
International Prospective Register of Systematic Reviews, identifier CRD42020210299.
PubMed: 34900694
DOI: 10.3389/fonc.2021.748885