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Oral Surgery, Oral Medicine, Oral... Sep 2019The aim of this systematic literature review was to focus on the use of diffusion-weighted magnetic resonance imaging (DWI) in the evaluation of salivary gland diseases.
OBJECTIVES
The aim of this systematic literature review was to focus on the use of diffusion-weighted magnetic resonance imaging (DWI) in the evaluation of salivary gland diseases.
STUDY DESIGN
Databases were searched, and original research manuscripts up to 2018 were identified by using the keywords "diffusion" combined with "salivary gland," "salivary gland neoplasm," "sialadenitis," "parotid gland," "submandibular gland," "sublingual gland," "minor salivary gland," "salivary gland fistula," "salivary gland calculi," "salivary ducts," "xerostomia," and "sialorrhea." Only English language manuscripts and studies pertaining to DWI were selected.
RESULTS
In all, 66 investigations regarding various salivary gland diseases, such as neoplasms, postirradiation changes, and inflammatory and autoimmune diseases, were included. Most study objectives involved the use of the apparent diffusion coefficient (ADC) in differentiating between benign lesions and malignant neoplasms. Histologic features of evaluated samples were heterogeneous.
CONCLUSIONS
DWI may improve the differential diagnosis of salivary gland diseases, particularly in distinguishing between benign and malignant neoplasms. A unique ADC cutoff value could not be established because of the heterogeneity of the methods applied for ADC assessment and the heterogeneity of the diseases. DWI and the ADC are valuable tools in the diagnosis of salivary gland disease.
Topics: Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Humans; Magnetic Resonance Imaging; Parotid Gland; Salivary Gland Diseases; Xerostomia
PubMed: 31029591
DOI: 10.1016/j.oooo.2019.02.020 -
Journal of Cranio-maxillo-facial... Jun 2019Parotidectomy is the most classic and unequivocal intervention for parotid neoplasm. The operative outcomes and postoperative complications of parotidectomy between... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Parotidectomy is the most classic and unequivocal intervention for parotid neoplasm. The operative outcomes and postoperative complications of parotidectomy between harmonic scalpel and electrocautery gained more prominence in physician. In spite of much research work within the past years, there was an obvious lack of randomized controlled trial to resolve this question. Hence, a quantitative and qualitative meta-analysis was essential to evaluate the differences in these two types of hemostasis method.
METHOD
The major electronic databases, including Pubmed, Embase, Cochrane library, Google Scholar, China National Knowledge Infrastructure and Chinese Scientific and Technological Journal databases were using the key words "electrocautery", "electrocoagulation", "harmonic scalpel", "ultrasonic scalpel", "ultrasonic dissector", "parotidectomy" and "parotid surgery". 9 articles were included in our systematic review and meta-analysis. The operative time, intraoperative blood loss, hospital stay, salivary fistula and transient facial nerve paralysis were the outcome measures. Odds ratios (ORs) with 95% confidence intervals (CIs) were employed to evaluate the effect size for categorical outcomes and mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes.
RESULTS
In our meta-analysis, there was a significant reduction in operation time [mean difference: -20.97; 95%CI=(-24.02,-17.92); P < 0.00001], intraoperative blood loss [mean difference: -20.75, 95%CI=(-22.32,-19.18); P < 0.00001], hospital stay [mean difference: -0.83; 95%CI=(-1.10,-0.57); P < 0.00001], salivary fistula [ORs: 0.30, 95%CI=(0.08,1.14)] and transient facial nerve paralysis [OR:0.33, 95%CI=(0.19,0.58),P = 0.0001] in harmonic scalpel group compared with electrocautery group.
CONCLUSION
This meta-analysis indicated that compared with electrocautery, harmonic scalpel (HS)was transcendent in the aspects of operative time, intraoperative blood loss, hospital stay, salivary fistula and transient facial nerve paralysis. The harmonic scalpel, as an efficient and useful instrument, was advocated in parotidectomy.
Topics: Blood Loss, Surgical; China; Electrocoagulation; Humans; Operative Time; Surgical Instruments
PubMed: 30954384
DOI: 10.1016/j.jcms.2019.01.008 -
International Journal of Oral and... Jul 2019The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial... (Meta-Analysis)
Meta-Analysis
The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial superficial parotidectomy (PSP). A comprehensive literature investigation was conducted by searching electronic databases. A systematic review and meta-analysis of comparative studies were performed to assess ECD and PSP for the treatment of BPTs with fixed-effects models. The outcomes analysed were transient or permanent facial nerve injury, Frey syndrome, recurrence rate, infection, and salivary fistula/sialocele. A total of 1641 patients from seven studies (1120 ECD-treated and 521 PSP-treated patients) were included in this meta-analysis. Transient facial nerve injury (odds ratio (OR)=0.28, 95% confidence interval (CI): 0.11-0.71; p=0.008) and Frey syndrome (OR=0.12, 95% CI: 0.03-0.48; p=0.003) were less prevalent in the ECD group. The rates of permanent facial nerve injury (OR=0.77, 95% CI: 0.35-1.70; p=0.520), recurrence rate (OR=0.17, 95% CI: 0.02-1.75; p=0.14), infection (OR=0.70, 95% CI: 0.07-6.67; p=0.76), and salivary fistula/sialocele (OR=0.40, 95% CI: 0.06-2.66; p=0.350) were similar in both groups. Although there was a trend that ECD showed a reduced risk for complications, the present results are not sufficient to conclude that ECD is more beneficial than PSP.
Topics: Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Sweating, Gustatory
PubMed: 30871850
DOI: 10.1016/j.ijom.2019.01.030 -
Otology & Neurotology : Official... Apr 2019To examine the etiology, clinical course, and management of recurrent peripheral facial nerve paralysis.
PURPOSE
To examine the etiology, clinical course, and management of recurrent peripheral facial nerve paralysis.
METHODS
Retrospective review at a single tertiary academic center and systematic review of the literature. Clinical presentation, laboratory and imaging findings, treatment and outcome for all cases of recurrent ipsilateral, recurrent contralateral, and bilateral simultaneous cases of facial paralysis are reviewed.
RESULTS
Between 2000 and 2017, 53 patients [41.5% men, 29 median age of onset (range 2.5 wk-75 yr)] were evaluated for recurrent facial nerve paralysis at the authors' institution. Twenty-two (41.5%) cases presented with ipsilateral recurrences only, while the remaining 31 patients (58.5%) had at least 1 episode of contralateral recurrent paralysis. No cases of bilateral simultaneous facial nerve paralysis were observed. The median number of paretic events for all patients was 3 (range 2-20). The median nadir House-Brackmann score was 4, with a median recovery to House-Brackmann grade 1.5 over a mean recovery time of 61.8 days (range 1-420 d). Diagnostic evaluation confirmed Melkersson-Rosenthal syndrome in four (7.5%) cases, neurosarcoidosis in two (3.7%), traumatic neuroma in one (1.9%), Ramsay Hunt syndrome in one (1.9%), granulomatosis with polyangiitis in one (1.9%), and neoplastic causes in three (5.7%) cases [facial nerve schwannoma (n = 2; 3.7%), metastatic squamous cell carcinoma to the deep lobe of the parotid gland (n = 1; 1.9%)]; ultimately, 77.4% (41) of cases were deemed idiopathic. Facial nerve decompression via a middle cranial fossa approach was performed in three (5.7%) cases without subsequent episodes of paralysis.
CONCLUSION
Recurrent facial nerve paralysis is uncommon and few studies have evaluated this unique population. Recurrent ipsilateral and contralateral episodes are most commonly attributed to idiopathic facial nerve paralysis (i.e., Bell's palsy); however, a subset harbor neoplastic causes or local manifestations of underlying systemic disease. A comprehensive diagnostic evaluation is warranted in patients presenting with recurrent facial nerve paralysis and therapeutic considerations including facial nerve decompression can be considered in select cases.
Topics: Cranial Fossa, Middle; Decompression, Surgical; Facial Nerve; Facial Nerve Diseases; Facial Paralysis; Herpes Zoster Oticus; Humans; Melkersson-Rosenthal Syndrome; Myoclonic Cerebellar Dyssynergia; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 30870370
DOI: 10.1097/MAO.0000000000002167 -
Pathology Oncology Research : POR Apr 2019Whole saliva is mainly composed of fluid produced by major and minor salivary glands. Major salivary glands including parotid, submandibular, and sublingual glands, are... (Meta-Analysis)
Meta-Analysis
Whole saliva is mainly composed of fluid produced by major and minor salivary glands. Major salivary glands including parotid, submandibular, and sublingual glands, are known to secrete fluid transported from serum as well as surrounding glandular tissues [1]. Beside the secretions from salivary glands, oral mucosa, periodontium, as well as oral microflora also contribute to the final content of whole saliva [1]. Whole saliva therefore represents a complex balance among local and systemic sources [2]. This allows for the application of saliva in the diagnosis not only for salivary gland disorders but also for oral diseases and systemic conditions [2]. The role of saliva as a diagnostic tool in detecting Oral Squamous Cell Carcinoma. Articles published in PUBMED, EMBASE, COCHRANE, GOOGLE, manual search and back references of the articles for last 5 years extracted 77 articles. Studies which considered saliva as a diagnostic tool were included. Statistical analysis with Receivers Operating Curve to establish sensitivity and specificity of the salivary biomarkers as a diagnostic tool to detect Oral Squamous Cell Carcinoma were included for meta analysis. The measure of effect with 95% confidence interval were meta analysed for 9 articles in which 308 healthy individuals compared with 340 patients with Oral Squamous Cell Carcinoma. Highly sensitive salivary biomarkers for detecting Oral Squamous Cell Carcinoma were MMP-9, Chemerin, Choline + Betaine + Pipecolinic Acid + I - Carnitine(confidence interval ranges from 0.83-1.0). The narrow confidence interval of 0.95 + (0.88-1.00) was seen for MMP-9 followed by 1.00 + (0.78-1.00) for chemerin. Highly specific biomarkers for Oral Squamous Cell Carcinoma were MMP-9 (specificity -100%,), Chemerin(specificity-100%), over expressed mi RNA 136 with specificity of 0.88(0.69-0.97), under expressed mi RNA 27B with specificity of 1.0(0.66-1.00). Saliva can be used as a diagnostic tool with highly sensitive and specific markers namely MMP-9, Chemerin for early detection of Oral Squamous Cell Carcinoma.
Topics: Biomarkers, Tumor; Chemokines; Early Detection of Cancer; Humans; Intercellular Signaling Peptides and Proteins; Matrix Metalloproteinase 9; Mouth Neoplasms; Saliva; Sensitivity and Specificity; Squamous Cell Carcinoma of Head and Neck
PubMed: 30712193
DOI: 10.1007/s12253-019-00588-2 -
Head & Neck Apr 2019Current management of metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid is surgical excision and postoperative radiotherapy. In the node-negative neck,... (Meta-Analysis)
Meta-Analysis
Current management of metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid is surgical excision and postoperative radiotherapy. In the node-negative neck, there is debate about the role of elective neck dissection (END), irradiation or observation. This systematic review assesses the prevalence of occult cervical disease and the evidence for END. A literature search was performed using Medline and Embase. All papers describing management of the neck in metastatic CSCC to the parotid were assessed for inclusion. Eighty-nine papers were identified and 17 met inclusion criteria. A total of 874 ENDs were performed in 874 patients with metastatic CSCC to the parotid with no clinically evident cervical disease. The overall prevalence of occult disease in a random effects model was 22.5% (95% confidence intervals 18.9-26.0). The prevalence of occult cervical disease in metastatic CSCC to the parotid is high. END is recommended in this patient group.
Topics: Carcinoma, Squamous Cell; Disease-Free Survival; Elective Surgical Procedures; Female; Humans; Male; Neck Dissection; Neoplasm Invasiveness; Neoplasm Staging; Parotid Neoplasms; Prognosis; Skin Neoplasms; Survival Rate
PubMed: 30536662
DOI: 10.1002/hed.25561 -
European Archives of... Feb 2019Recurrent pleomorphic adenoma poses a significant treatment challenge, considering its propensity for further recurrence and potential for malignant transformation. The...
PURPOSE
Recurrent pleomorphic adenoma poses a significant treatment challenge, considering its propensity for further recurrence and potential for malignant transformation. The role of adjuvant radiotherapy in its management is widely debated. The aim of this study was to determine whether adjuvant radiotherapy is more effective than surgical resection alone in patients with recurrent pleomorphic adenoma of the parotid gland, in terms of further recurrence, malignant transformation and treatment-related complications.
METHODS
Using PRISMA guidelines, a systematic review comparing adjuvant radiotherapy with surgery alone in the treatment of recurrent pleomorphic adenoma was conducted. Pubmed, OVID, EBSCO, Embase, The Cochrane Library, SCOPUS and OpenGrey databases from 1988 to 2018 were searched. Quality analysis was carried out using the Newcastle-Ottawa Scale and narrative synthesis used to summarise results.
RESULTS
Of 891 records screened, eight studies were included, assessing 366 participants. Two noted a benefit of adjuvant radiotherapy in reducing further recurrence. The remainder did not show significant benefit, although four showed a trend towards lower rates. Only one case of malignant transformation was identified in a patient not irradiated. Similar rates of facial nerve dysfunction were identified between groups.
CONCLUSION
The available evidence suggests that adjuvant radiotherapy reduces recurrence rates in patients with recurrent pleomorphic adenoma and certain adverse prognostic factors. While it appears not to have significant adverse effects, given the lack of prospective evidence, we recommend careful use in patients at high risk of further recurrence and further research in the form of well-designed randomised controlled trials.
Topics: Adenoma, Pleomorphic; Cell Transformation, Neoplastic; Humans; Neoplasm Recurrence, Local; Parotid Neoplasms; Radiotherapy, Adjuvant
PubMed: 30426229
DOI: 10.1007/s00405-018-5205-z -
Pediatric Blood & Cancer Mar 2019A systematic search of PubMed, EMBASE, and the Cochrane Library for studies from 2000 to 2017 including children aged 0-19 with salivary gland cancer was performed. In... (Meta-Analysis)
Meta-Analysis
A systematic search of PubMed, EMBASE, and the Cochrane Library for studies from 2000 to 2017 including children aged 0-19 with salivary gland cancer was performed. In 19 studies, 749 children (median age of 14.2 years, female to male ratio of 1.4:1) were included; 72% had parotid tumors and 95% underwent surgery, of whom 65% had surgery alone and 24% with adjuvant radiotherapy. Low-grade and stage mucoepidermoid carcinoma were the most frequent cancer. The 5-year overall- and disease-free survival was 94% and 83%. Recurrence was observed in 20% at a median of 1.1 years from diagnosis.
Topics: Combined Modality Therapy; Humans; Prognosis; Salivary Gland Neoplasms; Survival Rate
PubMed: 30378272
DOI: 10.1002/pbc.27543 -
Clinical Imaging 2018To assess the added benefit of combining different MRI techniques for preoperative diagnosis of parotid tumors when compared to conventional MRI and advanced MRI... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the added benefit of combining different MRI techniques for preoperative diagnosis of parotid tumors when compared to conventional MRI and advanced MRI techniques alone with meta-analysis.
METHODS
A comprehensive PubMed electronic database search was performed for original diagnostic studies up to July 2017. The methodologic quality of each study was evaluated by two independent reviewers who used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Statistical analysis included pooling of sensitivity and specificity with 95% confidence intervals (CI). All analyses were conducted using STATA (version 12.0), RevMan (version 5.2), and Meta-Disc 1.4 software programs.
RESULTS
Pooled sensitivity and specificity of conventional MRI, diffusion weighted imaging (DWI), dynamic contrast enhanced (DCE) and the above combination were 76% (95%CI)/91% (95%CI)/80% (95%CI)/86% (95%CI) and 83% (95%CI)/56% (95%CI)/90% (95%CI)/90% (95%CI).
CONCLUSION
Conventional MRI combined with DWI and DCE showed higher diagnostic accuracy than conventional or advanced MRI alone, supporting their use in parotid tumors diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Contrast Media; Databases, Factual; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Parotid Neoplasms; Sensitivity and Specificity; Software; Young Adult
PubMed: 29908348
DOI: 10.1016/j.clinimag.2018.05.026 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jun 2017The aim of this study is to systematically assess the clinical outcomes of extracapsular dissection (ECD) and superficial parotidectomy (SP), and to provide evidences... (Meta-Analysis)
Meta-Analysis
The aim of this study is to systematically assess the clinical outcomes of extracapsular dissection (ECD) and superficial parotidectomy (SP), and to provide evidences for the clinical decision for treatment of parotid gland benign tumors. Relevant studies that compared the outcomes of extracapsular dissection and superficial parotidectomy for the parotid benign tumors were searched in Pubmed, CNKI and Wangfang data databases, and Meta-analysis was performed using software RevMan 5.0. Fifteen studies were selected for the Meta-analysis. A total of 2 929 participants were included in those studies, of which 1 796 underwent ECD and 1 133 underwent SP. The recurrence rates for ECD and SP were 1.29% (23 of 1 776 cases) and 1.48% (16 of 1 081 cases), respectively. There were no statistically significant in recurrence rate between ECD and SP. The rates of transient facial nerve paresis for ECD and SP were 5.48% (74 of 1 350) and 22.94% (139 of 606), that of permanent facial nerve paralysis were 0.66% (8 of 1 221) and 2.71% (15 of 554). The incidences of Frey's syndrome in ECD group and SP group were 1.91% (26 of 1 360) and 16.71% (111 of 664), that of fistula in were 0.53% (5 of 946) and 2.96% (10 of 338). ECD could reduce the risk for complications compared with SP. This systematic review with Meta-analysis suggests that ECD has a similar recurrence rate as SP with fewer postoperative complications. ECD may be considered as an alternative surgical modality for select benign parotid tumor.
Topics: Adenoma, Pleomorphic; Dissection; Evidence-Based Medicine; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 29775003
DOI: 10.13201/j.issn.1001-1781.2017.11.011