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Raymond MJ, Ottinger A, Rowley MA, Bobian M, Dornhoffer J, Brennan E, Rizk HG. A Scoping Review of Otologic Manifestations of Hematologic Malignancies. Otol Neurotol 2024; 45:362-375. [PMID: 38437804 DOI: 10.1097/mao.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the otologic and neurotologic symptoms, physical examination findings, and imaging features secondary to hematologic malignancies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including PubMed, Scopus, and CINAHL, were searched for articles including patients with otologic manifestations of leukemia, lymphoma and multiple myeloma. Data collected included patient and study demographics, specific hematologic malignancy, timing and classification of otologic symptoms, physical examination findings, imaging features and methods of diagnosis. Pooled descriptive analysis was performed. RESULTS Two hundred seventy-two articles, of which 255 (93.8%) were case reports and 17 (6.2%) were case series, reporting on 553 patients were identified. Otologic manifestations were reported on 307 patients with leukemia, 204 patients with lymphoma and 42 patients with multiple myeloma. Hearing loss and unilateral facial palsy were the most common presenting symptoms for 111 reported subjects with leukemia (n = 46, 41.4%; n = 43, 38.7%) and 90 with lymphoma (n = 38, 42.2%; n = 39, 43.3%). Hearing loss and otalgia were the most common presenting symptoms for 21 subjects with multiple myeloma (n = 10, 47.6%; n = 6, 28.6%). Hearing loss and unilateral facial palsy were the most common otologic symptoms indicative of relapse in subjects with leukemia (n = 14, 43.8%) and lymphoma (n = 5, 50%). CONCLUSION Hearing loss, facial palsy, and otalgia might be the first indication of a new diagnosis or relapse of leukemia, lymphoma, or multiple myeloma. Clinicians should have a heightened level of suspicion of malignant etiologies of otologic symptoms in patients with current or medical histories of these malignancies.
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Affiliation(s)
| | - Allie Ottinger
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - M Andrew Rowley
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Michael Bobian
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jim Dornhoffer
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | | | - Habib G Rizk
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
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2
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De Luca P, Di Stadio A, Marra P, Colacurcio V, Scarpa A, Ricciardiello F, Ralli M, Longo F, Salzano G, de Vincentiis M, Iaconetta G, Salzano FA, Camaioni A. Systematic Review of Management and Survival Outcome of Parotid Cancers with Lateral Skull Base Invasion. Indian J Otolaryngol Head Neck Surg 2023; 75:2713-2721. [PMID: 37636674 PMCID: PMC10447298 DOI: 10.1007/s12070-023-03787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 08/29/2023] Open
Abstract
Lateral skull base involvement from parotid cancers is a rare condition and is considered a poor prognostic indicator. The aim of this study was to systematically review the literature of parotid tumors with temporal bone invasion to analyze the survival outcome. A systematic literature review was performed in August 2022, without time limits, and 289 patients affected by parotid gland cancers and lateral skull base involvement were included. The most common symptoms in parotid tumors at the onset were indolent mass, facial weakness, pain, and hearing loss; the chi-square value is 23.1063, with a statistically significance (p = < 0.000121). The five most common histologies were adenoid cystic carcinoma, acinic cell carcinoma, mucoepidermoid carcinoma, adenocarcinoma, and squamous cell carcinoma. The facial nerve function after surgery showed statistically significance (functional vs. non-functional; chi-square was 91.7698, p = < 0.00001). Mean follow-up was 36.2 months (range 0.3-192). At the last follow-up, more patients died of disease (DOD; 60/289, 21%) than other causes (DOOC; 5/289, 2%). There is a statistically significant correlation between patients died for tumor (DOD) and patients died for other causes (DOOC) (p = < 0.0001), suggesting that the lateral skull base invasion negatively impacts on survival. Basing on the results of our systematic review, lateral skull base involvement from parotid recurrent/advance tumors should be considered a poor prognostic factor, as the majority of patients die due to this condition. It also would be necessary to have "clear"works, with full data (demographic, clinical, surgical data), and with a longer follow up, in order to assess the best treatment modality of these patients.
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Affiliation(s)
- Pietro De Luca
- Head and Neck Department, Otolaryngology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Pasquale Marra
- ENT Department A.O.R.N. “S.G., Moscati”, Avellino, Italy
| | - Vito Colacurcio
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Massimo Ralli
- Department of Sense Organs, University Sapienza, Rome, Italy
| | - Francesco Longo
- Hospital “Casa Sollievo della Sofferenza” IRCCS – San Giovanni Rotondo, Foggia, Italy
| | - Giovanni Salzano
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS “Fondazione G. Pascale”, Naples, Italy
| | | | - Giorgio Iaconetta
- Department of Neurosurgery, University Hospital of Salerno, Fisciano, Italy
| | | | - Angelo Camaioni
- Head and Neck Department, Otolaryngology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
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Zanoletti E, Marioni G, Nicolai P, Mazzoni A. The contribution of oncological lateral skull base surgery to the management of advanced head-neck tumors. Acta Otolaryngol 2023; 143:101-105. [PMID: 36883304 DOI: 10.1080/00016489.2023.2174270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Lateral skull base is a complex area between the brain and the neck that is characterized by a large anatomic variability in narrow spaces and wide heterogeneity of tissues. The complexity of the anatomy makes it more difficult to accurately identify tumor spread and surgical planning is here particularly demanding. AIMS Oncological skull base surgery is conceived for malignant lesions originating in, secondarily infiltrating, or in close proximity to the lateral skull base. It is also conceived for selected aggressive or benign lesions of the parapharyngeal space and infratemporal fossa abutting the skull base, or crossing it from above downwards to the neck. This paper is focused on the role that oncological skull base surgery plays to resect tumors in this area. METHODS AND RESULTS Three main types of head and neck lesions can be identified as paradigms of the philosophy of oncological lateral skull base surgery, and are herein presented: (i) primary malignant tumors of the ear; (ii) advanced malignant parotid tumors; (iii) primary malignant or locally aggressive tumors of the infratemporal fossa-parapharyngeal space. The en-bloc lateral and subtotal temporal bone resections, the en-bloc temporo-parotid resection and the combined subtemporal-transcervical-transparotid resection are described, respectively. CONCLUSIONS AND SIGNIFICANCE Different histologies are found in the lateral skull base and adjacent areas, and each histology has its own pattern of growth and undetected spreading in a difficult-to-reach surgical area. The leading principle is to create a wide access through soft tissues and bone removal far enough from the tumor to obtain a complete resection, en-bloc radical resection in malignancies. The entity of dissection is obviously modulated on the tumor triad (histology, pattern of growth, extent) and is achieved through the en-bloc and combined approaches that are here described.
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Affiliation(s)
- Elisabetta Zanoletti
- Otolaryngology Section, Department of Neurosciences DNS, University Hospital of Padua, Padua, Italy
| | - Gino Marioni
- Otolaryngology Section, Department of Neurosciences DNS, University Hospital of Padua, Padua, Italy
| | - Piero Nicolai
- Otolaryngology Section, Department of Neurosciences DNS, University Hospital of Padua, Padua, Italy
| | - Antonio Mazzoni
- Otolaryngology Section, Department of Neurosciences DNS, University Hospital of Padua, Padua, Italy.,Formerly Neurosciences Department, Ospedali Riuniti of Bergamo, Bergamo, Italy
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Zanoletti E, Tealdo G, Franz L, Cazzador D, Nicolai P, Mazzoni A. From "Extended total parotidectomy" to "Temporo-parotid resection" for locally advanced parotid tumors: Outlining a shift in surgical perspective. Oral Oncol 2022; 131:105975. [PMID: 35724528 DOI: 10.1016/j.oraloncology.2022.105975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Elisabetta Zanoletti
- Otolaryngology-Skull Base Section, Neurosciences Department, University of Padova, Italy
| | - Giulia Tealdo
- Otolaryngology-Skull Base Section, Neurosciences Department, University of Padova, Italy
| | - Leonardo Franz
- Otolaryngology-Skull Base Section, Neurosciences Department, University of Padova, Italy
| | - Diego Cazzador
- Otolaryngology-Skull Base Section, Neurosciences Department, University of Padova, Italy
| | - Piero Nicolai
- Otolaryngology-Skull Base Section, Neurosciences Department, University of Padova, Italy
| | - Antonio Mazzoni
- Otolaryngology-Skull Base Section, Neurosciences Department, University of Padova, Italy
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Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed. Ann Plast Surg 2022; 89:196-200. [DOI: 10.1097/sap.0000000000003061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perineural Invasion of the Intratemporal Facial Nerve: How Far Proximally Do We Chase the Positive Margin? Otol Neurotol 2021; 42:1572-1579. [PMID: 34411066 DOI: 10.1097/mao.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine recurrence patterns in patients with head and neck cancers requiring facial nerve sacrifice and to determine the optimal management of the positive proximal facial nerve margin. STUDY DESIGN Case series with chart review. SETTING Tertiary care center. PATIENTS One hundred fifty-five patients with head and neck malignancies who underwent sacrifice of the facial nerve between March 1, 1999 and October 31, 2020. Demographics, preoperative facial nerve function, prior oncologic treatment, histologic type, operative details, adjuvant treatment, recurrence patterns, and overall survival were reviewed. MAIN OUTCOME MEASURES Recurrence rates and recurrence location. RESULTS Thirteen patients (8%) had positive proximal margins on final pathologic evaluation. Six of 13 (46%) experienced disease recurrence. No disease recurred proximally along the facial nerve. The recurrence rate was 26% for negative proximal facial nerve margins. Segments of the facial nerve biopsied included: extratemporally (n = 78), at the stylomastoid foramen (36), mastoid segment (22), second genu (7), tympanic (6), geniculate (3), labyrinthine (1), and IAC (2). Median patient follow-up was 30.3 months. CONCLUSIONS Our data suggest that a conservative approach to a positive proximal facial nerve margin is optimal with respect to operative planning, patient morbidity, and disease recurrence patterns. Recurrence proximally along the facial nerve is an exceedingly rare event and the necessity of biopsy proximal to the geniculate ganglion, and in some cases even to the second genu, is called into question.
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Leedman S, Wormald R, Flukes S. Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region. J Laryngol Otol 2021; 135:1-6. [PMID: 34583793 DOI: 10.1017/s0022215121002607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure. METHODS A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia. RESULTS Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30). CONCLUSION Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.
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Affiliation(s)
- S Leedman
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
| | - R Wormald
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
| | - S Flukes
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
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8
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Kline NL, Bhatnagar K, Eisenman DJ, Taylor RJ. Survival outcomes of lateral skull base tumors following temporal bone resection. Head Neck 2021; 43:2414-2422. [PMID: 33851465 DOI: 10.1002/hed.26707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Lateral skull base tumors often necessitate temporal bone resection (TBR), although clinical outcomes can be unfavorable. Factors influencing survival and recurrence after TBR for cutaneous and salivary malignancies were evaluated. METHODS Twenty-six TBR subjects were included. Survival and recurrence outcomes were estimated at 1, 2, and 5 years postresection. Prognostic factors were analyzed using univariate and multivariate Cox regression. RESULTS Two years postresection, the overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) rates were 61%, 74%, and 49%, respectively, and 51%, 63%, and 45% at 5 years. On univariate analysis, preoperative facial nerve dysfunction and intraoperative nerve sacrifice worsened OS, DSS, and RFS. Prior surgery and adjuvant radiation independently predicted reduced OS, DSS, and RFS on multivariate analysis. CONCLUSIONS Mortality is highest in the first 2 years following resection. Preoperative facial nerve dysfunction, facial nerve sacrifice, and prior radiation are negative predictors of survival and recurrence.
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Affiliation(s)
- Neila L Kline
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kavita Bhatnagar
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David J Eisenman
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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9
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Tanavde VA, Broderick J, Windon MJ, Fakhry C, Stewart CM, Eisele DW, Creighton FX. Factors and Outcomes Associated With Temporal Bone Resection for Primary Parotid Malignancy. Laryngoscope 2021; 131:E2461-E2468. [PMID: 33797071 DOI: 10.1002/lary.29547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE(S) Although parotid cancer invading into the temporal bone makes up only a small fraction of all parotid cancers, it is more common and relatively understudied compared with primary cancer of the external auditory canal. The objective of this study was to determine what factors are associated with receiving parotidectomy with temporal bone resection (TBR) and the immediate postoperative outcomes. METHODS We reviewed the National Cancer Database (2004-2015) for patients with primary parotid malignancy who received parotidectomy with or without TBR. Patient demographic, clinical, and perioperative variables were collected and then compared. Multivariate logistic regression was performed to determine factors associated with receiving TBR. RESULTS We identified 134 patients who received parotidectomy with TBR and 16,595 who received parotidectomy only. Reported in terms of odds ratios (95% confidence interval), our multivariate model showed having surgery at an academic facility (1.91 [1.34-2.71], P < .001), clinical stage III or IV (7.48 [1.65-33.96] and 31.37 [7.61-129.32], P = .009 and P < .001, respectively), histologic grade II to IV (4.36 [1.51-12.57], 4.31 [1.53-12.15], and 6.74 [2.26-20.13], P = .006, .006, and .001, respectively), and adenoid cystic histology (3.23 [2.02-5.17], P < .001) were significantly and independently associated with receiving TBR. There was no significant difference in 30-day readmission, or 30-day or 90-day mortality, but the rate of positive surgical margins was significantly higher in those who underwent TBR. CONCLUSION Demographic variables are not significant factors for receiving TBR. Tumor characteristics, such as clinical stage and histologic type, and receiving surgical treatment at an academic facility were more strongly associated with receiving TBR. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2461-E2468, 2021.
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Affiliation(s)
- Ved A Tanavde
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Joseph Broderick
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | | | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Evaluation of Lateral Temporal Bone Resection in Locally Advanced Tumours of the Parotid Gland. Indian J Otolaryngol Head Neck Surg 2019; 71:1402-1407. [PMID: 31750185 DOI: 10.1007/s12070-018-1483-4] [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] [Received: 07/26/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022] Open
Abstract
This study evaluated the effects of lateral temporal bone resection (LTBR) on local tumour control in patients with locally advanced parotid gland tumours. The medical records of seven patients treated with radical parotidectomy combined with LTBR for locally advanced primary parotid tumour at the Otolaryngology Department of Dokuz Eylul University between January 1995 and December 2016 were retrospectively evaluated. Demographic variables, tumour characteristics, treatment properties, postoperative complications, follow-up durations and local, regional and distant recurrences were analysed. Before referral to our clinic, four patients had de novo primary parotid tumours, and three patients had a recurrence of primary parotid tumours. The histopathologic diagnoses were squamous cell carcinoma in two patients, and adenosquamous carcinoma, malignant myoepithelial carcinoma, adenocarcinoma, adenoid cystic carcinoma and spindle cell sarcoma in the other patients. During the follow-up period, one patient died due to postoperative pulmonary embolism in the first month, and four patients died due to distant metastasis without local or regional recurrences. LTBR combined with radical parotidectomy in locally advanced primary malignant parotid gland tumours is a feasible surgical technique for local tumour control. However, the most common cause of death in these cases is distant metastases, despite appropriate resection.
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11
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Carpenter PS, Burgette RC, Leonetti JP, Marzo SJ. Auricular complications in parotid, temporal bone, infratemporal fossa, and lateral skull base surgery. EAR, NOSE & THROAT JOURNAL 2017; 96:E27-E31. [PMID: 28231373 DOI: 10.1177/014556131709600216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neoplasms located in the parotid region, temporal bone, infratemporal fossa, and lateral skull base represent a challenge due to their difficult anatomic location and surrounding neurovascular structures. A variety of surgical approaches are appropriate to access this area, although several of them can place the auricular blood supply in danger. If the auricular blood supply is compromised, ischemia and, eventually, avascular necrosis of the auricle can occur. Auricular necrosis often can cause patients a delay in adjuvant radiation therapy and result in the need for additional reconstructive procedures. Therefore, it is imperative to identify risk factors associated with the development of this disabling complication. We conducted a retrospective review of 32 individuals undergoing treatment of benign and malignant lesions in the parotid gland, infratemporal fossa, and lateral skull base. To identify potential risk factors for auricular necrosis, the patients were analyzed based on the type of neoplasm (malignant or benign), risk factors affecting blood flow (diabetes mellitus, smoking history, prior radiation, prior surgery), body mass index, and the length of surgery. In our population examined, 3 instances of auricular necrosis occurred. None of the potential risk factors proved to be statistically significant (although malignant pathology approached significance at p = 0.07). Two of the patients required an auriculectomy with reconstruction. The third had multiple postoperative clinic visits for surgical debridement. Although no potential risk factors were statistically significant, surgeons should remain cognizant of the auricular blood supply while performing surgery via preauricular and postauricular approaches to this area.
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Affiliation(s)
- Patrick S Carpenter
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
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12
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Metastatic cutaneous squamous cell carcinoma of the parotid gland: prognostic factors. The Journal of Laryngology & Otology 2017; 132:264-269. [DOI: 10.1017/s0022215117001323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Metastatic cutaneous squamous cell carcinoma is the most common parotid malignancy in Australasia. Prognostic indicators are not clearly defined and the extent of surgical resection required is controversial.Methods:A retrospective analysis was conducted of 63 patients who underwent surgery for metastatic cutaneous squamous cell carcinoma of the parotid gland at a tertiary hospital over a 10-year period.Results:The five-year overall survival rate was 53 per cent, the disease-specific survival rate was 78 per cent and the locoregional control rate was 72 per cent. Immunosuppression and no adjuvant radiotherapy were associated with a significant reduction in disease-specific survival. None of the factors analysed had a significant effect on locoregional control rates.Conclusion:More extensive surgery, including lateral temporal bone resection, may improve local control rates in cases of more advanced disease. The reduced survival of immunocompromised patients must be considered when planning their management.
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13
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Kadakia S, Chan D, Ducic Y, Cristobal R, Mourad M. Increased local recurrence in advanced parotid malignancy treated with mastoidectomy without lateral temporal bone resection. Oral Maxillofac Surg 2017; 21:7-11. [PMID: 27696236 DOI: 10.1007/s10006-016-0586-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence. STUDY DESIGN The study design is a case series with chart review. SETTING The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014. SUBJECTS AND METHODS The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery. RESULTS Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949). CONCLUSIONS Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone. LEVEL OF EVIDENCE Level of evidence is a 4 case series.
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Affiliation(s)
- Sameep Kadakia
- Department of Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - David Chan
- Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, USA.
| | - Ricardo Cristobal
- Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, USA
| | - Moustafa Mourad
- Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, USA
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Lewis AG, Tong T, Maghami E. Diagnosis and Management of Malignant Salivary Gland Tumors of the Parotid Gland. Otolaryngol Clin North Am 2017; 49:343-80. [PMID: 27040585 DOI: 10.1016/j.otc.2015.11.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Malignant parotid tumors are heterogeneous and diverse. Accurate diagnosis requires a pathologist familiar with the various histologic subtypes, immunohistochemistry stains, and common translocations. Clinical course varies according to tumor subtype, ranging from indolent, slow-growing adenoid cystic carcinoma to rapidly progressive, possibly fatal, salivary ductal carcinoma. Histologic grade is important in prognosis and therapy. Surgery remains the mainstay of treatment when negative margins can be achieved. Radiation improves locoregional control of tumors with high-risk features. Chemotherapy for parotid tumors can be disappointing. Studies of new targeted therapies have not offered significant benefits.
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Affiliation(s)
- Aaron G Lewis
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Tommy Tong
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Ellie Maghami
- Division of Head and Neck Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Kopeć T, Mikaszewski B, Jackowska J, Waśniewska-Okupniak E, Szyfter W, Wierzbicka M. Treatment of Parotid Malignancies—10 Years of Experience. J Oral Maxillofac Surg 2015; 73:1397-402. [DOI: 10.1016/j.joms.2014.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/07/2014] [Accepted: 12/25/2014] [Indexed: 11/26/2022]
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Carlson ML, Patel NS, Modest MC, Moore EJ, Janus JR, Olsen KD. Occult Temporal Bone Facial Nerve Involvement by Parotid Malignancies with Perineural Spread. Otolaryngol Head Neck Surg 2015; 153:385-91. [DOI: 10.1177/0194599815591160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/22/2015] [Indexed: 11/17/2022]
Abstract
Objective To characterize disease presentation and outcomes following surgical treatment of parotid malignancies with occult temporal bone facial nerve (FN) involvement. Study Design Case series with chart review. Setting Tertiary academic referral center. Subjects and Methods Thirty consecutive patients (mean age 58 years; 77% men) who underwent surgery for parotid malignancies with occult perineural involvement of the intratemporal FN were included. Primary outcome measures included margin status and recurrence. Results The mean duration of clinical follow-up was 49 months, and the most common presenting symptom was FN paresis (n = 23; 77%) followed by pain (n = 15; 50%). To obtain a proximal FN margin, 27 patients (90%) underwent mastoidectomy, and 3 patients (10%) had lateral temporal bone resection. The intratemporal FN margin was cleared in 26 patients (87%), most commonly in the mastoid segment (60%). Adjuvant therapy was given in 25 patients (83%). Ten patients (33%) experienced locoregional (4; 13%) and/or distant (8; 27%) recurrence at a median of 19 months (mean 26, 2–54 months) following surgery. Locoregional failure was significantly more common in cases with a positive intratemporal FN margin (66% vs 8%; P = .045). Overall 1-, 3-, and 5-year disease-specific survival rates were 83%, 79%, and 72%, respectively. Conclusions Perineural invasion of the intratemporal FN by parotid malignancy is uncommon. Normal preoperative FN function does not preclude histopathologic involvement. Temporal bone FN exploration should be considered when a positive margin is encountered at the stylomastoid foramen, as failure to do so is associated with an increased rate of locoregional recurrence.
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Affiliation(s)
- Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Neil S. Patel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mara C. Modest
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Kerry D. Olsen
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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McRackan TR, Fang TY, Pelosi S, Rivas A, Dietrich MS, Wanna GB, Labadie RF, Haynes DS, Bennett ML. Factors associated with recurrence of squamous cell carcinoma involving the temporal bone. Ann Otol Rhinol Laryngol 2014; 123:235-9. [PMID: 24671478 DOI: 10.1177/0003489414524169] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to better identify factors associated with recurrence of squamous cell carcinoma (SCC) involving the temporal bone. METHODS A retrospective study was conducted at a tertiary hospital. Sixty patients who were diagnosed over a 10-year period with SCC involving the temporal bone and underwent surgical resection were analyzed. All patients were staged based on the University of Pittsburgh staging system. Demographic, intraoperative, and pathologic data were analyzed with respect to recurrence. RESULTS Thirteen (21.7%) patients were T1, 8 (13.3%) T2, 7 (11.7%) T3, and 32 (53.3%) T4. Eighteen patients (30.0%) recurred in the study period. The mean time to recurrence was 5.8 months. Tumors originating in the skin overlying the parotid gland and the external auditory canal had higher recurrence rates than those from the auricle/postauricular skin and temporal bone (P = .05). Direct parotid and perineural spread accounted for 15.0% of all routes of temporal invasion but resulted in 22.2% of all recurrences (P = .04). Increased N stage was statistically associated with increased risk of recurrence (P = .01). Cervical, as compared to perifacial and parotid, lymph node involvement was associated with increased risk of recurrence (odds ratio = 6.91; 95% confidence interval, 1.11-42.87). CONCLUSION We have identified multiple factors that are associated with increased recurrence of SCC involving the temporal bone.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Shao A, Wong DKC, McIvor NP, Mylnarek AM, Chaplin JM, Izzard ME, Patel RS, Morton RP. Parotid metastatic disease from cutaneous squamous cell carcinoma: Prognostic role of facial nerve sacrifice, lateral temporal bone resection, immune status and P-stage. Head Neck 2013; 36:545-50. [DOI: 10.1002/hed.23323] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 01/19/2023] Open
Affiliation(s)
- Angus Shao
- Department of Otolaryngology - Head and Neck Surgery; Auckland City Hospital; Auckland New Zealand
| | - Danny K. C. Wong
- Department of Otolaryngology - Head and Neck Surgery; Auckland City Hospital; Auckland New Zealand
| | - Nicholas P. McIvor
- Department of Otolaryngology - Head and Neck Surgery; Auckland City Hospital; Auckland New Zealand
| | - Alex M. Mylnarek
- Department of Otolaryngology - Head and Neck Surgery; Auckland City Hospital; Auckland New Zealand
| | - John M. Chaplin
- Department of Otolaryngology - Head and Neck Surgery; Auckland City Hospital; Auckland New Zealand
| | - Mark E. Izzard
- Department of Otolaryngology - Head and Neck Surgery; Auckland City Hospital; Auckland New Zealand
| | - Rajan S. Patel
- Department of Otolaryngology - Head and Neck Surgery; Auckland City Hospital; Auckland New Zealand
| | - Randall P. Morton
- Department of Otolaryngology - Head and Neck Surgery; Counties Manukau District Health Board; Manukau City Auckland New Zealand
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19
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Abstract
Primary temporal bone tumors are rare. Suspicious lesions of the ear canal should be biopsied for diagnosis. Surgical resection to achieve negative margins is the mainstay of treatment. Small tumors can be treated with lateral temporal bone resection. Parotidectomy and neck dissection are added for disease extension and proper staging. Higher staged tumors generally require subtotal temporal bone resection or total temporal bone resection. Adjuvant postoperative radiotherapy has shown improved survival for some patients. Chemotherapy has an emerging role for advanced stage disease. Evaluation and management by a multidisciplinary team are the best approach for patients with these tumors.
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Affiliation(s)
- Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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