Lymphoepithelial lesion of accessory parotid presenting as a buccal space mass

Buccal space tumours

OBJECTIVE

To review the available literature as it pertains to the buccal space with a specific focus on the pathologies encountered within this space. Clinical presentation, investigations, and surgical approaches to the region are also reviewed.

METHODS

A systematic review of the available literature was performed on buccal space tumours from 1980 to 2017. Data was extracted on clinical presentation, investigations and surgical approaches to the buccal space. The pathologies encountered in the buccal space were reviewed and presented.

RESULTS

Forty-nine unique articles were reviewed, with a total 217 patients. The age of the patients ranged from 0 to 83 with a mean age of 45.8. A total of 51 pathologies were reported. The majority of these were vascular and salivary gland pathologies. The majority of salivary gland neoplasms were malignant. However a wide variety of benign and malignant soft tissue tumours were also reported to occur in this region.

CONCLUSIONS

The buccal space is a small and complex region with a variety of pathologies occurring within it. This review clarifies the differential diagnosis of a mass which presents in this area and the pathologies which occur within it.

Clinical management of masses arising from the accessory parotid gland

OBJECTIVE

Accessory parotid lesions are clinically rare and its management remains poorly understood. The aim of this study was to analyze the clinical management of accessory parotid lesions.

STUDY DESIGN

From April 1999 to November 2008, a retrospective analysis of 32 patients with accessory parotid lesions was performed. The preoperative examinations, surgical treatment, and prognosis were recorded and analyzed.

RESULTS

Among the 32 patients, there were 8 men and 24 women with an overall average age of 45 years. These patients always presented without obvious symptoms, and the masses were moderate to hard in hardness without tenderness, mobile, and with clear boundary. The pathologic diagnoses were 24 benign and 8 malignant lesions. Surgery and surgery plus radiotherapy were performed in the patients with benign and malignant lesions, respectively, with good prognosis.

CONCLUSIONS

Accessory parotid lesions are rare, and the clinical manifestation is always the same for benign tumors. Surgical resection and surgical resection plus radiotherapy are the primary choices of treatment for benign and malignant lesions, respectively. The prognosis is always good.

Lesions of the accessory parotid gland in children

The accessory parotid gland, a little-known and seldom-mentioned anatomical variant, is a nodule of normal salivary tissue separate from the main parotid gland, located on the masseter muscle and connected to the Stensen duct at that level. It can be the site of both congenital and acquired lesions.

Management of buccal space tumors by rhytidectomy approach with superficial musculoaponeurotic system reconstruction

PURPOSE

To show that the rhytidectomy approach without a submandibular limb can be successfully used for excision of buccal space tumors and how this technique allows reconstruction of the contour defect associated with tumor extirpation by utilization of the superficial musculoaponeurotic system (SMAS) interposition.

PATIENTS AND METHODS

Five cases of buccal space tumors are presented: two accessory lobe of parotid tumors, one parotid duct cyst, one nodular fasciitis of anterior masseter, and one lymphoma.

RESULTS

Rhytidectomy approach without a submandibular limb incision afforded adequate exposure to the tumors with excellent cosmetic results. Furthermore, SMAS interposition, which was allowed through this technique, ameliorated the contour defect created.

CONCLUSION

Rhytidectomy approach with SMAS interposition is effective for management of buccal space tumors.

Surgical management of accessory parotid tumors

Accessory parotid gland tumors are defined as masses within salivary gland tissue located adjacent to Stensen's duct, but separate from the main body of the parotid gland. These tumors usually present as asymptomatic cheek masses. There is a temptation to excise these masses locally; however, the likelihood of injury to branches of the facial nerve is high. The best surgical approach to tumors in the accessory parotid region is via a standard parotid incision and concomitant superficial parotidectomy. Eight patients have been surgically treated with accessory parotid gland masses. Six patients had mixed tumors, one had a low grade mucoepidermoid carcinoma, and one had a localized parotitis. Our approach included a standard parotid incision, raising an anterior flap beyond the mass, and exposing the main trunk of the facial nerve, with careful tracing of all its branches. This approach to accessory parotid gland tumors is superior in that it provides a better margin of resection and minimizes functional and cosmetic deformities. Most importantly, there is less danger of injury to branches of the facial nerve.