-
Cancer Medicine Oct 2023Optimum management of the N0 neck is unresolved in parotid salivary gland cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis and... (Observational Study)
Observational Study
BACKGROUND
Optimum management of the N0 neck is unresolved in parotid salivary gland cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis and its´ clinical use is increasing for head and neck tumors. The object of this study was to establish whether the technique is applicable to detect distribution of sentinel nodes for parotid tumors.
MATERIALS AND METHODS
Prosepective observational study in 30 patients with benign or low-grade T1-T2N0 malignant tumors in the parotid gland planned for surgical treatment. Distribution of SN was detected with a preoperative ultrasound-guided peritumoral injection with a technetium-99 (Tc-99 m) laballed tracer followed by a SPECT-CT and intraoperative measurement in the neck and parotidal tissue. In patients with cytologically suspected malignant tumor or highly unclerar cytology, SNB was also performed.
RESULTS
Sentinel nodes (SNs) were detected in 26/30 cases. Out of these, 7 presented with only one SN, whereas multiple sentinel nodes where detected in 19 cases. No SNs were found in neck level 1. SN was detected in level 5 independent of tumor location within the parotid gland. An intraparotidal distribution of SNs was more frequent in larger tumors.
CONCLUSIONS
The use of SN-technique in the planning of surgical treatment of parotid tumors seems feasible. It may be of clinical value for patients with parotid cancer to enable a more accurate staging and to detect occult metastasis in the SNs within the parotid as well as in the neck, enabaling the possibility to surgically remove all positive SNs at primary surgery and with reduced surgical morbidity.
Topics: Humans; Parotid Neoplasms; Feasibility Studies; Sentinel Lymph Node Biopsy; Lymphatic Metastasis; Neck; Lymph Nodes; Neoplasm Staging
PubMed: 37776164
DOI: 10.1002/cam4.6612 -
International Journal of Surgery Case... Oct 2023Solitary fibrous tumor is a rare neoplasm that can affect any part of the body, also head and neck region. Etiology is unknown. The incidence is slightly higher in...
INTRODUCTION
Solitary fibrous tumor is a rare neoplasm that can affect any part of the body, also head and neck region. Etiology is unknown. The incidence is slightly higher in males, the age ranges from 11 to 79 years.
PRESENTATION OF CASE
It's the first case in our country of left parotid solitary fibrous tumor, removed by partial parotidectomy with facial nerve preservation. Histology examination showed diffuse spindle-shaped cells proliferation, moderate polymorphism, low mitotic index (<4 mitoses per 10 HPF), partially bordered by fibrous capsule. Immunohistochemistry showed STAT6, CD34, CD99 positivity. Six-months follow-up didn't show sign of recurrence.
DISCUSSION
Solitary fibrous tumor is a mesenchymal spindle cell neoplasm with fibroblastic differentiation ubiquitous in soft tissues, that involved the head and neck region in 6 % of cases. Etiology is unknown. The possible pathogenesis is NAB2-STAT6 gene fusion. It's asymptomatic or symptoms are related to space-occupying mass. Diagnostic work up involves imaging, immunohistochemistry, histology. Radiographic finding may lead to incorrect assessment of the mass: the same imaging features are present in pleomorphic adenoma, the most frequent tumor of salivary glands.
CONCLUSION
This case report aims to stress that, although rare, solitary fibrous tumor should be considered in differential diagnosis in case of indolent salivary gland mass, since it may require more invasive approach (e.g., total parotidectomy, adjuvant radiotherapy). It would like to highlight the role of multidisciplinary team to define the best therapy, tailored for the patient, as well as to give awareness to a rare but sometimes aggressive tumor.
PubMed: 37742355
DOI: 10.1016/j.ijscr.2023.108855 -
Turkish Archives of Otorhinolaryngology Jun 2023To analyze the demographic characteristics and the pathological results of neck dissection in primary parotid gland (PG) cancer patients, and to investigate the effects...
OBJECTIVE
To analyze the demographic characteristics and the pathological results of neck dissection in primary parotid gland (PG) cancer patients, and to investigate the effects of histopathological parameters (perineural invasion, lymphovascular invasion, and extracapsular spread), neck metastasis, stage and lymph node ratio (LNR) on survival.
METHODS
Patients who underwent parotidectomy for malignant PG tumors between 2000 and 2019 years were retrospectively reviewed from the medical records. Thirty patients who were treated with parotidectomy and neck dissection were included in the study. Lymph node ratio was calculated as the ratio of the number of metastatic lymph nodes (LN) to the total number of excised LNs. Tumor stage, regional LN metastasis, LNR, perineural invasion, lymphovascular invasion, and extracapsular spread were reviewed for the effects on survival with the Kaplan-Meier analysis.
RESULTS
The study included 17 (57%) male and 13 (43%) female patients. Their mean age was 67.93±16.90 years (range, 50-85 years). The average number of the excised LN was 26.03±11.79 (range, 3-50). Mean LNR was 0.16±0.26. The Kaplan-Meier analysis showed that neck metastasis (p=0.001) and LNR (p<0.001) were associated with shorter survival times compared to perineural invasion (p=0.818), lymphovascular invasion (p=0.154), extracapsular spread (p=0.410) and stage (p=0.294). In multivariate COX regression analysis, only LNR had a statistically significant difference (p=0.027) compared to the other parameters.
CONCLUSION
The present study suggests that LNR and neck metastasis are associated with shorter survival times in PG cancers. Lymph node ratio can be used as a prognostic marker in these patients.
PubMed: 37727816
DOI: 10.4274/tao.2023.2023-3-5 -
Annals of Maxillofacial Surgery 2023This study describes a partial parotidectomy (PP) under local anaesthesia (LA) without regional block (LAwRB) assisted by electromyographic monitoring of the facial...
THE RATIONALE
This study describes a partial parotidectomy (PP) under local anaesthesia (LA) without regional block (LAwRB) assisted by electromyographic monitoring of the facial nerve, to consolidate the feasibility, efficacy and safety of these procedures without general anaesthesia (GA).
PATIENT CONCERNS
An 82-year-old with a lump in the left parotid gland suspected for non-Hodgkin lymphoma (NHL) needed a histological examination to start chemotherapy.
DIAGNOSIS AND TREATMENTS
Because of multiple comorbidities, the authors performed a PP under LAwRB electromyographically guided by the NIM Vital (Medtronic)™.
OUTCOMES
The procedure was quick and did not require conversion to GA. The histopathological examination confirmed the NHL. No haematoma, sialocoele, earlobe numbness and transient or permanent facial palsy were observed.
TAKE-AWAY LESSONS
The electrophysiologic monitoring of the facial nerve improves the efficacy, safety and feasibility of parotid surgery under LA, avoiding adverse effects of GA, need of regional block and reducing hospital stay.
PubMed: 37711536
DOI: 10.4103/ams.ams_89_22 -
Journal of Otolaryngology - Head & Neck... Sep 2023The post-operative management of parotidectomies is highly provider dependent. No guidelines are currently available for timing of parotid drain removal. This study...
BACKGROUND
The post-operative management of parotidectomies is highly provider dependent. No guidelines are currently available for timing of parotid drain removal. This study aimed to assess: (1) outcomes and complications after early drain removal (< 4 h, post-operative day [POD] 0) versus late drain removal (POD ≥ 1); (2) current Canadian provider practices.
METHODS
A single surgeons ten-year parotidectomy practice was reviewed, spanning his practice change from routine POD ≥ 1 drain removal to POD 0 removal, with extraction of patient demographic, disease, and complication variables. An anonymous, cross-sectional survey on parotid drain practices was distributed to Canadian Society of Otolaryngology-Head and Neck Surgery members. Descriptive statistics, Wilcoxon Rank Sum, and unpaired student's t-tests were calculated.
RESULTS
In total, 526 patients were included and 44.7% (235/526) had drains removed POD 0. There was no significant difference in hematoma or seroma rates between the POD 0 and POD ≥ 1 drain removal cohorts. The national survey on parotid drain management had 176 responses. The majority (67.9%) reported routinely using drains after parotidectomy and 62.8% reported using a drain output based criteria for removal. The most common cut-off output was 30 ml in 24 h (range 5-70 ml).
CONCLUSION
There was no difference in hematoma or seroma rates for patients with parotid drains removed on POD 0 versus POD ≥ 1. Our national survey found significant variation in Canadian parotidectomy drain removal practices, which may be an area that can be further assessed to minimize hospital resources and improve patient care.
Topics: Humans; Cross-Sectional Studies; Seroma; Canada; Device Removal; Hematoma
PubMed: 37705038
DOI: 10.1186/s40463-023-00665-2 -
International Journal of Surgery Case... Sep 2023Acinic cell carcinoma (AciCC) is a rare entity in which high-grade transformation (HGT), formerly dedifferentiation, is uncommon. This case report presents a rare case...
INTRODUCTION AND IMPORTANCE
Acinic cell carcinoma (AciCC) is a rare entity in which high-grade transformation (HGT), formerly dedifferentiation, is uncommon. This case report presents a rare case of AciCC, with rapid transformation to metastatic high-grade dedifferentiated pathology after initial curative treatment.
CASE PRESENTATION
A 58-year-old woman presented in the medical oncology clinic with a progressive swelling on the right side of her face. Magnetic resonance imaging revealed a 5 × 5 cm lobulated parotid gland lesion, and fine needle aspiration biopsy was consistent with carcinoma. After informed consent, a Modified-Blair incision was given as a standard approach to the right preauricular area under general anaesthesia, and a right superficial parotidectomy with the removal of the tumor and selective lymph node dissection was performed. Histopathology of the resected mass was reported as parotid AciCC. She was given adjuvant radiation therapy. A repeat PET CT scan ten weeks after the completion of her adjuvant radiation treatment showed local disease recurrence as well as multiple pulmonary deposits. A repeat biopsy was reported as DOG-1 positive dedifferentiated (high-grade) acinic cell carcinoma, and she was offered platinum-based palliative systemic chemotherapy.
CLINICAL DISCUSSION
Parotid acinic cell carcinomas with high-grade transformation are rare. This case highlights its critical diagnostic markers, curative and palliative management and long-term follow-up.
CONCLUSION
The transformation of parotid AciCC to high-grade, dedifferentiated pathology is unusual and belligerent. Hence, these tumors need intense treatment with a multimodality approach. Close follow-ups with history and physical examination, along with periodic imaging, should be considered for these patients.
PubMed: 37672826
DOI: 10.1016/j.ijscr.2023.108784 -
A new modified limited incision for superficial parotidectomy compared to modified Blair's incision.Annals of Medicine and Surgery (2012) Sep 2023Many incisions have been used to perform parotidectomy, but they result in a visible scar on the neck and may cause patient dissatisfaction by producing disfigurement...
BACKGROUND
Many incisions have been used to perform parotidectomy, but they result in a visible scar on the neck and may cause patient dissatisfaction by producing disfigurement sometimes.
AIM OF STUDY
The aim of this study is to use a modified limited incision for superficial parotidectomy as an alternative to the classical incision, with no obvious scarring and without affecting the identification of the facial nerve, resulting in better cosmesis.
PATIENTS AND METHODS
A prospective comparative study on 100 patients has undergone superficial parotidectomy using a modified limited incision and another 100 patients who have undergone superficial parotidectomy using the modified Blair's incision (control group) for variant benign pathologies. The surgeries were conducted in four hospitals (three private and one public) in Baghdad, Iraq, from January 2016 to September 2022. In both groups, the patients were followed up through outpatient visits to assess the cosmetic result of the incision and detect postoperative complications.
RESULTS
All tumors were removed with no need for extending the skin incision. The cosmetic result of the incision was very satisfactory and only a nominal scar could be seen 6 months after surgery. Five percent of patients only developed postoperative complications.
CONCLUSION
A modified limited incision for superficial parotidectomy provides better patient satisfaction compared to a modified Blair's incision. The modified limited incision can be performed safely with a better cosmetic appearance of the surgical scar compared to the standard incision.
PubMed: 37663706
DOI: 10.1097/MS9.0000000000001123 -
Korean Journal of Radiology Sep 2023The intra-parotid facial nerve (FN) can be visualized using three-dimensional double-echo steady-state water-excitation sequence magnetic resonance imaging...
OBJECTIVE
The intra-parotid facial nerve (FN) can be visualized using three-dimensional double-echo steady-state water-excitation sequence magnetic resonance imaging (3D-DESS-WE-MRI). However, the clinical impact of FN imaging using 3D-DESS-WE-MRI before parotidectomy has not yet been explored. We compared the clinical outcomes of parotidectomy in patients with and without preoperative 3D-DESS-WE-MRI.
MATERIALS AND METHODS
This prospective, non-randomized, single-institution study included 296 adult patients who underwent parotidectomy for parotid tumors, excluding superficial and mobile tumors. Preoperative evaluation with 3D-DESS-WE-MRI was performed in 122 patients, and not performed in 174 patients. FN visibility and tumor location relative to FN on 3D-DESS-WE-MRI were evaluated in 120 patients. Rates of FN palsy (FNP) and operation times were compared between patients with and without 3D-DESS-WE-MRI; propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for surgical and tumor factors.
RESULTS
The main trunk, temporofacial branch, and cervicofacial branch of the intra-parotid FN were identified using 3D-DESS-WE-MRI in approximately 97.5% (117/120), 44.2% (53/120), and 25.0% (30/120) of cases, respectively. The tumor location relative to FN, as assessed on magnetic resonance imaging, concurred with surgical findings in 90.8% (109/120) of cases. Rates of temporary and permanent FNP did not vary between patients with and without 3D-DESS-WE-MRI according to PSM (odds ratio, 2.29 [95% confidence interval {CI} 0.64-8.25] and 2.02 [95% CI: 0.32-12.90], respectively) and IPTW (odds ratio, 1.76 [95% CI: 0.19-16.75] and 1.94 [95% CI: 0.20-18.49], respectively). Conversely, operation time for surgical identification of FN was significantly shorter with 3D-DESS-WE-MRI (median, 25 vs. 35 min for PSM and 25 vs. 30 min for IPTW, < 0.001).
CONCLUSION
Preoperative FN imaging with 3D-DESS-WE-MRI facilitated anatomical identification of FN and its relationship to the tumor during parotidectomy. This modality reduced operation time for FN identification, but did not significantly affect postoperative FNP rates.
Topics: Adult; Humans; Facial Nerve; Prospective Studies; Magnetic Resonance Imaging; Parotid Gland; Treatment Outcome
PubMed: 37634641
DOI: 10.3348/kjr.2022.0850 -
Journal of Personalized Medicine Jul 2023(1) Background: In surgical procedures for maxillofacial tumours, it is challenging to preserve functional and cosmetic properties in the affected patients. The use of...
(1) Background: In surgical procedures for maxillofacial tumours, it is challenging to preserve functional and cosmetic properties in the affected patients. The use of fat grafting is considered as a valuable alternative to overcome postoperative aesthetic asymmetry problems. (2) Methods: In this study, we enrolled thirty patients with parotid gland tumours in which a partial or complete parotidectomy was performed with positioning in the parotid bed of autologous dermis-fat grafts. We evaluated the satisfaction rate of the patients and the objective efficacy in solving the deformity by comparing MRI data before and after surgery. (3) Results: Twenty-six patients showed a satisfying cosmetic result with proper facial symmetry between the affected side and the healthy one. Two patients presented mild postsurgical complications such as haematomas, and two patients reported temporary weakness of the facial nerve related to the parotidectomy. (4) Conclusions: Based on the imaging data obtained via MRI before and after surgery, we can assess that the employment of fat grafts in parotidectomy surgical procedures gives good cosmetic results and does not affect the post operative management and follow up of oncologic patients.
PubMed: 37623451
DOI: 10.3390/jpm13081200 -
Plastic and Reconstructive Surgery.... Aug 2023Massive resection of a malignant tumor of the head and neck region often requires loss of critical nerves, including the spinal accessory nerve. Recently, vascularized...
Massive resection of a malignant tumor of the head and neck region often requires loss of critical nerves, including the spinal accessory nerve. Recently, vascularized nerve grafts (VNGs) have been used to repair facial and other nerve defects with successful outcomes, even in cases involving factors that can inhibit nerve regeneration, such as radiotherapy. However, the effectiveness of these nerve grafts against postoperative radiotherapy has yet to be explored. We report the first successful case in reconstructing a spinal accessory nerve defect after total left parotidectomy with radical neck dissection, using a vascularized vastus lateralis motor nerve graft and an anterolateral thigh flap based on the lateral circumflex femoral system, with great shoulder function outcomes even after postoperative radiotherapy. A branch of vastus lateralis motor nerve perfused by the accompanying descending branch of lateral femoral circumflex vessel was used as a nerve graft, and was repaired in an end-to-end manner. The patient underwent postoperative radiotherapy to the area of operation. At 6-months follow-up, the patient was capable of 90 degrees lateral shoulder abduction, and at 18 months, achieved full-range shoulder abduction and reported neither functional limitations of the shoulder nor complaints of any shoulder pain (Disabilities of Arm, Shoulder, and Hand score 0). Although further study is necessary to fully understand the superiority of VNGs over postoperative radiotherapy, immediate nerve reconstruction using VNG for accessory nerve defects in patients scheduled for radiotherapy postoperation may be extremely beneficial for preserving shoulder motor function and sustaining the patient's quality of life.
PubMed: 37621917
DOI: 10.1097/GOX.0000000000005174