-
European Archives of... Apr 2021Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland surgery among Otolaryngologist-Head and Neck Surgeons continues to be a matter of debate.
MATERIALS AND METHODS
A systematic review and meta-analysis of the literature was conducted including articles from 1970 to 2019 to try to determine the effectiveness of intraoperative facial nerve monitoring in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without intraoperative facial nerve monitoring.
RESULTS
Ten articles met inclusion criteria, with a total of 1069 patients included in the final meta-analysis. The incidence of immediate and permanent postoperative weakness following parotidectomy was significantly lower in the IFNM group compared to the unmonitored group (23.4% vs. 38.4%; p = 0.001) and (5.7% vs. 13.6%; p = 0.001) when all studies were included. However, when we analyze just prospective data, we are not able to find any significant difference.
CONCLUSION
Our study suggests that IFNM may decrease the risk of immediate post-operative and permanent facial nerve weakness in primary parotid gland surgery. However, due to the low evidence level, additional prospective-randomized trials are needed to determine if these results can be translated into improved surgical safety and improved patient satisfaction.
Topics: Facial Nerve; Facial Nerve Injuries; Facial Paralysis; Humans; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Prospective Studies; Retrospective Studies
PubMed: 32654023
DOI: 10.1007/s00405-020-06188-0 -
American Journal of Otolaryngology 2020To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms.
OBJECTIVE
To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms.
DATA SOURCES
MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials.
REVIEW METHODS
A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Studies were included if they reported surgical management and outcomes of patients with accessory parotid gland neoplasms.
RESULTS
After screening 3532 records, 15 studies were included with a total of 187 patients. Benign tumors consisted of 61.5% of cases. External open, transoral, and preauricular endoscopic approaches were used for 82.3%, 11.3%, and 6.5% of cases, respectively. Accessory lobe resection alone, concurrent with partial parotidectomy, and concurrent with total parotidectomy were used in 54.8%, 43.0%, and 2.2% of cases, respectively. Complication rates were similar between histology groups (7.8% benign vs. 8.3% malignant, p = 0.82). Accessory lobe resection with concurrent partial parotidectomy had the lowest overall complication rate (6.3%). Resections limited to the accessory lobe were found to have an overall complication rate of 8.7%.
CONCLUSION
The results offer an overview of the surgical management and complications for accessory parotid gland tumors. Overall surgical complication rates found in these case series may be lower for management of accessory gland tumors than rates available in the literature for tumors within the main parotid gland.
Topics: Adult; Aged; Aged, 80 and over; Endoscopy; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Treatment Outcome; Young Adult
PubMed: 32580067
DOI: 10.1016/j.amjoto.2020.102610 -
Oral Surgery, Oral Medicine, Oral... Oct 2021The aim of this systematic review was to describe the epidemiology, diagnostic criteria, differential diagnosis, treatment, prognostic factors, and treatment outcomes of... (Review)
Review
OBJECTIVE
The aim of this systematic review was to describe the epidemiology, diagnostic criteria, differential diagnosis, treatment, prognostic factors, and treatment outcomes of secretory carcinoma.
STUDY DESIGN
A comprehensive search of Lilacs, PubMed, Science Direct, and Web of Science databases was conducted to identify all case reports, letter to the editor, and histopathologic reclassifications regarding salivary gland secretory carcinoma published in English, Spanish, French, and Portuguese.
RESULTS
The final analysis included 119 studies, which totaled 642 secretory carcinoma diagnoses, with 239 case reports and 403 diagnostic reclassifications, mostly in the United States. The age range was 5 to 87 years, and cases were predominantly in males (58.7%) and mostly affecting the parotid glands (73.7%). The disease usually presents as a slow-growing, painless mass. The main differential diagnosis is acinic cell carcinoma, and the tumor is usually treated with surgery. The prognosis is considered favorable, although there have been reports of local recurrences, distant metastases, and deaths.
CONCLUSIONS
It is important that clinicians become aware of this salivary gland neoplasm and report clinical data, clinical course, management and long-term follow-up. There is an urgent need to conduct more clinical trials, especially on tropomyosin receptor kinase (TRK) inhibitors and other potential target therapy modalities.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma, Acinar Cell; Child; Child, Preschool; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Salivary Gland Neoplasms; Salivary Glands; Young Adult
PubMed: 32493686
DOI: 10.1016/j.oooo.2020.04.007 -
Journal of Cranio-maxillo-facial... Jun 2020Salivary gland tumors are predominantly benign and frequently localized in the parotid gland (P). The treatment consists primarily of surgical removal; however, the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Salivary gland tumors are predominantly benign and frequently localized in the parotid gland (P). The treatment consists primarily of surgical removal; however, the appropriate extent remains a subject of debate. In suitable tumors, superficial parotidectomy (SP) may be substituted for less invasive partial superficial parotidectomy (PSP) (I C). This systematic review analyzed the available literature, comparing PSP and SP with regards to several postoperative outcome parameters (O).
MATERIALS AND METHODS
Established medical databanks were screened for articles evaluating outcomes of PSP compared with SP, published between 1955 and 2019. These data were assessed by pooled risk and odds ratios via meta-analysis.
RESULTS
11 studies with 1272 patients were included. There was no significant difference in tumor recurrence between PSP and SP (primary outcome). Furthermore, no differences in the occurrence of permanent facial nerve paralysis (FNP), salivary fistula, great auricular nerve analgesia, or hematoma were observed between the groups. However, PSP displayed significantly reduced rates of transient FNP, Frey's syndrome, scar deformity, and xerostomia, as well as shorter surgical time, compared with SP (secondary outcomes).
CONCLUSION
Based on these data, PSP can be recommended as a surgical technique for the treatment of superficially located, small, benign parotid tumors.
Topics: Humans; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Sweating, Gustatory
PubMed: 32362539
DOI: 10.1016/j.jcms.2020.04.002 -
Otolaryngology--head and Neck Surgery :... Aug 2020To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address...
OBJECTIVE
To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management.
DATA SOURCES
PubMed-National Center for Biotechnology Information and Scopus databases.
REVIEW METHODS
A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment.
RESULTS
Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status.
CONCLUSION
The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.
Topics: Cranial Nerve Neoplasms; Facial Nerve; Humans; Neurilemmoma; Treatment Outcome
PubMed: 32228141
DOI: 10.1177/0194599820913639 -
American Journal of Clinical Pathology May 2020Sjögren syndrome (SS) is considered as a major etiologic factor for primary salivary gland lymphoma (SGL). However, the percentage of SGL that is caused by SS (and thus... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Sjögren syndrome (SS) is considered as a major etiologic factor for primary salivary gland lymphoma (SGL). However, the percentage of SGL that is caused by SS (and thus the real impact of SS on SGL epidemiology) is unclear. We aimed to assess the prevalence of SS in patients with SGL through a systematic review and meta-analysis.
METHODS
Electronic databases were searched for studies assessing the presence of SS in patients with SGL. Pooled prevalence of SS in SGL was calculated, with a subgroup analysis based on histotype (mucosa-associated lymphoid tissue [MALT] vs non-MALT).
RESULTS
Sixteen studies with 665 SGLs were included. Pooled prevalence of SS in SGL was 18.2%, with high heterogeneity among studies. In MALT SGL, the prevalence of SS was 29.5%, with moderate heterogeneity. In non-MALT SGL, the prevalence of SS was 0%, with null heterogeneity.
CONCLUSIONS
SS seems to be responsible for a significant but minor portion of SGLs. SS appears involved in MALT-type SGL but not in other histotypes.
Topics: Humans; Lymphoma; Salivary Gland Neoplasms; Salivary Glands; Sjogren's Syndrome
PubMed: 32076706
DOI: 10.1093/ajcp/aqaa005 -
APMIS : Acta Pathologica,... Mar 2020Intraductal carcinomas (IDCs) are rare, not well-characterized salivary gland tumors. A systematic literature review of pure IDCs (without stromal invasion) of low-grade...
Intraductal carcinomas (IDCs) are rare, not well-characterized salivary gland tumors. A systematic literature review of pure IDCs (without stromal invasion) of low-grade (LG-IDCs) or high-grade (HG-IDCs) was performed: IDCs were classified using the apocrine (AR+/S100-) vs intercalated (S100+/AR-) classification. Eighty-two LG-IDCs and 11 HG-IDCs were identified (84% parotid; 11% oral; 3% submandibular; 1% lacrimal; and 1% unknown). Out of 11 HG-IDCs, 2 HG-IDCs (18%) recurred as HG-IDC or invasive carcinoma. IDCs were classified as follows: intercalated (30%); mixed apocrine and intercalated (27%); apocrine (11%); oncocytic (6%); intercalated with focal oncocytic features (1%); and unclassifiable (25%). Double AR/S100 expressors (4%) or discrepancies between morphology and immunophenotype (9%) were found. Apocrine features and necrosis were more frequent in HG-IDCs (55%; 45%). Pleomorphism favored HG-IDCs (especially when combined with >10 mitoses/10 HPFs and/or Ki67 index >10%), being associated with apocrine areas at least in 3 HG-IDCs (27%). IDCs were typically mammaglobin+/ER-/PR-/DOG1-. No immunomarker clearly distinguished HG-IDCs from LG-IDCs. About 57% IDCs (16 LG-IDCs, 1 HG-IDC) showed RET rearrangements, including NCOA4-RET (eight intercalated and two unclassifiable IDCs) and TRIM27-RET fusions (two mixed IDCs). No ETV6, ALK-1, ROS, NTRK3, MAML2, MAML3, or PLAG1 rearrangements were identified. Complete excision and total sampling should exclude invasive areas.
Topics: Biomarkers, Tumor; Carcinoma, Intraductal, Noninfiltrating; Humans; Neoplasm Recurrence, Local; Salivary Gland Neoplasms; Salivary Glands
PubMed: 31697865
DOI: 10.1111/apm.13009 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Sep 2019The aim of this study is to systematically assess the postoperative outcomes of partial superficial parotidectomy(PSP) and superficial parotidectomy(SP) by... (Meta-Analysis)
Meta-Analysis
The aim of this study is to systematically assess the postoperative outcomes of partial superficial parotidectomy(PSP) and superficial parotidectomy(SP) by systematic literature review and Meta-analysis, and to provide a theoretical basis for the selection of the appropriate surgical approach in clinical process. Relevant studies that compared the outcomes of PSP and SP for the parotid benign tumors were searched in Pubmed, CNKI and Wanfangdata databases, and Meta-analysis was performed using software RevMan 5.0. 24 studies were selected for the Meta-analysis. A total of 2 795 participants were included in those studies, of whom 1 301 underwent PSP and 1 494 underwent SP. The recurrence rates for PSP and SP were 1.14%(10 of 874) and 0.6%(6 of 993), respectively. There were no statistically significant difference in recurrence rate between PSP and SP. The rates of transient facial nerve paresis for PSP and SP were 11.60%(122 of 1 052) and 27.37%(350 of 1 279), respectively. The rates of permanent facial nerve paralysis for PSP and SP were 1.04%(6 of 579) and 4.46%(31 of 695), respectively. The incidences of Frey's syndrome in PSP group and SP group were 9.20%(95 of 1 033) and 30.32%(409 of 1 349), respectively. The rate of salivary fistulafor PSP and SP were 5.38%(37 of 688) and 11.25%(65 of 578). PSP could reduce the risk for complications compared with SP. This systematic review with meta-analysis suggests that PSP has a similar recurrence rate as SP, but PSP can significantly reduce the postoperativecomplications.
Topics: Evidence-Based Medicine; Humans; Neoplasm Recurrence, Local; Otorhinolaryngologic Surgical Procedures; Parotid Gland; Parotid Neoplasms; Postoperative Complications
PubMed: 31446709
DOI: 10.13201/j.issn.1001-1781.2019.09.019 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Apr 2019Salivary adenoid cystic carcinoma (SACC) is a common malignant tumor in the oral and maxillofacial region and accounts for approximately 3%-5% of all head and neck...
Salivary adenoid cystic carcinoma (SACC) is a common malignant tumor in the oral and maxillofacial region and accounts for approximately 3%-5% of all head and neck carcinomas. SACC always occurs in the palatal salivary gland and parotid gland. The tumor has the characteristics of strong invasion, perineural invasion, high hematogenous metastasis, and low lymph node metastasis rate. The biological characteristics of SACC determine the specificity of clinical treatment. Thus far, few clinical trials have investigated the efficacy of systemic therapy owing to the rarity of SACC with lung metastasis. Moreover, long-term results are poor, and no consensus on standard treatment has been reached yet. This systematic review aims to provide a retrospective analysis of treatment options and prognosis for SACC with lung metastasis and evidence for future clinical treatment.
Topics: Carcinoma, Adenoid Cystic; Cell Line, Tumor; Humans; Neoplasm Invasiveness; Prognosis; Retrospective Studies; Salivary Gland Neoplasms
PubMed: 31168990
DOI: 10.7518/hxkq.2019.02.015 -
The Surgeon : Journal of the Royal... Feb 2020The true incidence of primary parotid squamous cell carcinoma (SCC) is unknown and likely overestimated in the literature. The aim of this systematic review is to...
INTRODUCTION
The true incidence of primary parotid squamous cell carcinoma (SCC) is unknown and likely overestimated in the literature. The aim of this systematic review is to examine the diagnosis, aetiology and incidence of parotid SCC by analysing studies evaluating primary parotid SCC.
METHODS
A systematic search of Medline, EMBASE and Cochrane library was performed. A narrative synthesis was done.
RESULTS
A total of 14 observational retrospective studies on primary parotid SCC were included. There are currently no standard criteria for ascertainment of primary parotid SCC. Primary parotid SCC is thought to be due to squamous metaplasia within the ductal epithelium and subsequent invasive squamous carcinoma. Histological features that favour primary disease includes SCC confined to parotid parenchyma with no direct communication to the skin and the absence of mucin. Incidence of primary parotid SCC varied from 1.54 to 2.8 cases per million person-years. Around 30%-86% of patients recorded to have primary parotid SCC on clinical records, when scrutinised, were in fact secondary to parotid lymph node involvement following regional advancement from skin or upper aerodigestive tract SCC.
CONCLUSION
Primary parotid SCC is rare and it is currently a diagnosis of exclusion. Thorough clinical assessment including endoscopy, preoperative imaging and the scrutiny of histopathological findings allow for differentiation between primary and secondary SCC within the parotid. This thus affects both initial treatment and subsequent follow-up.
Topics: Carcinoma, Squamous Cell; Global Health; Humans; Incidence; Lymph Nodes; Lymphatic Metastasis; Neoplasm Recurrence, Local; Parotid Neoplasms
PubMed: 31040083
DOI: 10.1016/j.surge.2019.03.006