-
International Journal of Clinical... 2024Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the...
Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the prognostic significance of the clinical stage of parotid gland metastases and the incidence of occult cervical lymph node involvement in cSCC of the head. Our retrospective analysis includes 39 patients with cSCC parotid gland metastases, 15 of whom had concurrent cervical node involvement. In 32 patients, the lymph nodes manifested at stage N3b. A total of 26 patients were treated with parotidectomy, 9 patients received radiotherapy alone, and 4 received symptomatic therapy. The surgical treatment included either total conservative (21 cases) or superficial parotidectomy (5 cases) and neck dissection (therapeutic neck dissections in 11 cases and elective in 14 cases). In all cases, surgery was performed with sufficient tumour-free resection margins. Adjuvant radiotherapy was administered postoperatively in 16 patients. Occult metastases were present in 21% of cases after an elective neck dissection, but not in any case in the deep lobe of the parotid gland. The five-year overall survival and recurrence-free interval were 52% and 55%, respectively. Patients with the cN3b stage and G3 histological grade tend to have a worse prognosis, but not at a statistically significant level. The prognosis was not worse in patients with concurrent parotid and cervical metastases compared to those with metastases limited to the parotid gland only. The addition of adjuvant irradiation, in comparison to a single modality surgical treatment, was the only statistically significant prognostic factor that reduced the risk of death from this diagnosis (=0.013). The extent of parotidectomy (partial vs. total) had no impact on either the risk of recurrence or patient prognosis. The combination of surgery with irradiation provides the best results and should be applied to all patients who tolerate the treatment. A partial superficial parotidectomy should be sufficient, with a minimum risk of occult metastasis in the deep lobe. Conversely, the relatively high incidence of occult neck metastases indicates that patients could likely benefit from elective neck dissection.
Topics: Humans; Carcinoma, Squamous Cell; Parotid Gland; Skin Neoplasms; Retrospective Studies; Parotid Neoplasms; Neoplasm Staging
PubMed: 38410673
DOI: 10.1155/2024/5525741 -
Eye (London, England) Jun 2024Orbital surgery benefits from well-designed instrumentation that offers gentle tissue manipulation, high manoeuvrability and control. Nevertheless, in confined spaces,...
PURPOSE
Orbital surgery benefits from well-designed instrumentation that offers gentle tissue manipulation, high manoeuvrability and control. Nevertheless, in confined spaces, tissue manipulation must be accomplished with exceptionally high accuracy and precision. This is where robotic surgery offers an advantage. We aimed to evaluate a robotic-assisted surgical system's feasibility, safety and outcome in assisting tumour clearance.
PATIENTS AND METHODS
A case series of patients with advanced periocular tumours undergoing robotic-assisted globe-sparing resection was performed using the DaVinci XI system (Intuitive Surgical, Inc). Institutional ethics and multidisciplinary approval were sought in all cases.
RESULTS
Four patients with advanced periocular tumours underwent robotic-assisted orbital surgery at a mean age of 63 years (range 42-86). Two patients were diagnosed with squamous cell carcinoma, and two had basal cell carcinoma. One patient was found to have positive lymph nodes at the time of surgery and underwent simultaneous parotidectomy and lymph node clearance. Clear resection of the primary tumour was achieved in all patients; three patients underwent further resection due to narrow margins prior to reconstruction. Patients were follow-up for at least one year, and three remained disease-free. One patient with pre-existing extra-orbital disease developed metastatic disease four months post-op. All patients preserved vision peri-operatively, with no complaints of diplopia. Moderate ocular surface disease was noted in two patients.
CONCLUSION
Our series highlights the potential advantage of three-dimensional optics, multi-directional instrumentation and motion scaling technology to achieve globe-sparing tumour resection in advanced periocular tumours. However, further robotic instrumentation development is required for orbital surgery.
Topics: Humans; Feasibility Studies; Middle Aged; Male; Robotic Surgical Procedures; Female; Aged; Adult; Aged, 80 and over; Carcinoma, Squamous Cell; Orbital Neoplasms; Carcinoma, Basal Cell; Ophthalmologic Surgical Procedures; Treatment Outcome; Orbit; Eyelid Neoplasms
PubMed: 38388832
DOI: 10.1038/s41433-024-02932-6 -
National Journal of Maxillofacial... 2023The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome.
AIM OF THE STUDY
The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome.
MATERIAL AND METHODS
Data of 102 patients assessed from hospital records who underwent parotid surgery between the years 2013 and 2018 were obtained. Parameters included age, sex, socio-demographic profile, presenting complaints, examination findings, and cytopathology. Surgical techniques, post-operative complications such as a facial scar, retro-mandibular and pre-auricular depression, facial palsy, Frey's syndrome, and numbness over the ear lobule were analyzed.
RESULT
Out of a total of 102 patients, 54.0% of patients were male, and 45.1% were female. The mean age of patients was 33.30 ± 13.87 years ranging from 7 to 65 years. The most common clinical presentation was swelling in the parotid region (95.1%), and associated symptoms with swelling were pain (17.5%), facial palsy (4.9%), discharging sinus (4.9%), and ulcerative lesions (1%) at the time of presentation. Pleomorphic adenoma was the most common benign neoplasm (76.5%), followed by Warthin's tumors (2.9%). Mucoepidermoid carcinoma was the most common malignant neoplasm (3.9%). After parotid surgery, 35% of patients had a sensory impairment or hypoesthesia of the ear lobule, and 23.28% had temporary facial nerve weakness. 5.0% of patients had permanent facial weakness, and 2.06% of patients had weakness of the marginal mandibular nerve.
CONCLUSION
Pleomorphic adenoma and mucoepidermoid carcinoma are the most common benign and malignant tumors, respectively, and parotidectomy is the treatment of choice, depending on the tumor location. Successful treatment depends on early diagnosis and histopathological and radiological investigations. Sensory impairment and temporary facial nerve paralysis are the most common post-operative complications, which are minimized by proper knowledge of anatomy and meticulous dissection of the facial nerve during parotid surgery.
PubMed: 38273931
DOI: 10.4103/njms.njms_111_22 -
Advances in Radiation Oncology Jan 2024For patients without pathologic evidence of cervical disease after neck dissection for cutaneous squamous cell carcinoma involving the parotid region, inclusion of the...
PURPOSE
For patients without pathologic evidence of cervical disease after neck dissection for cutaneous squamous cell carcinoma involving the parotid region, inclusion of the ipsilateral cervical neck in the postparotidectomy radiation volume is routinely performed. We report our experience with selective avoidance of the ipsilateral neck for patients undergoing postoperative radiation to the parotid bed.
METHODS AND MATERIALS
From January 2014 to December 2023, a total of 30 consecutive patients underwent postoperative radiation after parotidectomy for cutaneous squamous cell carcinoma involving the parotid area. All patients had previously had a neck dissection confirming pathologic N0 disease. Treatment was delivered using intensity modulated radiation therapy to a median dose of 60 Gy (range, 56-66 Gy). The radiation target volumes included the parotid bed only, with deliberate avoidance of the ipsilateral cervical neck. The median pathologic tumor size of the parotid tumor was 3.3 cm (range, 0.2-9.4 cm). Final pathologic evaluation showed positive microscopic margins in 8 patients (27%), perineural invasion in 17 patients (57%), and facial nerve involvement in 6 patients (20%).
RESULTS
There were no isolated nodal failures. One patient developed an ipsilateral neck recurrence approximately 8 months after completion of radiation therapy. This occurred 2 months subsequent to the development of local recurrence. The 5-year actuarial rates of local (parotid) control, neck control, and overall survival were 87%, 97%, and 76%, respectively.
CONCLUSIONS
Omission of the ipsilateral neck from the parotid volume does not compromise disease control for pathologically N0 patients undergoing postoperative radiation for cutaneous squamous cell carcinoma involving the parotid region. Practical implications are discussed.
PubMed: 38260235
DOI: 10.1016/j.adro.2023.101306 -
Cureus Dec 2023Facial nerve integrity is the cornerstone of parotid surgery. Although a variety of anatomical landmarks have been employed, facial nerve injury still happens causing...
Facial nerve integrity is the cornerstone of parotid surgery. Although a variety of anatomical landmarks have been employed, facial nerve injury still happens causing devastating functional and cosmetic sequelae. The retromandibular vein is considered one of the most consistent structures lying just deep into the facial nerve. In our cadaveric study, we found a fenestrated retromandibular vein lying superficial to the bifurcation of the facial nerve. This rare anatomical variation would have been a challenge for a hypothetic parotidectomy. Surgeons should be aware of both anterograde and retrograde dissection of the facial nerve and choose the most proper approach to preserve the integrity of the facial nerve.
PubMed: 38259421
DOI: 10.7759/cureus.50973 -
Cureus Dec 2023Parotid oncocytoma is a rare salivary gland tumour. Management does not require surgical intervention if diagnosed on a preoperative biopsy. A 64-year-old man presented...
Parotid oncocytoma is a rare salivary gland tumour. Management does not require surgical intervention if diagnosed on a preoperative biopsy. A 64-year-old man presented with a parotid mass diagnosed as mcSCC on fine-needle aspiration cytology (FNAC). Surgical histopathology following parotidectomy demonstrated an oncocytoma of the parotid gland. Parotid oncocytomas are rare; therefore, diagnosis can be difficult. An MRI, CT, and US-guided biopsy are required for diagnosis. Ultrasound-guided core biopsy (UGSB) is more sensitive and specific when compared to FNAC for diagnosing malignant tumours. Diagnoses of benign salivary gland tumours on biopsy remain challenging. The aim of this article is to highlight the difficulty of diagnosing salivary gland tumours. We further aim to outline the contributing features that lead to this misdiagnosis and suggest steps to circumvent it in the future. This report describes the challenges in diagnosing salivary gland tumours and outlines the contributing features of this misdiagnosis. We add to the literature an additional case of a parotid oncocytoma.
PubMed: 38249277
DOI: 10.7759/cureus.50853 -
Journal of Personalized Medicine Jan 2024The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of...
BACKGROUND
The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of surgical procedure, the most common complication is Frey's syndrome (FS). Traditionally, FS includes unilateral gustatory sweating and flushing of the facial skin lining the parotid compartment. Recent research describes atypical discomfort associated with FS. The aim of this study was to assess the late prevalence and severity of both usual and atypical symptoms after parotidectomy for benign tumors.
METHODS
We conducted a cross-sectional study involving 86 subjects who underwent superficial parotidectomy at least one year before the study. The questionnaire included the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale supplemented by specific questions about symptoms.
RESULTS
Sixty-seven out of eighty-six (77.9%) cases reported almost one symptom. The most frequent symptom was itch (36/67-53.7%), followed by pain (35/67-52.2%), while 28/67 (41.8%) subjects complained of atypical symptoms without flushing or sweating. A desire to treat the discomfort was reported by 50/67 (74.6%) subjects.
CONCLUSIONS
Late postparotidectomy local discomfort is not infrequent and includes both usual and "unusual" symptoms almost equally. Our results suggest the importance of informing patients about the occurrence of the syndrome and the available treatment options during pre- and postoperative counseling.
PubMed: 38248797
DOI: 10.3390/jpm14010096 -
Journal of Medical Case Reports Jan 2024Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic... (Review)
Review
BACKGROUND
Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic carcinoma with chondrosarcoma to the best of our knowledge. They consist of distinct carcinomatous and sarcomatous components and may arise de novo or from a preexisting pleomorphic adenoma.
CASE PRESENTATION
Herein we present a case of an 80-year-old white female who presented with progressively increasing left facial swelling over 6 weeks. Magnetic Resonance Imagining revealed a mass (3.4 cm) in the parotid gland with a predominant cystic/necrotic component. The cytology was atypical (Milan3) and a total parotidectomy and selective lymph node dissection was done. The resection showed extensive necrosis with high grade sarcomatous (chondrosarcoma) areas. The epithelial component was adenoid cystic carcinoma with perineural invasion. The patient is currently undergoing radiotherapy of the tumor bed and skull base due to propensity of perineural invasion of the adenoid cystic component. The most common carcinomas in carcinosarcomas of salivary glands are adenocarcinoma and squamous cell carcinoma.
CONCLUSION
Carcinosarcoma is a high-grade aggressive lesion with a poor prognosis and should be treated aggressively. More studies are needed to understand the origin of these tumors.
Topics: Humans; Female; Aged, 80 and over; Parotid Gland; Parotid Neoplasms; Carcinoma, Adenoid Cystic; Carcinosarcoma; Chondrosarcoma; Bone Neoplasms
PubMed: 38243328
DOI: 10.1186/s13256-023-04280-7 -
Clinical and Experimental... Feb 2024This study aimed to compare the oncological outcomes of partial versus superficial or total parotidectomy for superficial T1 or T2 primary parotid cancers and...
OBJECTIVES
This study aimed to compare the oncological outcomes of partial versus superficial or total parotidectomy for superficial T1 or T2 primary parotid cancers and investigate their prognostic factors and recurrence patterns.
METHODS
The medical records of 77 patients with T1-2 primary parotid malignancies between May 2003 and March 2022 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the prognostic factors associated with overall survival, disease-free survival, and local and distant recurrence.
RESULTS
The average follow-up duration was 70.2 months (range, 12-202 months). The 5-year overall and disease-free survival rates were 88.7% and 77.1%, respectively. Twenty-two patients underwent partial parotidectomy, and 55 underwent superficial or total parotidectomy. There were no significant differences in the disease recurrence (P=0.320) and mortality rates (P=0.884) of the partial and superficial or total parotidectomy groups. The mean duration of surgery was shorter and the overall complication rates were significantly lower in the partial group than in the superficial or total parotidectomy group (P=0.049). Sixteen cases of recurrence occurred during the study period (20.8%). Univariate analyses showed that high-grade tumors (P=0.006), lymphovascular invasion (P=0.046), and regional lymph node metastasis (P=0.010) were significant risk factors for disease recurrence. Multivariate analysis identified regional lymph node metastasis as an independent prognostic factor for disease recurrence (P=0.027), and lymphovascular invasion as an independent prognostic factor for overall survival (P=0.033).
CONCLUSION
The conservative surgical approach of partial parotidectomy can yield oncological outcomes comparable to those of superficial or total parotidectomy with careful patient selection in T1-2 parotid cancers.
PubMed: 38228134
DOI: 10.21053/ceo.2023.00014 -
In Vivo (Athens, Greece) 2024Primary squamous cell carcinoma of the parotid gland (pPSCC) is a rare tumor, accounting for less than 3% of all parotid carcinomas. There is no general consensus on the... (Review)
Review
BACKGROUND/AIM
Primary squamous cell carcinoma of the parotid gland (pPSCC) is a rare tumor, accounting for less than 3% of all parotid carcinomas. There is no general consensus on the management of this tumor, since clinical experience for pPSCC is minimal. Moreover, pPSCC is often misdiagnosed for metastatic cutaneous carcinoma. In our study, we focused on evaluating its biological and clinical characteristics, treatment results and prognosis. We proposed an update on diagnostic and therapeutic management of pPSCC.
PATIENTS AND METHODS
The retrospective cohort included 18 patients diagnosed and treated for pPSCC in three tertiary head and neck centers between 2008 and 2022. We retrospectively evaluated their prognosis and established a therapeutic recommendation after analyzing our own and previously published data.
RESULTS
Fourteen of 18 tumors were diagnosed in stage IV. Five-year overall survival was 36 months. Six patients received palliative therapy. Twelve patients underwent parotidectomy, neck dissection, and adjuvant radiotherapy. Remission was achieved in 8 patients (follow-up interval 3-56 months). One patient died with recurrent disease. The others are alive and in complete remission.
CONCLUSION
The definitive diagnosis of pPSCC must meet the histological and clinical criteria. First of all, the metastatic origin of the tumor must be excluded. Five-year survival of this very aggressive tumor does not exceed 50%. Without surgery, the prognosis is poor. The best results, irrespective of tumor stage, are achieved with surgery. Therefore, a total parotidectomy, neck dissection (therapeutic or elective) and adjuvant radiotherapy are indicated for all resectable tumors.
Topics: Humans; Parotid Gland; Retrospective Studies; Neoplasm Staging; Carcinoma, Squamous Cell; Skin Neoplasms
PubMed: 38148050
DOI: 10.21873/invivo.13446