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Fikova A, Novak S, Kalfert D, Kuchar M, Zabrodsky M, Dostalova L, Balko J, Plzak J. Utility of fine-needle aspiration biopsy (FNAB) in parotid pleomorphic adenoma diagnosis and management. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:156-161. [PMID: 37431621 DOI: 10.5507/bp.2023.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/13/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Pleomorphic adenoma (PA), the most common benign tumour of the parotid gland, requires accurate preoperative diagnosis owing to its capacity for malignant transformation. The aim of this study was to evaluate our experience with ultrasound-guided fine-needle aspiration biopsy (FNAB) in the diagnostic algorithm for patients with PA and to assess clinical outcomes for those with different surgical approaches. MATERIAL AND METHODS We carried out a retrospective analysis of patients treated for parotid gland mass between 2010 and 2016. These had had preoperative FNAB and had undergone subsequent surgery. RESULTS 165 patients had FNAB with the result of PA and the definitive histology confirmed PA in 159 cases (96.4%). On the other hand, in 179 patients, the definitive histology showed PA and the preoperative FNAB result corresponded in 159 cases (88.9%). The measured sensitivity, specificity and accuracy of ultrasound-guided FNAB in the diagnosis of PA were, respectively, 88.83%, 96.23% and 92.31%. Most of the patients underwent superficial or partial superficial parotidectomy, followed by extracapsular dissection which was associated with statistically lower risk of facial nerve injury (P=0.04). CONCLUSION Ultrasound-guided FNAB is simple, accurate and valuable in the diagnosis of PA and provides results that can lead to the choice of less invasive operative treatment.
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Affiliation(s)
- Alzbeta Fikova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Stepan Novak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Kuchar
- Department of Otorhinolaryngology and Head and Neck Surgery, Bulovka University Hospital, Prague, Czech Republic
| | - Michal Zabrodsky
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lucie Dostalova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jan Balko
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Lombardi D, Tomasoni M, Nicolai A, Paderno A, Grammatica A, Arcuri M, Lancini D, Battocchio S, Ardighieri L, Bozzola A, Pittiani F, Farina D, Redaelli de Zinis LO, Nicolai P, Piazza C. Parotid pleomorphic and non-pleomorphic adenomas: a mono-institutional series of 512 patients. Eur Arch Otorhinolaryngol 2021; 279:2543-2551. [PMID: 34355271 DOI: 10.1007/s00405-021-07018-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Pleomorphic adenoma (PA) is the most common benign parotid tumor, with a well-known propensity to recur. Many factors have been advocated as prognostic, but there is no consensus on how they affect local control. We studied how PA recurrence-free survival (RFS) may be affected by the most relevant risk factors in a time-to-event analysis, comparing them with those observed in a population of non-PA (NPA). METHODS Patients undergoing parotidectomy for benign lesions between 2002 and 2018 in a single academic tertiary referral center were included. A description of patients, tumors, and treatment characteristics was performed, highlighting differences between PA and NPA. Analysis of PA RFS and relative risk factors was also conducted. RESULTS Eight hundred fifty patients underwent parotidectomy for benign lesions, 455 (53.5%) for PA and 57 (6.7%) for NPA. Significant differences between PA and NPA were age at surgery, surgical procedure, and resection margins. Recurrence occurred in 3.1% of PA, with a median disease-free interval of 54 months. 2-, 5-, and 10-year RFS were 99.2, 98.5, and 93.9%, respectively. Age < 18 years (HR = 31.31, p < 0.001), intraoperative tumor spillage (HR = 6.57, p = 0.041), extensive pseudo-capsule interruption (HR = 5.85, p = 0.023), and resection margins < 1 mm (HR = 3.16, p = 0.085) were associated with RFS. CONCLUSION Patients affected by NPA were significantly older and treated with more conservative surgical procedures compared to those with PA. In PA, younger age, major pseudo-capsule defects, and surgical margins were the most relevant factors affecting local control. These results confirm the importance of an appropriate surgical management and long-term follow-up in PA.
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Affiliation(s)
- Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alessio Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Mara Arcuri
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | | | - Laura Ardighieri
- Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Anna Bozzola
- Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Frida Pittiani
- Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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3
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Mashrah MA, Al-Sharani HM, Al-Aroomi MA, Abdelrehem A, Aldhohrah T, Wang L. Surgical interventions for management of benign parotid tumors: A systematic review and network meta-analysis. Head Neck 2021; 43:3631-3645. [PMID: 34288212 DOI: 10.1002/hed.26813] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.
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Affiliation(s)
- Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Maxillofacial Surgery, Motherhood and Childhood Hospital, Ministry of Health, Ibb, Yemen
| | - Hesham Mohammed Al-Sharani
- Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin, China.,Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Maged Ali Al-Aroomi
- Department of Oromaxillofacial - Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Taghrid Aldhohrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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Facchini V, Colangeli W, Kapitonov A, Bozza F, Becelli R. Long-term follow-up after extracapsular dissection of parotid pleomorphic adenomas - A retrospective study. Ann Maxillofac Surg 2021; 11:287-292. [PMID: 35265500 PMCID: PMC8848710 DOI: 10.4103/ams.ams_362_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Parotid pleomorphic adenoma (PPA) is the most common benign salivary gland neoplasm. Extracapsular dissection (ED) arose as a conservative surgical technique alternative to superficial parotidectomy to reduce complications. Materials and Methods: Patients who underwent ED for superficial, <3 cm, mobile parotid lumps (Quer I) between 2004 and 2008 were retrospectively analysed focusing on those with histological diagnosis of pleomorphic adenoma. A retrospective cohort study on 50 patients who accepted to undergo ultrasonography and clinical evaluation for at least 10 years since surgery was performed. Clinical data, surgical reports, and validated questionnaires for the assessment of complications, quality of life (QoL) and aesthetic satisfaction were analysed. Recurrence rate and complications after ED, with their QoL and aesthetic impact, were evaluated. Statistical analysis was performed setting α=0.05 as the level of significance. Results: Low occurrence of complications related to ED was seen. Overall QoL after ED was very good (range 1–7, mean 6,86), due to low complications incidence of complications and their low severity, as assessed by patients through Parotidectomy Outcome Inventory-8 questionnaire. Overall aesthetic satisfaction was high (range 1–10, mean 9,78). Aesthetic satisfaction and QoL was statistically related to onset of complications (P = 0.02504 and P = 0.001859). Tumour localization and dimension was not statistically related to onset of complications (P = 0.8207 and 0.7586). After a mean follow-up of 12.5 years, no recurrences were detected. Discussion: There is a lack of studies with a long-term follow-up after ED for the evaluation of recurrences and complications. Considering our results, the ED technique should be adopted as the first surgical approach for Quer I PPA without suspicion of malignancy.
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Schapher M, Koch M, Goncalves M, Mantsopoulos K, Iro H. Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow-up. Laryngoscope 2020; 131:E445-E451. [PMID: 32396221 DOI: 10.1002/lary.28696] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/17/2020] [Accepted: 04/01/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess long-term results after the treatment of parotid pleomorphic adenomas (PPAs) using different surgical techniques and focusing on recurrence rates and the risk of adverse effects. STUDY DESIGN Retrospective analysis. METHODS Retrospective analysis of 182 patients treated exclusively for PPAs at a tertiary referral center between 2000 and 2004. Thorough follow-up examinations over a mean period of 13 years were possible in 53.8% (n = 98/182). Tumors were categorized according to the European Salivary Gland Society (ESGS) system to improve the comparison of outcomes. After different surgical resection strategies, recurrence rates, postoperative facial nerve paresis (FNP), and incidence of Frey's syndrome were assessed. The follow-up period included clinical examinations and imaging of every patient in the treating department. RESULTS Of 182 patients, extracapsular dissection (ED) was performed in 29.7%, and other surgical modalities (OSMs), including facial nerve dissection, in 70.3%. After the long-term follow-up, 98% of all the patients (n = 96/98) were recurrence free. When recurrence rates were compared, no significant differences were noted (P < .331). ED resulted in significantly lower FNP rates compared to OSMs (P < .001). FNP rates significantly increased with size and location of the tumors according to ESGS categories (temporary and permanent FNP, P = .04). Surgical invasiveness corresponded to a significant increase in the incidence of Frey's syndrome (P < .001). CONCLUSIONS ED was associated with the lowest complication rates, but not with a higher risk of recurrence, when compared with OSM in the long-term course. As ED can be performed in the majority of PPAs, it can be regarded as the treatment of choice whenever possible. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E445-E451, 2021.
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Affiliation(s)
- Mirco Schapher
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
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7
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Siddiqui AH, Shakil S, Rahim DU, Shaikh IA. Post parotidectomy facial nerve palsy: A retrospective analysis. Pak J Med Sci 2020; 36:126-130. [PMID: 32063945 PMCID: PMC6994896 DOI: 10.12669/pjms.36.2.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background &Objectives: Transient paralysis of facial nerve is seen to vary from 15 % to 66 % in post-parotid surgery. The objective of this study was to find out the complications in post-parotidectomy with regards to facial nerve dysfunction since it is a vital structure encountered in parotid surgeries. Methods: This was a retrospective study through non probability convenient sampling technique carried from September 2010 to January 2019 in the Department of Otorhinolaryngology, Dow University of Health Sciences, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. Clinical data were recorded from 75 patients and out of them 70 patients had undergone surgery with parotid gland tumours and were reported on the morphology, age, sex, surgical procedure and complications, particularly facial nerve dysfunctions. In most cases ante-grade technique was performed to identify the facial nerve, whereas retrograde technique was used in recurring tumours, and in difficult cases. The stimulator of the nerve has not been used. The nature or severity of Facial nerve dysfunction was assessed in terms of either it is, permanent or temporary, total or incomplete in respect to its branches. Results: Among total 75 patients; the mean age was 38.75 ± 9.26 years with male to female ratio of 1:1. Majority of the patients were diagnosed as pleomorphic adenoma, i.e. 78.6% after which 12% were diagnosed as mucoepidermoid carcinoma. 88.6% of patients had superficial parotidectomy and 11.4% of patients had total parotidectomy. About 75% of patients had no complications. 5(7.1%) patients had complete facial nerve palsy. Damage to the mandibular, buccal and temporozygomatic branch was observed in 10(14%), 2(3%) and 1(1.4%) patients respectively. Conclusion: The most prevalent benign parotid tumour in this study was pleomorphic adenoma. After performing parotid surgery, it was predicted that the rate of complications related to the facial nerve injury was reduced as compared to the previous studies.
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Affiliation(s)
- Atif Hafeez Siddiqui
- Dr. Atif Hafeez Siddiqui, FCPS, Associate Professor of ENT. Department of ENT Head & Neck Surgery, Dow University of Health Sciences & Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Saad Shakil
- Dr. Saad Shakil, Resident PGY-4 ENT. Department of ENT Head & Neck Surgery, Dow University of Health Sciences & Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Danish Ur Rahim
- Dr. Danish ur Rahim, FCPS, Assistant Professor ENT. Department of ENT Head & Neck Surgery, Dow University of Health Sciences & Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Irfan Ahmed Shaikh
- Dr. Irfan Ahmed Shaikh, FCPS, Assistant Professor ENT. Department of ENT Head & Neck Surgery, Dow University of Health Sciences & Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
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8
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Famurewa B, Bello S, Omoregie O. Parotid gland neoplasms presenting as discrete infra-auricular swellings. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_59_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cheng PC, Lo WC, Chang CM, Huang TW, Cheng PW, Liao LJ. The outcome and decision-making of extracapsular dissection for benign superficial lobe parotid tumours: Our experience in 144 patients. Clin Otolaryngol 2019; 45:151-155. [PMID: 31755650 DOI: 10.1111/coa.13480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/24/2019] [Accepted: 11/17/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.).,Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Tsung-Wei Huang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.).,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan (R.O.C.)
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.).,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan (R.O.C.).,Medical Engineering Office, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
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10
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Martin H, Jayasinghe J, Lowe T. Superficial parotidectomy versus extracapsular dissection: literature review and search for a gold standard technique. Int J Oral Maxillofac Surg 2019; 49:192-199. [PMID: 31301925 DOI: 10.1016/j.ijom.2019.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/24/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Abstract
Benign parotid tumours usually present as a slow-growing, asymptomatic mass in the pre-auricular region. Although they are uncommon, surgical excision is the mainstay of treatment due to the risk of malignant transformation in some benign tumours. Surgical techniques have evolved over the years, with superficial parotidectomy and extracapsular dissection being the current procedures of choice. There is currently no gold standard, and it remains unclear which surgical modality is the superior option. A literature review was performed in relation to the relative merits of each technique and to evaluate the reasons underpinning the ongoing debate. A total of 16 papers comparing the main clinical outcomes of the procedures were critically reviewed using the PRISMA protocol. Overall, extracapsular dissection indicated a reduced recurrence rate, facial nerve paralysis, Frey syndrome, and operation time. The superior outcomes following extracapsular dissection could be attributed to the less radical nature of the procedure. However, there were various limitations identified within the review that may have affected the results. Selection bias was the most significant, with patients assigned to the different procedures depending on the tumour size and location. Consequently, the debate continues as to what constitutes the gold standard of care for benign parotid tumours.
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Affiliation(s)
- H Martin
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - J Jayasinghe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - T Lowe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
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11
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Lin YQ, Wang Y, Ou YM, Dong SY, Wang YD. Extracapsular dissection versus partial superficial parotidectomy for the treatment of benign parotid tumours. Int J Oral Maxillofac Surg 2019; 48:895-901. [PMID: 30871850 DOI: 10.1016/j.ijom.2019.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/26/2018] [Accepted: 01/28/2019] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Y Q Lin
- Department of Maxillofacial Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Y Wang
- The Central Laboratory of The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Y M Ou
- Department of General Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - S Y Dong
- Department of Stomatology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Y D Wang
- Department of Stomatology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
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12
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Does increasing the incidence of extracapsular dissection for benign tumors of the parotid correlate with an increased need for revision surgery? Oral Oncol 2019; 94:111-114. [DOI: 10.1016/j.oraloncology.2019.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 12/27/2022]
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Schapher M, Koch M, Agaimy A, Goncalves M, Mantsopoulos K, Iro H. Parotid pleomorphic adenomas: Factors influencing surgical techniques, morbidity, and long-term outcome relative to the new ESGS classification in a retrospective study. J Craniomaxillofac Surg 2019; 47:1356-1362. [PMID: 31331850 DOI: 10.1016/j.jcms.2019.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/11/2019] [Accepted: 06/19/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess long-term results after treatment of parotid pleomorphic adenomas (PPAs) with different surgical techniques, standardized according to the European Salivary Gland Society (ESGS) classification system. METHODS We analyzed ESGS categories, occurrence of facial nerve paresis (FNP), Frey's syndrome, histopathology, and recurrences. Surgical modalities were compared, differentiating techniques with and without facial nerve dissection. A strict protocol ensured a postoperative follow-up-period of more than 7 years. RESULTS 205 patients were included. A complete follow-up was possible in 138 patients, 77 of whom underwent extracapsular dissection (ED) and 61 of whom had other surgical modalities (OSMs). ESGS categories correlated with the extent of surgery, significantly with the risk for FNP and Frey's syndrome, but not with recurrences. Recurrences did not differ significantly between ED and OSMs, whereas the risks for FNP (p < 0.001 each) and Frey's syndrome (p = 0.000) were significantly higher after OSMs in comparison with ED. Young women with a stroma-rich (myxoid) tumor subtype appear to have the greatest risk for recurrences. CONCLUSION ED is the treatment of choice for PPAs, if possible, resulting in similar recurrence rates but significantly fewer comorbidities in comparison with more extensive surgery. After the treatment of PPAs, a long-term follow-up is needed, including imaging.
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Affiliation(s)
- Mirco Schapher
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
| | - Abbas Agaimy
- Department of Pathology, University of Erlangen-Nuremberg, Krankenhausstrasse 8-10, 91054, Erlangen, Germany.
| | - Miguel Goncalves
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
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Psychogios G, Rueger H, Jering M, Tsoures E, Künzel J, Zenk J. Ultrasound can help to indirectly predict contact of parotid tumors to the facial nerve, correct intraglandular localization, and appropriate surgical technique. Head Neck 2019; 41:3211-3218. [DOI: 10.1002/hed.25811] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/06/2019] [Accepted: 05/13/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Augsburg Augsburg Germany
| | - Holger Rueger
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Augsburg Augsburg Germany
| | - Monika Jering
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Augsburg Augsburg Germany
| | - Eleni Tsoures
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Augsburg Augsburg Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Mainz Mainz Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Augsburg Augsburg Germany
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Horisk N, Stephenson E, Sayers C, Reid J. Incidental finding of synchronous pleomorphic salivary adenoma and Warthin's tumour within a parotid gland. BMJ Case Rep 2019; 12:12/4/e228675. [PMID: 31023736 DOI: 10.1136/bcr-2018-228675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The presence of two histologically distinct lesions within the same salivary gland is rare. The majority of lesions detected in salivary glands are benign and unifocal. Ultrasound scans and MRI imaging may not detect separate lesions that are in close proximity and this presents a challenge for radiologists and surgeons in the diagnosis of salivary gland lesions. We present a case when incidentally two distinct lesions were discovered during extracapsular dissection of a suspected pleomorphic salivary adenoma. We aim to highlight the difficulty in diagnosing these rare entities using existing investigative techniques.
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Affiliation(s)
- Neil Horisk
- Oral and Maxillofacial Surgery, The Mid Yorkshire Hospitals NHS Trust, Wakefield, Yorkshire, UK
| | - Eleanor Stephenson
- Oral and Maxillofacial Surgery, The Mid Yorkshire Hospitals NHS Trust, Wakefield, Yorkshire, UK
| | - Craig Sayers
- Histopathology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, Yorkshire, UK
| | - Jonathon Reid
- Oral and Maxillofacial Surgery, The Mid Yorkshire Hospitals NHS Trust, Wakefield, Yorkshire, UK
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Abstract
Imaging studies are essential components of tumor diagnosis, staging, assessing tumor response to neoadjuvant and adjuvant therapies, and postoperative surveillance on completion of definitive treatment. Treatment of early stage clinically node negative oral cavity squamous cell carcinoma is controversial. Approximately 3% of all head and neck tumors arise within the parotid gland and most often within the superficial lobe, lateral to the facial nerve; about 80% are benign and most are pleomorphic adenoma. In patients with dry eyes failing multiple other treatment modalities and facing ongoing pain and loss of vision, microvascular transplant of the submandibular gland is a viable option.
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Affiliation(s)
- Kyle S Ettinger
- Department of Surgery, Division of Oral & Maxillofacial Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jacob G Yetzer
- Private Practice, Head and Neck Surgery, Nebraska Oral and Facial Surgery, 2600 S. 56th Street, Suite A, Lincoln, NE 68506, USA; Assistant Professor, Department of Surgery, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
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Kato MG, Erkul E, Nguyen SA, Day TA, Hornig JD, Lentsch EJ, Gillespie MB. Extracapsular Dissection vs Superficial Parotidectomy of Benign Parotid Lesions: Surgical Outcomes and Cost-effectiveness Analysis. JAMA Otolaryngol Head Neck Surg 2017; 143:1092-1097. [PMID: 28975191 DOI: 10.1001/jamaoto.2017.1618] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The clinical implications of extracapsular dissection over superficial parotidectomy are controversial and limited in data on cost-effectiveness. Objective To compare extracapsular dissection with superficial parotidectomy for benign parotid tumors with respect to surgical outcomes and cost-effectiveness. Design, Setting, and Participants This was a retrospective medical record review and cost-effectiveness analysis performed from August 2012 to November 2015 at a tertiary care institution. Adult patients (age ≥18 years) who underwent parotidectomy for benign parotid lesions were included. Exposures Treatment by extracapsular dissection or superficial parotidectomy. Main Outcomes and Measures Differences in postoperative complication rates and health services outcomes, including procedure time, anesthesia time, length of stay, and charges for surgeon, anesthesia, operating room, and hospital. Results A total of 46 parotidectomies consisting of 26 extracapsular dissections and 20 superficial parotidectomies met criteria. Of the 46 patients, 33 were women. Patient ages ranged from 18 to 83 years. Lesion features were similar between groups with most being pleomorphic adenoma. Procedure time (effect size, -1.31; 95% CI, -1.93 to -0.65), anesthesia time (effect size, -1.37; 95% CI, -1.99 to -0.70), and length of stay (effect size, -0.66; 95% CI, -1.25 to -0.05) were significantly shorter for extracapsular dissection compared with superficial parotidectomy. Moreover, anesthesia (effect size, -1.55; 95% CI, -2.19 to -0.86), operating room (effect size, -1.09; 95% CI, -1.69 to -0.45), and total hospital charges (effect size, -1.13; 95% CI, -1.74 to -0.49) were significantly less for extracapsular dissection while remaining charges, including surgeon, showed no difference. Finally, facial nerve weakness, great auricular nerve dysesthesia, and other relevant postoperative complications were comparable between groups. Conclusions and Relevance In the hands of an experienced surgeon, extracapsular dissection is a shorter, less costly, and equally safe alternative to traditional superficial parotidectomy when treating benign parotid lesions. Further follow-up is needed to ensure these perceived advantages are maintained over time.
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Affiliation(s)
- Masanari G Kato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Stony Brook University School of Medicine, Stony Brook, New York
| | - Evren Erkul
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Joshua D Hornig
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis
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Mantsopoulos K, Iro H. Letter to the Editor-1 regarding "Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience". Head Neck 2017; 40:215-216. [PMID: 29140574 DOI: 10.1002/hed.25011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/29/2017] [Indexed: 11/08/2022] Open
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Quiriny M, Dekeyser C, Moreau M, Digonnet A, Willemse E, Vanbel L, Andry G. Benign tumors of the parotid gland: a retrospective study of 339 patients. Acta Chir Belg 2017. [PMID: 28636472 DOI: 10.1080/00015458.2017.1287394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM Among 339 patients operated for benign tumor of the parotid gland: the recurrences and the postoperative complications rates were compared WITH those published in literature. MATERIALS AND METHODS About 339 patients operated: 274 primarily and 65 for recurrence or residual tumor. VARIABLES sex, age, surgical techniques, pre- or postoperative radiotherapy, histology, size and localization of the tumors, disease free intervals, recurrences and postoperative complications. RESULTS 177 men and 162 women. Median age: 55 years and mean follow-up: 10.4 years. About 39 patients had adjuvant radiotherapy (11.5%). After primary surgery, four patients experienced recurrences (1.5%). After salvage surgery, eight patients recurred (12.3%). The recurrence rate was the highest among pleomorphic adenomas. Facial paralysis was more frequent after salvage surgery. DISCUSSION Recurrence rate 10 years later was lower after primary than after salvage surgery (p = 0.01). There was no relation between adjuvant radiotherapy and recurrence rate probably because the low rate of recurrences. CONCLUSION Recurrence rate after primary surgery is lower after superficial or total parotidectomy than after other surgical techniques. Pleomorphic adenomas have the highest rate of recurrences. Age and sex have no significant influence over the rate of recurrences. The most frequent postoperative complications are facial paralysis and Frey's syndrome.
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Affiliation(s)
- Marie Quiriny
- Department of Surgery, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet, Brussels, Belgium
| | - Cécile Dekeyser
- Department of Surgery, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet, Brussels, Belgium
| | - Michel Moreau
- Biostatistics Center, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet, Brussels, Belgium
| | - Antoine Digonnet
- Department of Surgery, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet, Brussels, Belgium
| | - Esther Willemse
- Department of Surgery, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet, Brussels, Belgium
| | - Laurent Vanbel
- Department of Surgery, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet, Brussels, Belgium
| | - Guy Andry
- Department of Surgery, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet, Brussels, Belgium
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Quer M, Vander Poorten V, Takes RP, Silver CE, Boedeker CC, de Bree R, Rinaldo A, Sanabria A, Shaha AR, Pujol A, Zbären P, Ferlito A. Surgical options in benign parotid tumors: a proposal for classification. Eur Arch Otorhinolaryngol 2017. [DOI: 10.1007/s00405-017-4650-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen WL, Fan S, Zhang DM. Endoscopically assisted extracapsular dissection of pleomorphic adenoma of the parotid gland through a postauricular sulcus approach in young patients. Br J Oral Maxillofac Surg 2017; 55:400-403. [PMID: 28236489 DOI: 10.1016/j.bjoms.2017.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/09/2017] [Indexed: 01/27/2023]
Abstract
We evaluated the aesthetic outcomes in 11 young patients (mean (range) age 21.7 (16-28) years) who had endoscopically assisted extracapsular dissection of benign pleomorphic adenomas of the parotid gland through a postauricular sulcus approach. The tumours varied in size from 1.5×1.0cm to 2.5×2.0cm, and all were removed completely without rupture. The cosmetic result was excellent in 10 patients and good in one. Patients were followed up for eight to 40 months, and there was no recurrence. The technique is simple and feasible, and it achieves excellent aesthetic results in young patients.
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Affiliation(s)
- W-L Chen
- Department of Oral and Maxillofacial Surgery, Sun Yet-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - S Fan
- Department of Oral and Maxillofacial Surgery, Sun Yet-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - D-M Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yet-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Mantsopoulos K, Koch M, Iro H. Extracapsular dissection as sole therapy for small low-grade malignant tumors of the parotid gland. Laryngoscope 2017; 127:1804-1807. [DOI: 10.1002/lary.26482] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/17/2016] [Accepted: 11/30/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU); Erlangen Germany
| | - Michael Koch
- Department of Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU); Erlangen Germany
| | - Heinrich Iro
- Department of Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU); Erlangen Germany
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24
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Abstract
This article reviews the epidemiology, embryology, risk factors, clinical presentation, diagnostic work-up, and basic management principles for the more common benign parotid neoplasms. The various histopathologies are also discussed and summarized.
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Affiliation(s)
- Kevin Y Zhan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Sobia F Khaja
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Allen B Flack
- Department of Pathology, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC 29425, USA
| | - Terry A Day
- Division of Head & Neck Oncologic Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
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25
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Mantsopoulos K, Scherl C, Iro H. Investigation of arguments against properly indicated extracapsular dissection in the parotid gland. Head Neck 2016; 39:498-502. [DOI: 10.1002/hed.24629] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/10/2016] [Accepted: 10/07/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Konstantinos Mantsopoulos
- Department of OtorhinolaryngologyHead and Neck Surgery, University of Erlangen–NurembergErlangen Germany
| | - Claudia Scherl
- Department of OtorhinolaryngologyHead and Neck Surgery, University of Erlangen–NurembergErlangen Germany
| | - Heinrich Iro
- Department of OtorhinolaryngologyHead and Neck Surgery, University of Erlangen–NurembergErlangen Germany
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Kadletz L, Grasl S, Grasl MC, Perisanidis C, Erovic BM. Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience. Head Neck 2016; 39:356-360. [DOI: 10.1002/hed.24598] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lorenz Kadletz
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Matthäus C. Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Christos Perisanidis
- Department of Maxillofacial Surgery; Medical University of Vienna; Vienna Austria
| | - Boban M. Erovic
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
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27
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Coughlan CA, Verma SP. The Utility of Recurrent Laryngeal Nerve Monitoring During Open Pharyngeal Diverticula Procedures. Ann Otol Rhinol Laryngol 2016; 125:648-51. [PMID: 27084587 DOI: 10.1177/0003489416642815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The recurrent laryngeal nerve is at risk of injury during open pharyngeal diverticula operations. The utility of recurrent laryngeal nerve (RLN) monitoring during these procedures was investigated. METHODS A retrospective chart review was performed of 8 open pharyngeal diverticulectomies completed between 2009 and 2014. Intraoperative RLN monitoring took place during all operations. RESULTS Open pharyngectomy and myotomy was successfully performed in all cases. In two cases the RLN was encountered outside of its normal course. The identity of the nerve was confirmed with electrical stimulation and normal EMG response. Vocal fold motion was preserved in all cases. CONCLUSIONS Use of intraoperative nerve monitoring in pharyngeal diverticula procedures may be beneficial, especially during open operations for Killian-Jamieson diverticulum (KJD) and large Zenker diverticulum (ZD), where the RLN is typically encountered outside of its normal course.
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Affiliation(s)
- Carolyn A Coughlan
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Sunil P Verma
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
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Modified facelift incision for partial parotidectomy versus bayonet-shaped incision: a comparison using visual analog scale. Eur Arch Otorhinolaryngol 2016; 273:3269-75. [DOI: 10.1007/s00405-015-3878-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
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30
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Tirelli G, Cova MA, Boscolo-Rizzo P, Da Mosto MC, Makuc E, Gardenal N. Charcoal Suspension Tattoo: A New Technique for Intraoperative Detection of Small Tumors of the Parotid Gland. Ann Otol Rhinol Laryngol 2016; 125:529-35. [PMID: 26742545 DOI: 10.1177/0003489415625651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The current surgical trend in the treatment of pleomorphic adenomas of the parotid gland is to limit the extent of resection. This raises the need to correctly identify the mass within the normal parenchyma so as to avoid dissecting the entire superficial lobe of the gland. We describe ultrasound-guided tattooing as a technique to facilitate identification and excision of parotid pleomorphic adenomas. METHODS We reviewed 23 consecutive patients with pleomorphic adenoma of the parotid gland. All patients underwent ultrasound-guided tattooing of the lesions with a charcoal suspension. Baseline tumor and patients' characteristics, major and minor complications, and subjective tolerance to the procedure were recorded. We assessed the number of intralesionally marked masses and the percentage of intraoperatively detected marked lesions. RESULTS The injection was well tolerated. No major complications were recorded. In 2 cases (9%), a transient increase in lesion size was observed. No other minor complications were encountered. Charcoal was found inside the tumor in 19 cases (83%). In 4 cases (17%), it was found in the tissues above the lesion. Twenty-three lesions were intraoperatively detected (100%) and dissected. CONCLUSION Charcoal suspension tattooing is safe and well tolerated for the detection of small pleomorphic adenomas during parotid surgery.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Trieste, Italy
| | | | | | | | - Elisa Makuc
- Department of Radiology, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Trieste, Italy
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Tumor recurrence and complications of parotidectomy using the marginal mandibular branch as a landmark during the retrograde technique. J Craniofac Surg 2016; 26:e193-5. [PMID: 25759935 DOI: 10.1097/scs.0000000000001464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the recurrence of tumors and morbidity rates of postoperative complications associated with primary parotid pleomorphic adenomas treated with a parotidectomy using the marginal mandibular branch of the facial nerve as a landmark during the retrograde approach. PATIENTS AND METHODS Our study retrospectively analyzed the clinical data from 71 patients with a primary parotid pleomorphic adenoma who underwent a parotidectomy using the marginal mandibular branch of the facial nerve as a guide during the retrograde approach between November 2003 and August 2012. Three surgical modalities were involved in the study: a partial superficial parotidectomy was performed in 8 cases, a superficial parotidectomy was performed in 54 cases, and a total parotidectomy was performed in 9 cases. The recurrence of tumors and the morbidity rates of postoperative complications, such as transient facial nerve paralysis, permanent facial nerve paralysis, sensory deficiency, Frey syndrome, salivary fistulas, and xerostomia, were investigated. RESULTS Tumor recurrence occurred in only 1 case. Overall, the morbidity rates for transient facial nerve paralysis, permanent facial nerve paralysis, sensory deficiency, Frey syndrome, and xerostomia were 22.5%, 1.4%, 39.4%, 59.2%, and 8.5%, respectively. No cases developed a salivary fistula. CONCLUSION The use of the marginal mandibular branch of the facial nerve as a guide during the retrograde approach is a reliable and safe method for dissecting the facial nerve.
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Xie S, Wang K, Xu H, Hua RX, Li TZ, Shan XF, Cai ZG. PRISMA-Extracapsular Dissection Versus Superficial Parotidectomy in Treatment of Benign Parotid Tumors: Evidence From 3194 Patients. Medicine (Baltimore) 2015; 94:e1237. [PMID: 26313768 PMCID: PMC4602923 DOI: 10.1097/md.0000000000001237] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Benign parotid tumor is one of the most common neoplasms in head and neck region. Its therapeutic methods have been debatable topics over the past 100 years. Recently, some surgeons suggest that extracapsular dissection (ECD) instead of superficial parotidectomy (SP) for treatment of benign parotid tumor. This study aimed to compare ECD with SP in the treatment of benign parotid tumors by a meta-analysis.We searched Cochrane Library, PubMed, Embase, Ovid, and Web of Science databases on February 14, 2015 for studies that assessed clinical outcomes of SP and ECD as surgical techniques for the management of benign parotid tumors. Outcome data were evaluated by pooled risk ratio (RR) and corresponding 95% confidence interval (CI).After serious scrutiny, a total of 14 cohort studies with 3194 patients were included in this meta-analysis. The pooled RR revealed that there were no significant difference in tumor recurrence rate between ECD and SP (fixed-effect model: RR = 0.71, 95% CI = 0.40-1.27, P = 0.249; random-effect model: RR = 0.67, 95% CI = 0.38-1.23, P = 0.197). However, there were significantly lower incidences of transient facial nerve dysfunction (FND), permanent FND, and Frey's syndrome in patients of ECD group compared with SP group.ECD might be a good choice in treatment of the benign parotid tumor that were mobile, small, located in superficial lobe and without adhesion to facial nerve; ECD should be performed by the experienced surgeons with ability of dissection facial nerve, who should perform SP if tumor is found adhere to facial nerve during an operation; and a multicenter randomized control trial study is necessary to decide the optimal treatment of benign parotid tumor.
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Affiliation(s)
- Shang Xie
- From the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China (SX, KW, HX, T-ZL, X-FS, Z-GC) and Department of Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (R-XH)
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Mantsopoulos K, Velegrakis S, Iro H. Unexpected Detection of Parotid Gland Malignancy during Primary Extracapsular Dissection. Otolaryngol Head Neck Surg 2015; 152:1042-7. [DOI: 10.1177/0194599815578104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the oncologic and functional outcome in cases in which a false preoperative working hypothesis “benign parotid tumor” led to a primary extracapsular dissection being performed rather than a traditional, more radical surgical modality. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects and Methods The records of all patients treated for malignant tumors of the parotid gland between 2006 and 2012 were retrospectively studied. Patients were excluded from our study sample for insufficient data or if their histories indicated manifestation of malignant tumors without primary parotid origin (squamous cell carcinomas, lymphomas, melanomas), revision surgery, as well as concomitant or past malignant tumors. Consequently, a total of 29 patients with 30 primary malignant tumors of the parotid gland formed our study sample (14 men, 15 women; male:female ratio, 0.93:1; mean age, 55.4 years; range, 14-85 years). Results Of 30 cases, 22 had low-grade tumors. Further tumor cells were detected in only the histology specimens of the parotid in 3 of the 25 cases treated subsequently with completion parotidectomy. Five patients received adjuvant radiation. Five-year disease-specific survival was 100%; local disease control was 96.6%. Of 30 cases, 28 had House-Brackmann I after tumor treatment; the other 2 cases had a slight paralysis (House-Brackmann II). Conclusion Beginning with the “false” working hypothesis and performing an extracapsular dissection in unsuspected cases seems to have no adverse impact on patients’ survival and postoperative quality of life in cases in which definitive histology reveals malignancy.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stylianos Velegrakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Colella G, Cannavale R, Chiodini P. Meta-analysis of surgical approaches to the treatment of parotid pleomorphic adenomas and recurrence rates. J Craniomaxillofac Surg 2015; 43:738-45. [PMID: 25982213 DOI: 10.1016/j.jcms.2015.03.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/17/2015] [Accepted: 03/18/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Different types of surgical management of pleomorphic adenoma of the parotid gland are associated with different recurrence rates. MATERIAL AND METHODS A systematic review of literature until 2014 with meta-analysis was conducted. Inclusion criteria were original studies of patients with surgical management for pleomorphic adenoma of the parotid gland and recurrence rates, with a median follow-up period of 5 years. The Newcastle-Ottawa Quality Assessment Scale (NOQAS) was used to assess the quality. RESULTS Sixteen studies were included. Four studies show a low recurrence rate (0.01, 95% confidence interval [CI] = 0.00-0.02) after total parotidectomy. Twelve studies show a low recurrence rate (0.02, 95% CI = 0.01-0.03) after superficial parotidectomy. Six studies show a low recurrence rate (0.02, 95% CI = 0.01-0.04) after limited parotidectomy. Six studies demonstrate a low recurrence rate (0.01, 95% CI = 0.00-0.04) after extracapsular dissection. Five studies report a low-to-medium recurrence rate (0.08, 95% CI = 0.03-0.14) after extracapsular enucleation. CONCLUSION Information about recurrence rates, times of recurrence in relation to type of surgical treatment, and significance of capsule rupture is very poor. With regard to recurrence rates and surgical approaches, the types of operations that show the lowest recurrence rate are total parotidectomy and extracapsular dissection. Controversies over surgical treatment of PA of parotid gland remain, and the safest surgical method for the removal of this tumors has not been identified.
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Affiliation(s)
- Giuseppe Colella
- Department of Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - Rosangela Cannavale
- Department of Head and Neck Surgery, Second University of Naples, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, Naples, Italy
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Iro H, Zenk J. Salivary gland diseases in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc06. [PMID: 25587366 PMCID: PMC4273167 DOI: 10.3205/cto000109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment. The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized. Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and sometimes in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience. Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach.
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Affiliation(s)
- Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
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Mehta V, Nathan CA. Extracapsular dissection versus superficial parotidectomy for benign parotid tumors. Laryngoscope 2014; 125:1039-40. [PMID: 25363191 DOI: 10.1002/lary.24996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Vikas Mehta
- Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana, U.S.A
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Mantsopoulos K, Koch M, Klintworth N, Zenk J, Iro H. Evolution and changing trends in surgery for benign Parotid tumors. Laryngoscope 2014; 125:122-7. [DOI: 10.1002/lary.24837] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/29/2014] [Accepted: 06/17/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Michael Koch
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Nils Klintworth
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology; Head and Neck Surgery; Augsburg Hospital; Augsburg Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
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Witt RL, Iro H, McGurk M. The Role of Extracapsular Dissection for Benign Parotid Tumors. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0045-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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[Effect of a multifunctional instrument (HF scissors) in parotis surgery]. HNO 2014; 62:196, 198-201. [PMID: 24610088 DOI: 10.1007/s00106-013-2765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PROBLEM Lateral parotidectomy is a demanding surgical procedure and requires a large number of instruments with a high frequency (HF) of alternating. Many functions, such as preparing, spreading, coagulating and cutting could be combined by using scissors with an integrated function of bipolar coagulation. This study has targeted an investigation of technical application, influence on surgery time, frequency of HF application and change of instruments. MATERIAL AND METHODS In the period between 01 April 2011 and 30 September 2012 (18 months) 35 procedures of lateral parotidectomy in 35 patients were investigated. In all cases lateral parotidectomy was carried out with a similar technique (modified extracapsular preparation). Workflow data were used from a control group in the period between 01 January 2009 and 31 December 2010 (24 months). The following parameters from both groups were documented and evaluated: incision-suture times (subdivided into nine sections of the procedure), change of instruments, period of application for HF function and early facial nerve function (6 h and 6 days after surgery according to House-Brackmann). Additionally, in the HF+ group a questionnaire that facilitated subjective evaluation of instruments was analyzed. RESULTS It was possible to perform the surgery in both groups with neither technical nor surgical intraoperative complications. Incision-suture times showed an average reduction of 31.6 min (34.8 %) in the HF+ group. There was a reduction in the change of instruments compared to a conventional group (CONV) by up to 62.7 %. With the deployment of HF scissors there was a clear increase in the use of HF surgery by more than 100 % when comparing incision-suture times. Evaluation of both groups according to House-Brackmann showed a similar postoperative facial nerve function. The surgeons involved were of the opinion that in all 35 surgeries with HF scissors the intervention was easier and more comfortable. DISCUSSION The use of HF scissors is appropriate for parotid gland surgery and can be used in all steps of the procedure. Incision-suture time can be reduced and the ergonomics of the intervention can be improved. Up to now no negative effects have been found in the quality of the results.
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