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Ear, Nose, & Throat Journal Jun 2024Canalicular adenoma (CA) is a rare benign tumor of the salivary glands, predominantly affecting elderly females, with a strong predilection for the upper lip. While CA...
Canalicular adenoma (CA) is a rare benign tumor of the salivary glands, predominantly affecting elderly females, with a strong predilection for the upper lip. While CA commonly arises in the minor salivary glands, its occurrence in the parotid gland is exceptionally rare. In this report, we present a unique case of CA in the parotid gland, adding to the scant literature with only 8 documented instances. The patient, a 57-year-old Asian male, presented with a painless swelling in the left parotid gland that had been persisting for 8 years. Clinical examination and imaging studies identified a lobulated mass, prompting surgical intervention. The patient underwent a superficial parotidectomy, and pathological examination of the excised tissue confirmed the diagnosis of CA, with no signs of malignancy. This case illustrates the diagnostic and management challenges associated with CA, particularly given its rare presentation in the parotid gland. Accurate diagnosis is reliant on surgical biopsy, and careful surgical planning is imperative, especially considering the proximity of the facial nerve. Our case underscores the need for heightened awareness of CA's unique presentations, particularly within the Asian population. Given the potential for recurrence, long-term follow-up is essential. Further research is needed to elucidate the biological behavior of CA and to refine management strategies for optimal patient outcomes.
PubMed: 38881446
DOI: 10.1177/01455613241262652 -
Radiology Case Reports Aug 2024The primary malignant melanoma of the parotid is a rare and complex clinical entity, posing numerous diagnostic challenges due to the absence of melanin in the tumor and...
The primary malignant melanoma of the parotid is a rare and complex clinical entity, posing numerous diagnostic challenges due to the absence of melanin in the tumor and its histological similarities with other poorly differentiated lesions. Accurate diagnosis often requires advanced imaging techniques and immunohistochemical procedures to identify specific melanoma markers. Therapeutically, total parotidectomy with simultaneous cervical dissection is frequently recommended, although approaches combining surgery, chemotherapy, radiotherapy, or even immunotherapy are also being explored. Despite these advancements, malignant parotid melanoma continues to be associated with a grim prognosis, emphasizing the importance of ongoing research to improve therapeutic options and understanding of this rare pathology.
PubMed: 38872741
DOI: 10.1016/j.radcr.2024.05.005 -
Head & Neck Jun 2024Ear and temporal bone squamous cell carcinoma (ETBSCC) is a rare and aggressive malignant tumor with minimal clinicopathological studies. The object of this study was to...
BACKGROUND
Ear and temporal bone squamous cell carcinoma (ETBSCC) is a rare and aggressive malignant tumor with minimal clinicopathological studies. The object of this study was to retrospectively evaluate the predictive effect of clinicopathological variables on the 5-year overall survival (OS) rate of ETBSCC patients in a single tertiary medical center in Tianjin, China.
METHODS
A cohort of 44 patients with diagnosed ETBSCC from December 2012 to August 2022 were retrospectively studied. Univariate and multivariate analysis were, respectively, performed for the assessment of clinicopathological predictors, including sex, age, history of chronic suppurative otitis media (CSOM), lesion side, diameter, the choice of surgical approach, parotidectomy, neck dissection, adjuvant therapies, T stage, lymph node metastasis, tumor grade, margin, perineural invasion (PNI), and Ki-67 index.
RESULTS
Seventeen females and 27 males were included, with the mean age of 65 years old, ranging from 36 to 89 years. The 5-year OS rate was 43% (mean 51 months, 95% confidence interval [CI] = 39-64). Significant prediction of a worse prognosis for 5-year OS rate was observed under univariate analysis for advanced T stage, positive margin, identified PNI, and higher Ki-67 index, respectively. Advanced T stage was confirmed to be an independent prognostic factor strongly affecting 5-year OS rate among this cohort of patients using a multivariate cox proportional hazard model.
CONCLUSION
We found that clinicopathological parameters, especially postoperative pathological parameters, play a critical role in predicting the prognosis of ETBSCC patients.
PubMed: 38867407
DOI: 10.1002/hed.27818 -
Wounds : a Compendium of Clinical... May 2024Marjolin ulcer (MU) is an aggressive cutaneous malignancy that commonly occurs in those with a chronic wound such as post-burn scar. (Review)
Review
BACKGROUND
Marjolin ulcer (MU) is an aggressive cutaneous malignancy that commonly occurs in those with a chronic wound such as post-burn scar.
CASE REPORT
A 20-year-old male who sustained a flame burn over the scalp at 3 months of age developed a nonhealing ulcer over the burn scar 20 years later, which was treated with adequate surgical margins with adjuvant mold brachytherapy. Two months after completion of that treatment, he developed parotid nodal metastasis with positron emission tomography (PET)-positive bilateral cervical, supraclavicular, right suboccipital, and mesenteric lymph nodes that were treated with concurrent chemoradiation. One month later, the patient developed an ulcerative lesion involving the left parotid region with PET showing infiltration of the parotid gland, but with resolution of other previous sites of uptake. The patient was treated surgically with radical parotidectomy with elective neck dissection and reconstruction with locoregional flap. At 6-month follow-up, the patient developed extensive locoregional recurrence and distant metastasis and was started on oral metronomic therapy. The patient was alive with stable disease at 3-month follow-up after initiation of palliative chemotherapy.
CONCLUSION
Despite timely multimodality therapy, MU may present with a hostile clinical course with a short disease-free interval and early recurrence.
Topics: Humans; Male; Brachytherapy; Burns; Combined Modality Therapy; Neck Dissection; Neoplasm Recurrence, Local; Parotid Neoplasms; Plastic Surgery Procedures; Scalp; Skin Neoplasms; Skin Ulcer; Treatment Outcome; Adult
PubMed: 38861212
DOI: 10.25270/wnds/23138 -
Head & Neck Jun 2024Pleomorphic adenoma (PA) is a common parotid tumor, yet due to the relative rarity of deep lobe PA (DLPA), there is a paucity of information about its clinical...
BACKGROUND
Pleomorphic adenoma (PA) is a common parotid tumor, yet due to the relative rarity of deep lobe PA (DLPA), there is a paucity of information about its clinical presentation and surgical outcomes.
METHODS
We reviewed the charts of patients with previously untreated parotid PA between the years 1990 and 2015. Clinical parameters and surgical outcomes were compared between superficial lobe PA (SLPA) and DLPA.
RESULTS
The cohort comprised 147 cases of DLPA and 222 cases of SLPA. DLPA were larger (median 2.6 cm vs. 2.0 cm, p < 0.001), more often discovered incidentally on imaging (33%, n = 48) and had unique presentations (pharyngeal mass, dysphagia, otalgia). Postsurgical complications were more frequently observed in DLPA (41% vs. 30% in SLPA, p = 0.025), mainly transient facial nerve weakness. DLPA also showed higher recurrence rates (n = 6, 4.1% vs. n = 1, 0.4%, p = 0.016).
CONCLUSIONS
Parotidectomy for DLPA carries a higher risk of complications and recurrence compared to SLPA.
PubMed: 38850073
DOI: 10.1002/hed.27840 -
European Archives of... Jun 2024Scar formation after neck surgery is a frequent concern, impacting patients both physically and psychologically. Cosmetic appearance plays a crucial role in assessing...
BACKGROUND
Scar formation after neck surgery is a frequent concern, impacting patients both physically and psychologically. Cosmetic appearance plays a crucial role in assessing surgical success. At present, the evolving medical technologies introduces innovations like Geometric Electron Modulation (GEM) electrocautery. GEM technology offers potential benefits such as reduced thermal injury and consistent heat emission during surgery compared to conventional electrocautery.
OBJECTIVES
To compare the difference between postoperative neck scars from the surgical blade as the gold standard and geometric electron modulation electrocautery.
MATERIAL AND METHODS
A randomized controlled study was performed on the patients who were diagnosed with surgical conditions requiring neck surgery at the Department of Otolaryngology Head and Neck Surgery, King Chulalongkorn Memorial Hospital, from 2023 to 2024. The Patient and Observer Scar Assessment Scale was utilized to assess scar appearance at 1 and 3 months following the surgery, and the amount of blood loss during incision was recorded.
RESULTS
22 patients were enrolled to this study. At 1-month follow-up, we saw significant difference between GEM (20.32 ± 4.11) and the surgical blade (23.27 ± 4.59) (P = 0.008) from POSAS, patient scale but no significant difference in doctor scale, (GEM 21.55 ± 7.34, surgical blade 24.27 ± 7.88, P = 0.155). At 3-month follow-up, there were no significant difference between the groups both doctor (GEM 16.45 ± 4.62, surgical blade 17.65 ± 4.50, P = 0.411) and patient scale (GEM 13.15 ± 2.96, surgical blade 14.05 ± 3.33, P = 0.328).
CONCLUSION
GEM electrocautery had a superior scar outcome to a surgical blade at 1 month from the patient perspective. There was also significantly less blood loss in GEM compared with the surgical blade.
PubMed: 38847842
DOI: 10.1007/s00405-024-08771-1 -
Otolaryngologia Polska = the Polish... Jun 2024<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of...
<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of 10 years.</br> <b><br>Aim:</b> The aim of this study was to evaluate the therapeutic results and prognostic factors.</br> <b><br>Materials and methods:</b> This is a retrospective study of patients with parotid cancer treated with radiotherapy between 2008 and 2017 at the National Institute of Oncology in Rabat. Patients who received adjuvant or exclusive radiotherapy were included in this study. We performed a multivariate analysis for the factors related to locoregional control and overall survival.</br> <b><br>Results:</b> Initially, 74 patients (45 men and 29 women), at a median age of 57 years. were identified. At the time of diagnosis, 10 (13.6%), 36 (48.6%), and 28 (37.8%) patients were in stage II, III, and IVab, respectively. Sixty patients received adjuvant radiotherapy after parotidectomy and 14 patients received exclusive radiotherapy for an unresectable tumor. At 5 years, the rate of locoregional control and overall survival were 68.2% and 53.7%, respectively. Surgical resection and negative margins were significantly correlated with locoregional control. Lymph node involvement, unresectable tumors, high-grade histological types, and cystic adenoid carcinoma were significantly correlated with poor overall survival.</br> <b><br>Conclusions:</b> Acceptable long-term results are obtained with surgery combined with radiotherapy. Surgical resection remains essential for parotid cancer, given the disappointing results of treatment with radiotherapy alone.</br>.
Topics: Humans; Parotid Neoplasms; Male; Female; Middle Aged; Retrospective Studies; Aged; Adult; Radiotherapy, Adjuvant; Treatment Outcome; Neoplasm Staging; Prognosis; Aged, 80 and over
PubMed: 38808641
DOI: No ID Found -
European Archives of... May 2024To assess health-related quality of life (HRQoL) and its influencing factors in these pediatric patients undergoing parotidectomy.
PURPOSE
To assess health-related quality of life (HRQoL) and its influencing factors in these pediatric patients undergoing parotidectomy.
METHODS
This was a cross-sectional study that included 37 children and adolescents (≤ 19 years) with parotid gland tumors who were treated in Sichuan Cancer Hospital between January 2006 and November 2021. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The Wilcoxon rank sum test was used to analyze the factors influencing patients' HRQoL.
RESULTS
37 children and adolescents were included in the study, including 22 cases of benign tumors and 15 cases of malignant tumors. All patients underwent surgery, and some patients with malignant tumors received radiotherapy or chemotherapy. Malignancy, permanent facial palsy, and Frey syndrome were associated with worse HRQoL in children and adolescents with parotid gland tumors. Radiotherapy and no cervical lymph node dissection were associated with worse HRQoL in pediatric patients with malignancy. The surgical approach of parotid is not a factor influencing HRQoL.
CONCLUSION
Factors associated with HRQoL in children and adolescents with parotid gland tumors include pathological types, permanent facial palsy, and Frey syndrome. In addition, factors affecting patients with malignancy include lateral lymph node dissection and radiotherapy.
PubMed: 38777854
DOI: 10.1007/s00405-024-08705-x -
Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study.Aesthetic Surgery Journal May 2024Despite its significant roles in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, a...
BACKGROUND
Despite its significant roles in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, a consideration critical for ensuring the safety of neck surgeries.
OBJECTIVES
We aimed to clarify the anatomical discrepancies associated with the cervical branch of the facial nerve to enhance surgical safety.
METHODS
The study utilized twenty fresh-frozen hemiheads. A two-stage surgical procedure was employed, beginning with an initial deep-plane facelift including extensive neck dissection, followed by a superficial parotidectomy on fresh frozen cadavers. This approach allowed for a thorough exploration and mapping of the cervical nerve in relation to its surrounding anatomical structures.
RESULTS
Upon exiting the parotid gland, the cervical nerve consistently traveled beneath the investing layer of the deep cervical fascia for a brief distance, traversing the deep fascia to travel within the areolar connective tissue before terminating anteriorly in the platysma muscle. Single branch was observed in two cases, while two branches were noted in eighteen cases.
CONCLUSIONS
The cervical nerve's relatively deeper position below the mandible's angle facilitates a safer subplatysmal dissection via a lateral approach for the release of the cervical retaining ligaments. Due to the absence of a protective barrier, the nerve is more susceptible to injuries from direct trauma or thermal damage caused by electrocautery, especially during median approaches.
PubMed: 38748536
DOI: 10.1093/asj/sjae111 -
Iranian Journal of Otorhinolaryngology May 2024Parotid pleomorphic adenomas necessitate surgical intervention, with a growing emphasis on preserving salivary function post-surgery due to its critical role in...
INTRODUCTION
Parotid pleomorphic adenomas necessitate surgical intervention, with a growing emphasis on preserving salivary function post-surgery due to its critical role in maintaining oral health and overall quality of life. This study aims to evaluate a surgical method meticulously designed to preserve salivary function following partial superficial parotidectomy, utilizing Technetium-99m scintigraphy.
MATERIALS AND METHODS
This single-center prospective cohort study was conducted in Mashhad, Iran, between 2022 and 2023. The study encompassed 40 patients diagnosed with parotid pleomorphic adenomas, ages 20 to 64, undergoing partial superficial parotidectomy. The salivary function was evaluated using Technetium-99m scintigraphy three weeks post-operation.
RESULTS
Most participants underwent right parotid surgery (62.5%, n=25) instead of left parotid surgery (37.5%, n=15). The outcomes of the partial superficial parotidectomy indicated no complications during the three-week post-operative period. Saliva secretion rates on the operated side were preserved across the cohort. A significant difference in saliva secretion rates was observed between the operated and contralateral sides (P<0.01) for both right and left parotid surgery groups. No significant correlation was found between the time elapsed post-surgery and saliva secretion rates (P=0.48).
CONCLUSION
Our study demonstrated that the superficial parotidectomy technique is notably effective when focused on preserving the salivary function of the deep parotid gland. Not only does it maintain saliva secretion on the operated side, but it also boasts an admirable safety profile. There were no recorded complications, and duct preservation was achieved in most instances.
PubMed: 38745682
DOI: 10.22038/IJORL.2024.76003.3551