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Head and Neck Pathology Dec 2022Metastases account for 6-25% of parotid tumors, often presenting dilemmas in their diagnosis.
BACKGROUND
Metastases account for 6-25% of parotid tumors, often presenting dilemmas in their diagnosis.
METHODS
Parotid metastases diagnosed on histology/cytology were retrieved. MUC2, MUC5AC, androgen receptor immunohistochemistry was performed in select cases.
RESULTS
Fifty-one samples were identified from 42 patients, including 14 aspirates, 7 biopsies and 30 parotidectomies. Previous history was available in 17 cases, 13 parotidectomies accompanied excision of the primary, and relevant clinical data was unavailable for 12 patients. Majority (81%) had head and neck primaries; eye and ocular adnexa were the commonest subsite (52.4%), and sebaceous carcinoma the commonest histology (33%). When history was unavailable, most metastases were initially diagnosed as poorly differentiated carcinoma/malignant tumor, or mucoepidermoid carcinoma on cytology.
CONCLUSIONS
Intraparotid metastases encompass a wide spectrum, often mimicking primary salivary gland neoplasms, particularly on limited samples. Metastases should be considered when histological/cytological features are unusual; detailed clinical information and ancillary techniques aid in arriving at an accurate diagnosis.
Topics: Humans; Parotid Gland; Tertiary Care Centers; Carcinoma
PubMed: 35576094
DOI: 10.1007/s12105-022-01458-1 -
Maedica Sep 2022We present the case of a patient with a Merkel cell carcinoma (MCC) of the left preauricular area. A 84-year-old Greek man was examined at the outpatient ENT Department...
Treatment of Merkel Cell Carcinoma Using Intraoperative Flow Cytometry (iFC) Protocol, Optimized for Head and Neck Lesions, as a Means for Tumor Margin Evaluation - a Case Presentation.
We present the case of a patient with a Merkel cell carcinoma (MCC) of the left preauricular area. A 84-year-old Greek man was examined at the outpatient ENT Department of our clinic with a lesion in the preauricular area that had appeared four months ago. The patient history included antihypertensive and antihyperlipidemic therapy as well as treatment for dementia. The excision of the skin lesion was performed under local anesthesia. The histological examination revealed a Merkel cell carcinoma. The patient underwent a computed tomography (CT) scan that showed a lesion with clear limits in the left parotid gland and lymph nodes. Under general anesthesia, he underwent a left superficial parotidectomy, left submandibular gland excision and radical neck dissection. Histological preparations were analyzed using an intraoperative flow cytometry (iFC) protocol. A radiation therapy concluded the patient's treatment. Even if MCC appears as a less common and more aggressive skin cancer type, a clinician always has to include it in the differential diagnosis of a skin lesion. We found the use of iFC very useful for the diagnosis of this skin cancer.
PubMed: 36540589
DOI: 10.26574/maedica.2022.17.3.726 -
Laryngoscope Investigative... Dec 2020As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused...
OBJECTIVE
As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered.
MATERIALS AND METHODS
All patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed.
RESULTS
A total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, < .0001). Among patients with intact FN, post-operative short- and long-term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short- and long-term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes.
CONCLUSION
This is the largest single-surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long- and short-term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting.
LEVEL OF EVIDENCE
4.
PubMed: 33364399
DOI: 10.1002/lio2.480 -
Indian Journal of Otolaryngology and... Dec 2022Benign schwannoma is a slow growing encapsulated tumor arising from the sheath of Schwann, The majority had extra-cranial localization. We report in this review three...
Benign schwannoma is a slow growing encapsulated tumor arising from the sheath of Schwann, The majority had extra-cranial localization. We report in this review three cases of a rare extra cranial localization of benign schwannoma in the trachea, frontal sinus and intraparotid facial nerve. The first case diagnosed in a 10-years-old boy, presented with a painless, slow growing mass evolving for three years in the left parotidic region, total conservative parotidectomy was done. The second case concerned a 38-years-old, was admitted to the emergency department with acute inspiratory dyspnea, endoscopic exploration revealed a polylobed tracheal tumor, complete tumor excision was done endoscopically. The third case was about a 33 years old patient, presented a gradually enlarging frontal swelling associated with headache and left nasal obstruction, the endoscopic examination revealed a gray pinkish, smooth and firm soft tissue mass occupying the entire left nasal cavity, CT scan and MRI were requested to assess the characteristics and extent of the tumor, The surgical intervention combined two approaches: trans facial through a mid-frontal incision, and endonasal one. Histopathological examination confirmed the diagnosis of benign schwannoma in all these cases.
PubMed: 36742770
DOI: 10.1007/s12070-021-02878-1 -
Danish Medical Journal Mar 2024Complications and recurrence within benign salivary gland surgery are not systematically registered in Denmark. Patient-reported outcome measures are increasingly...
INTRODUCTION
Complications and recurrence within benign salivary gland surgery are not systematically registered in Denmark. Patient-reported outcome measures are increasingly included in clinical and health policy decision-making, and therefore it is crucial that this type of data is valid. A patient-reported questionnaire regarding outcome after benign parotid gland surgery has been developed and implemented in a national German database. We aimed to translate the Parotidectomy Outcome Inventory 8 (POI-8) into Danish and validate it.
METHODS
The questionnaire was translated. The study population was recruited from a single centre from 6 December 2019 to 1 June 2022. Patients > 18 years of age who had undergone their first parotid salivary gland surgery for a benign tumour were included. The questionnaire underwent pilot-testing and test-retesting; it was sent to respondents twice at a 14-day interval. For the categorical variables, the reliability of the items was tested using the weighted kappa-coefficient.
RESULTS
A weighted kappa coefficient of 0.74 and Cronbach's alpha of 0.78 were found. No significant difference was found between testing at day 0 and 14.
CONCLUSIONS
We have translated and validated the Danish version of the POI-8, finding acceptable levels of the weighted kappa coefficient and Cronbach's alpha. We suggest the systematic use of PROMs in Danish healthcare and specifically in parotidectomy for benign neoplasms.
FUNDING
No funding.
TRIAL REGISTRATION
Not relevant.
Topics: Humans; Reproducibility of Results; Delivery of Health Care; Surveys and Questionnaires; Salivary Glands; Denmark
PubMed: 38533879
DOI: 10.61409/A10230633 -
Ear, Nose, & Throat Journal Nov 2023Apocrine hidrocystoma is a cystic tumor originating from apocrine sweat glands. It is predominantly located in the eyelid margins. Here, we report a case of apocrine...
Apocrine hidrocystoma is a cystic tumor originating from apocrine sweat glands. It is predominantly located in the eyelid margins. Here, we report a case of apocrine hidrocystoma of the parotid gland in a 19-year-old man who was referred to our outpatient clinic with a 5-year history of a gradual swelling in the left parotid region. The patient underwent left superficial parotidectomy. Histological examination confirmed the diagnosis of apocrine hidrocystoma. The case is original by the tumor's location: to the best of our knowledge, this could be the first case in English and French literature reporting an apocrine hidrocystoma affecting the parotid gland. The purpose of this article is to report our case and discuss its clinical and anatomopathological features as well as its differential diagnoses.
Topics: Male; Humans; Young Adult; Adult; Hidrocystoma; Parotid Gland; Sweat Gland Neoplasms; Eyelids; Diagnosis, Differential
PubMed: 34219505
DOI: 10.1177/01455613211031028 -
Indian Journal of Otolaryngology and... Oct 2019Kimura's disease, also known as Eosinophilic Granuloma, is a rare chronic condition seen mainly in Oriental population. It presents with subcutaneous nodules,...
Kimura's disease, also known as Eosinophilic Granuloma, is a rare chronic condition seen mainly in Oriental population. It presents with subcutaneous nodules, lymphadenopathy, salivary gland hypertrophy with peripheral eosinophilia and raised serum IgE levels; rarely renal involvement may also be present. Its etiology mainly remains unknown. We present a case series of two patients. Our first case is a middle aged female which presented with a parotid swelling, mimicking a parotid neoplasm. Further investigations revealed associated intra-parotid and cervical lymphadenopathy. An excisional biopsy in the form of Superficial Parotidectomy with lymph node excision was done. Histopathological examination of the excised specimen revealed it to be a case of Kimura's disease. Our second case, a young adult, presented with a gradually increasing post-auricular swelling. Preliminary investigations in this case pointed towards Kimura's disease. Excision biopsy of the lesion was done. Histopathological studies confirmed the diagnosis for the same. Both the patients are under our regular follow up and remain disease-free at a follow up of 1 year and 8 months respectively.
PubMed: 31742081
DOI: 10.1007/s12070-019-01601-5 -
Cureus Nov 2023The facial nerve is the seventh of 12 cranial nerves found in the head and neck region that facilitates several nerve fibers and pathways to perform various functions.... (Review)
Review
The facial nerve is the seventh of 12 cranial nerves found in the head and neck region that facilitates several nerve fibers and pathways to perform various functions. Iatrogenic facial nerve injury during surgeries of the head and neck is common, ranging from 4-6%, particularly in procedures that involve mobilization or resection of associated anatomical structures. Any injury to the facial nerve or its branches impacts the quality of life and patient satisfaction as the degree of iatrogenic injury may result in partial or complete facial nerve paralysis. Of the various implementable techniques available to avoid injury, electromyography (EMG) has recently been widely used to monitor facial nerve function intraoperatively to determine the degree of injury and predict postoperative weakness. The purpose of this study was to analyze and review existing scientific literature in determining the role of intraoperative facial nerve monitoring (IFNM) with EMG in decreasing the incidence and degree of intraoperative facial nerve injury among commonly performed surgeries involving the facial nerve. A systematic review was conducted from articles published between September 2006 and December 2022. Suitable articles were identified from the MEDLINE/PubMed databases using relevant terms to meet the inclusion criteria. Articles were subsequently coded based on the inclusion/exclusion criteria as well as the type of surgery performed with concurrent use of EMG and the results from intraoperative monitoring. A total of 47 articles were found in relation to the use of IFNM, including studies to reduce the incidence and determine preventative measures to decrease nerve injury. Eleven articles were used to evaluate the use of EMG during various head and neck surgeries in decreasing the incidence of intraoperative facial nerve injury. Sources found were primarily divided based on the type of surgery performed when determining the use of EMG. Four sources tested the efficacy of EMG during parotidectomy, four sources during vestibular schwannoma resection, two sources during cochlear implant surgeries, and one during a lymphatic malformation surgery. IFNM also decreased the duration of surgery, the severity of facial nerve palsy, and the average time of facial nerve paralysis recovery. IFNM was found to not significantly predict facial nerve injury in the setting of intraoperative nerve injury but tended to preserve potential facial nerve function in vestibular schwannoma cases. The surgical setting determined the efficacy and use of IFNM in decreasing the incidence of facial nerve weakness and paralysis. IFNM had the best preventative and prognostic value when used in vestibular schwannoma resection, and the least in cochlear implants, with mixed evidence seen in the setting of parotidectomy. Overall, IFNM using EMG as an adjunct during surgery may reduce the risk of iatrogenic injury; however, additional studies must be performed to determine the degree of long-term patient satisfaction and quality of life achieved in the setting of IFNM.
PubMed: 38060739
DOI: 10.7759/cureus.48367 -
Asian Journal of Surgery Feb 2023Facial nerve palsy is one of the most common complications in parotid gland surgery. This report evaluates the effectiveness of applying Tumescent solution for...
BACKGROUND
Facial nerve palsy is one of the most common complications in parotid gland surgery. This report evaluates the effectiveness of applying Tumescent solution for preserving the facial nerve in parotidectomy.
MATERIAL AND METHODS
Prospective and descriptive clinical study on 34 patients undergoing parotidectomy with facial nerve preservation. Before skin incision, 5-10 min, we injected 100-200 ml of the Tumescent solution into the surgical area. We recorded the surgical method, tumor size, length of surgery, pathological results and facial nerve dysfunction. All patients were followed for a period ranging from 6 to 24 months.
RESULTS
There were 14 patients with malignant tumors and 20 patients with benign tumors. The length of surgery lasted from 90 to 180 min, with an average of 126.8 min. The number of patients having temporary facial paralysis was 22 cases (64.7%), recovery time ranged from 1 week to 6 months, and no permanent facial paralysis cases were recorded. The clinical occurrence of Frey's syndrome was five cases (14.7%).
CONCLUSIONS
The application of Tumescent solution for preserving facial nerves in parotidectomy could minimize nerve injury and shorten the length of surgery.
Topics: Humans; Facial Nerve; Facial Paralysis; Parotid Neoplasms; Prospective Studies; Postoperative Complications; Retrospective Studies
PubMed: 35963669
DOI: 10.1016/j.asjsur.2022.07.155 -
Ochsner Journal 2022Awareness of the opioid epidemic is promoting opioid stewardship in health care. For many commonly performed procedures in general surgery and gynecology, regimented...
Awareness of the opioid epidemic is promoting opioid stewardship in health care. For many commonly performed procedures in general surgery and gynecology, regimented opioid prescribing practices and/or multimodal nonopioid regimens are adequate for optimizing pain management and minimizing opioid dependence. We investigated opioid prescribing patterns for otolaryngology procedures at a tertiary hospital with the aim of characterizing postoperative pain and opioid use. This cross-sectional study with a patient survey was conducted in a tertiary care academic otolaryngology practice. Patients ≥18 years who underwent 1 of 41 common surgical procedures at an academic hospital between 2013 and 2017 were enrolled. Patients with any diagnosis of malignancy were excluded. Patients were analyzed according to surgery type (rhinoplasty, sinonasal surgery, tonsillectomy, parotidectomy, thyroidectomy, otologic surgery, and laryngoscopy), and those who had surgery in 2017 were surveyed via telephone interview using a standardized questionnaire. A total of 3,152 patients met the study criteria, of whom 95.7% received an opioid prescription. Commonly prescribed opioid agents were hydrocodone-acetaminophen, oxycodone-acetaminophen, and acetaminophen-codeine. A median of 30 pills was prescribed per surgery, with little variation between different surgery types. Reported patient utilization was highest for parotid surgery and tonsillectomy and lowest for laryngoscopic, thyroid, and otologic surgery. Among all patients who received a prescription for opioids, 5.8% required a refill. Among the surveyed patients, 19.6% reported that they did not obtain the prescribed opioid, while 58.4% said they took half, less than half, or none of the prescribed opioid supply. Only 10.8% of surveyed patients disposed of the excess drugs in a recommended fashion. Our findings showed that the quantity of opioid prescriptions does not reflect actual patient analgesic use for elective surgeries in otolaryngology. Differential analgesic requirements for specific surgeries should be considered when prescribing postoperative analgesia.
PubMed: 35355643
DOI: 10.31486/toj.21.0054