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Maedica Mar 2024We present the case of a patient with solitary fibrous tumor of the masticator space with unusual extension. A 43-year-old woman presented with a painless mass with...
We present the case of a patient with solitary fibrous tumor of the masticator space with unusual extension. A 43-year-old woman presented with a painless mass with intraoral extension on the right cheek. The B-scan sonograph and magnetic resonance imaging revealed the extension of the tumor. The biopsy performed under local anesthesia raised the suspicion of a solitary fibrous tumor. Tumor excision included a preoperative tumor embolization. The surgical removal of the tumor included a partial parotidectomy on the right side, insertion of masseteric and temporalis muscle, resection of the middle part of the zygomatic bone and stabilization of the bone with a plate, mobilization of the tumor from the maxillary sinus and the pterygopalatine fossa through an endoscopic approach and an approach via partial resection of the anterior wall of the maxillary sinus after identifying and sparing the infraorbital nerve. Ôhe histological findings confirmed the diagnosis of solitary fibrous tumor. The patient's treatment completed with radiation therapy, and 2.5 years later, there was recurrence in the right temporal area. To our knowledge, this is the second reported case of solitary fibrous tumor arising in the masticator space and the only case with extension intraorally and in the paranasal sinuses. Tumor embolization and complete surgical excision are the most frequently recommended treatments.
PubMed: 38736934
DOI: 10.26574/maedica.2024.19.11.154 -
International Journal of Surgery Case... Jun 2024Multifocal nodular oncocytic hyperplasia (MNOH), alternatively known as Benign Nodular Oncocytosis, was first identified by Schwartz and Feldman in Cancer in 1969. It...
INTRODUCTION AND IMPORTANCE
Multifocal nodular oncocytic hyperplasia (MNOH), alternatively known as Benign Nodular Oncocytosis, was first identified by Schwartz and Feldman in Cancer in 1969. It manifests as numerous nodular growths of oncocytic cells scattered within the salivary gland tissue; Bilateral and multifocal lesions in the parotid gland are rare occurrences. Among these, bilateral multifocal oncocytic lesions are even less common.
CASE PRESENTATION
We report a case of 59-year-old woman with no prior medical or surgical history who presented to our ENT department due to a gradual, painless enlargement of both parotid glands that had been ongoing for four months. She underwent bilateral parotidectomy. Histologic exam confirmed the diagnosis of bilateral multifocal nodular oncocytic hyperplasia with a histological variant of clear cells. The postoperative course was unremarkable.
CLINICAL DISCUSSION
Diagnosis presents challenges due to the rarity of this condition. Precise diagnosis relies on imaging techniques such CT scans and MRI features. There is no consensus on the therapeutic management.
CONCLUSIONS
Our case report adds to the scarce literature concerning this condition, emphasizing the importance of careful clinical evaluation, precise diagnosis, and proper management.
PubMed: 38735212
DOI: 10.1016/j.ijscr.2024.109663 -
Ear, Nose, & Throat Journal May 2024This study aimed to determine the prevalence of complications after parotidectomy and identify factors associated with these complications. Data from patients who...
This study aimed to determine the prevalence of complications after parotidectomy and identify factors associated with these complications. Data from patients who underwent parotidectomy for neoplasms in 2 tertiary centers were analyzed. Patient characteristics and postoperative complications were collected. Demographics, diabetes, and smoking status were evaluated using descriptive statistics. The prevalence of complications was determined and associations with smoking, surgical type, preoperative facial nerve involvement, final pathology, and Milan category were examined using chi-squared and correlation analyses. Majority of patients were male (59.5%), falling within the age range of 31 to 50 years (42.7%). The most common complication was facial nerve weakness (23.6%), followed by seroma (19.1%), ear numbness (17.3%), and tumor recurrence (8.7%). Xerostomia demonstrated a correlation with smoking, while more invasive types of surgery showed associations with surgical site infection and tumor recurrence. Malignant disease on the final pathology and higher Milan category exhibited links with salivary fistula. No clear associations were found between preoperative facial nerve involvement and any of the complications. Age and body mass index (BMI) did not demonstrate significant correlations with complications. This study highlights the prevalence and associations of postparotidectomy complication. Facial nerve weakness was the most common followed by seroma and ear numbness. Smoking was correlated with xerostomia, while more invasive type of surgery was correlated with infection and recurrence. Age and BMI did not have associations. Personalized approaches and understanding factors for effective management are important. Further research is recommended to validate the outcome and understand the recovery from parotidectomy.
PubMed: 38721821
DOI: 10.1177/01455613241244656 -
Journal of Medical Case Reports May 2024Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have... (Review)
Review
BACKGROUND
Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting.
CASE PRESENTATION
A 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma.
CONCLUSIONS
Surgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.
Topics: Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Magnetic Resonance Imaging; Lymphoma
PubMed: 38698413
DOI: 10.1186/s13256-024-04553-9 -
The Journal of Laryngology and Otology May 2024
PubMed: 38695360
DOI: 10.1017/S0022215124000823 -
The Laryngoscope Apr 2024To define a novel classification of first branchial cleft anomalies (FBCAs) based on the relationship between lesions and the facial nerve in terms of radiographic...
OBJECTIVE
To define a novel classification of first branchial cleft anomalies (FBCAs) based on the relationship between lesions and the facial nerve in terms of radiographic imaging findings and to introduce the corresponding surgical managements.
METHODS
The clinical data were retrospectively reviewed. Novel classification was proposed according to the head-neck MRI findings and surgical records. FBCAs limited in the cartilaginous segment of external auditory canal (EAC) or superficial parotid gland capsule were classified as type A. Lesions close to the FN and(or) involved into the parotid gland with no scar formation and no previous parotidectomy were classified as type B. FBCAs adhered to the FN and(or) invaded the parotid gland with scar formation due to previous surgery were classified as type C. Appropriate surgery approaches was also described, which was correlated with classification.
RESULTS
Fifty-one patients were included, and one patient suffered from bilateral lesions. Thirty-one, twelve, and nine lesions were classified as type A, type B, and type C FBCAs, respectively. One type A patient (1.92%) suffered from recurrence during follow-up. Temporary facial palsy (House-Brackmann II) was identified in 2 type C patients (3.85%) after surgery and recovered to normal within 2 months. One type B patient (1.92%) suffered from facial paralysis due to the FN injury and underwent facial nerve graft simultaneously. No patients with type C complained of hearing loss postoperatively.
CONCLUSION
This novel classification clearly illustrates definitely relationship between lesion and the facial nerve and appropriate surgical strategies were proposed based on the novel classification.
LEVEL OF EVIDENCE
4 Laryngoscope, 2024.
PubMed: 38676459
DOI: 10.1002/lary.31477 -
Journal of Clinical Medicine Apr 2024: Parotidectomies are indicated for a variety of reasons. Regardless of the indication for surgery, facial reanimation may be required because of facial nerve sacrifice...
: Parotidectomies are indicated for a variety of reasons. Regardless of the indication for surgery, facial reanimation may be required because of facial nerve sacrifice or iatrogenic damage. In these cases, facial restoration performed concurrently with ablative surgery is considered the gold standard, and delayed reanimation is usually not attempted. A retrospective review of all patients who underwent parotidectomies from 2009 to 2022 in a single institution was performed. Indications, surgical techniques, and outcomes of an algorithmic template were applied to these cases using the Sunnybrook, Terzis scores, and Smile Index. A comparison was made between immediate vs. late repairs. Of a total of 90 patients who underwent parotidectomy, 17 (15.3%) had a radical parotidectomy, and 73 (84.7%) had a total or superficial parotidectomy. Among those who underwent complete removal of the gland and nerve sacrifice, eight patients (47.1%) had facial restoration. There were four patients each in the immediate ( = 4) and late repair (n = 4) groups. Surgical techniques ranged from cable grafts to vascularized cross facial nerve grafts (sural communicating nerve flap as per the Koshima procedure) and vascularized nerve flaps (chimeric vastus lateralis and anterolateral thigh flaps, and superficial circumflex perforator flap with lateral femoral cutaneous nerve). The algorithm between one technique and another should take into consideration age, comorbidities, soft tissue defects, presence of facial nerve branches for reinnervation, and donor site morbidity. While immediate facial nerve repair is ideal, there is still benefit in performing a delayed repair in this algorithm.
PubMed: 38673542
DOI: 10.3390/jcm13082269 -
Cureus Mar 2024Metastasis from early-stage sebaceous carcinoma of the eyelid to the salivary glands is considered very rare, occurring in less than 3% of early-stage patients. We...
Metastasis from early-stage sebaceous carcinoma of the eyelid to the salivary glands is considered very rare, occurring in less than 3% of early-stage patients. We report the case of a 72-year-old Caucasian man with a parotid tumor. Fine needle aspiration was consistent with a salivary duct carcinoma. A subtotal parotidectomy with ipsilateral neck dissection was performed. The pathology report revealed a sebaceous carcinoma with one parotid and two cervical lymph nodes infiltrated. The patient had a history of an early-stage sebaceous carcinoma of the upper eyelid two years before, which was revealed after the histological examination. An early-stage eyelid sebaceous carcinoma can metastasize to lymph nodes of the parotid glands. A close follow-up should not be neglected.
PubMed: 38654808
DOI: 10.7759/cureus.56838 -
European Archives of... Apr 2024The preoperative diagnosis of salivary gland cancer (SGC) is crucial for the application of appropriate treatment, particularly involving the extension of the resection.
BACKGROUND
The preoperative diagnosis of salivary gland cancer (SGC) is crucial for the application of appropriate treatment, particularly involving the extension of the resection.
METHODS
Retrospective search of medical database identified 116 patients treated surgically with malignant tumors of salivary gland between 2010 and 2020. Analysis included the demographical data, clinical course, type of surgical and adjuvant treatment, histology type and margin status, perivascular invasion (LVI), perineural invasion (PNI), metastatic lymph nodes (LN). Facial nerve function, recurrence-free and overall survival were evaluated. Adequate statistics were used for data analysis.
RESULTS
The final cohort included 63 SGC patients, with adenoid cystic carcinoma the most common pathological type (27%, n = 17), followed by adenocarcinoma (17.4% n = 11). T1 and T2 patients accounted for majority cases (n = 46). The lymph node metastases were confirmed with the histopathology in 31.7% (n = 20). Distant metastases were observed in 4.8% of cases (n = 3). 38% (n = 24) of SGC were treated selectively with surgery, 49.2% (n = 31) had postoperative radiotherapy and 15.9% (n = 10)-radio-chemotherapy. The final facial nerve function was impaired in 38% of patients. Mean overall survival (OS) for all patients was 108.7 (± 132.1) months, and was the most favorable for acinar cell carcinoma (118.9 ± 45.4) and the poorest for squamous cell carcinoma (44 ± 32). Cox regression analysis of disease-free survival and OS identified significant association only with patients' age over 65 years, the hazard ratio of 7.955 and 6.486, respectively.
CONCLUSIONS
The efficacy of treatment modalities for SGC should be verified with regard to the histopathological type, but also the patients' age should be taken into account.
PubMed: 38649542
DOI: 10.1007/s00405-024-08650-9 -
Journal of Oral and Maxillofacial... Apr 2024Post-parotidectomy wound dressing techniques lack of robust evidence, creating variation in practice. The choice between conventional and pressure dressing is typically...
BACKGROUND
Post-parotidectomy wound dressing techniques lack of robust evidence, creating variation in practice. The choice between conventional and pressure dressing is typically based on expert opinions and individual preferences and the anticipated benefits of reduced drainage and shorter drain retention in pressure dressing hasn't demonstrated yet.
PURPOSE
The purpose of this study is to assess the advantage of pressure dressing following parotidectomy compared to conventional dressing.
STUDY DESIGN, SETTING, SAMPLE
This study was an open-label randomized controlled trial recruiting the patients aged 18 and above undergoing parotidectomy at the Otolaryngology Department of King Chulalongkorn Memorial Hospital between March 2021 and September 2022. Our exclusion criteria were as following: (1) underwent parotidectomy combined with neck dissection, (2) prior irradiation to the parotid gland or head and neck region, (3) prior parotidectomy within the previous year, (4) consumption of anticholinergic medications, (5) bleeding disorders or coagulopathies.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE
The predictor variable was postoperative dressing, and subjects were randomly assigned to pressure or conventional dressing.
MAIN OUTCOME VARIABLE(S)
The primary outcome variables were drain output (ml) measured every 8 hours and reported in the term of total drain output and duration of drain use. The secondary outcome variables were post-parotidectomy complications (if any), complications from the pressure dressing and pain scores.
COVARIATES
The covariates were underlying disease, smoking, alcohol drinking, types of parotidectomy (extension of surgery), and pathologic result.
ANALYSES
The appropriate univariate and bivariate statistics were computed, and the level of statistical significance was set at P value < .05.
RESULTS
A total of 40 patients were enrolled, with 20 in each group. Average age was 59.10 ± 10.60 years in the pressure dressing group and 55.70 ± 18.90 years in the conventional dressing group. Baseline characteristics were the same in both groups. The average volume of drain output in the pressure dressing group was 44.25 ± 25.20 ml, compared to 37.05 ± 22.74 ml in the conventional dressing group (P = .34). Moreover, the average duration of drain placement for the pressure dressing group was 27.65 ± 9.86 hours, while it was 26.90 ± 11.23 hours for the conventional group (P = .83). Notably, there were no significant differences between the two groups regarding sialocele and pain scores. Furthermore, no complications from the application of pressure dressing were observed.
CONCLUSION AND RELEVANCE
Pressure dressing does not provide significant benefits over conventional dressing after parotidectomy concerning drain output, duration of drain placement, or surgical complications.
PubMed: 38648860
DOI: 10.1016/j.joms.2024.03.038