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Landman A, Chaudhry Z, Escobar F, Rossi J, Rossi FH. Teaching neuro-image: a case of gustatory hyperhidrosis. Acta Neurol Belg 2024; 124:639-640. [PMID: 37209259 DOI: 10.1007/s13760-022-02168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/27/2022] [Indexed: 05/22/2023]
Affiliation(s)
- Avi Landman
- University Central Florida College of Medicine, Orlando, FL, USA
| | - Zunir Chaudhry
- University Central Florida College of Medicine, Orlando, FL, USA
| | - Freddy Escobar
- University Central Florida College of Medicine, Orlando, FL, USA
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Chai XD, Jiang H, Tang LL, Zhang J, Yue LF. Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix. World J Clin Cases 2024; 12:1578-1584. [PMID: 38576730 PMCID: PMC10989425 DOI: 10.12998/wjcc.v12.i9.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Frey syndrome, also known as ototemporal nerve syndrome or gustatory sweating syndrome, is one of the most common complications of parotid gland surgery. This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes, visual stimuli, or eating. AIM To investigate the preventive effect of acellular dermal matrix (ADM) on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection. METHODS Retrospective data from 82 patients were analyzed to assess the correlation between sex, age, resection sample size, operation time, operation mode, ADM usage, and occurrence of postoperative Frey syndrome. RESULTS Among the 82 patients, the incidence of Frey syndrome was 56.1%. There were no significant differences in sex, age, or operation time between the two groups (P > 0.05). However, there was a significant difference between ADM implantation and occurrence of Frey syndrome (P < 0.05). ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes. CONCLUSION ADM can effectively prevent Frey syndrome and delay its onset.
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Affiliation(s)
- Xian-Da Chai
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Huan Jiang
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Ling-Ling Tang
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Jing Zhang
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Long-Fei Yue
- Department of General Practice, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
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Callanan E, Mcnamara P, Ingle G. Neurosarcoidosis with chronic cough and Horner's syndrome. Pract Neurol 2024; 24:116-120. [PMID: 38160054 DOI: 10.1136/pn-2023-003816] [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] [Accepted: 11/09/2023] [Indexed: 01/03/2024]
Abstract
A 62-year-old man attended ophthalmology for a simple ptosis repair. He had a chronic cough, a Horner's syndrome with post-gustatory hyperhidrosis. He was referred to the respiratory and neurology teams. MR scan of his head and neck found evidence of multifocal disease at the skull base and carotid canal, and further tests identified additional deposits in the hilar lymph nodes, heart and sacrum. A transbronchial biopsy confirmed the diagnosis of sarcoidosis. His symptoms and imaging responded well to corticosteroids, but he still undergoes regular imaging. We discuss the features of Horner's syndrome, and the autonomic associations of a chronic cough.
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Affiliation(s)
- Emma Callanan
- Internal Medicine, Luton and Dunstable University Hospital, Luton, Luton, UK
| | | | - Gordon Ingle
- National Hospital for Neurology and Neurosurgery, London, UK
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Hofmeister N, Ames M, Lee A. Postprandial facial rash in an infant. JAAPA 2024; 37:31-32. [PMID: 38386930 DOI: 10.1097/01.jaa.0001005636.68497.c5] [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: 02/24/2024]
Abstract
ABSTRACT This article describes an infant who developed a facial rash within minutes of eating certain foods. The rash resolved within 30 minutes. The patient was diagnosed with auriculotemporal syndrome or Frey syndrome, which is characterized by sweating or flushing in the preauricular area when the patient consumes certain foods, especially those that are acidic, sour, or spicy. Because most patients outgrow the syndrome, no treatment is needed.
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Affiliation(s)
- Nicole Hofmeister
- At the Mayo Clinic in Rochester, Minn., Nicole Hofmeister is a PA and instructor in family medicine, Michael Ames is an NP and instructor in family medicine, and Amanda Lee is an NP and instructor in family medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Singh C, Silky S, Agarwal AC, Gupta T, Sinha M, Sharma P. Perplexing First Branchialcleft Anomalies-A Case Series with Review of Literature. Indian J Otolaryngol Head Neck Surg 2024; 76:1454-1460. [PMID: 38440503 PMCID: PMC10909038 DOI: 10.1007/s12070-023-04243-w] [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: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 03/06/2024] Open
Abstract
Incomplete obliteration of the branchial apparatus results in the formation of branchial cleft anomalies. First branchial cleft anomalies may persist anywhere in the first branchial arch, from the external auditory canal at the level of the bony cartilaginous junction to the submandibular triangle. The majority of cases present in childhood as an opening in the skin though they may present as cysts or neck masses, mostly mistaken for neck abscesses which leads to inadequate treatment and complications. Here different cases of first branchial cleft anomalies with variable presentation and treatment are illustrated. The need for proper diagnosis and adequate treatment cannot be overemphasized to avoid mismanagement and complications.
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Affiliation(s)
- Charu Singh
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Silky Silky
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | | | - Tejaswi Gupta
- Mayo Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Mohit Sinha
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Pooja Sharma
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
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Marchese MR, Rossi F, Settimi S, Galli J. Late Prevalence of Typical and Atypical Symptoms of Frey's Syndrome after Parotidectomy for Benign Tumor. J Pers Med 2024; 14:96. [PMID: 38248797 PMCID: PMC10820002 DOI: 10.3390/jpm14010096] [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: 10/29/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of surgical procedure, the most common complication is Frey's syndrome (FS). Traditionally, FS includes unilateral gustatory sweating and flushing of the facial skin lining the parotid compartment. Recent research describes atypical discomfort associated with FS. The aim of this study was to assess the late prevalence and severity of both usual and atypical symptoms after parotidectomy for benign tumors. METHODS We conducted a cross-sectional study involving 86 subjects who underwent superficial parotidectomy at least one year before the study. The questionnaire included the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale supplemented by specific questions about symptoms. RESULTS Sixty-seven out of eighty-six (77.9%) cases reported almost one symptom. The most frequent symptom was itch (36/67-53.7%), followed by pain (35/67-52.2%), while 28/67 (41.8%) subjects complained of atypical symptoms without flushing or sweating. A desire to treat the discomfort was reported by 50/67 (74.6%) subjects. CONCLUSIONS Late postparotidectomy local discomfort is not infrequent and includes both usual and "unusual" symptoms almost equally. Our results suggest the importance of informing patients about the occurrence of the syndrome and the available treatment options during pre- and postoperative counseling.
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Affiliation(s)
- Maria Raffaella Marchese
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
| | - Federica Rossi
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Stefano Settimi
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Jacopo Galli
- Otolaryngology Division, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (M.R.M.); (J.G.)
- Section of Otolaryngology, Head-Neck and Sense Organs Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
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Palma LF, Porfírio TDS, Serrano RV, Campos L, de Moraes LOC. Photobiomodulation Therapy for Managing Motor and Sensory Dysfunctions Following Temporomandibular Joint Surgery: A Case Report. J Lasers Med Sci 2023; 14:e67. [PMID: 38318222 PMCID: PMC10843219 DOI: 10.34172/jlms.2023.67] [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: 09/08/2023] [Accepted: 11/10/2023] [Indexed: 02/07/2024]
Abstract
Introduction: Surgical procedures involving the temporomandibular joint (TMJ) are frequently associated with nerve injuries and subsequent dysfunctions. Considering that traumatic peripheral nerve injuries may resolve slowly and their prognosis is generally unpredictable, the current study aimed to report a clinical case in which both motor (affecting the temporal and zygomatic branches of the facial nerve) and sensory dysfunctions (affecting the auriculotemporal nerve of the trigeminal nerve) following TMJ surgery were effectively treated by using photobiomodulation therapy (PBMT). Case Report: PBMT sessions, involving a total of 30 facial points, were administered twice a week for 10 weeks. The following parameters were utilized: wavelength of 808 nm, energy density of 75 J/cm2, power output of 100 mW, total energy of 3 J, and duration of 30 seconds per point. A considerable improvement in both facial asymmetry and muscle function was achieved within 5 weeks, along with a total restoration of cutaneous sensitivity. By the 10th week of PBMT, the facial movement dysfunction was completely resolved. Conclusion: According to the current case, PMBT seems to be an effective intervention to manage motor and sensory nerve dysfunctions following TMJ surgery.
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Affiliation(s)
- Luiz Felipe Palma
- Department of Pathology, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Luana Campos
- Graduate Program in Implantology, University of Santo Amaro, School of Dentistry, São Paulo, SP, Brazil
| | - Luís Otávio Carvalho de Moraes
- Department of Pathology, Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, SP, Brazil
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Kostares E, Kostares M, Kostare G, Kantzanou M. Prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures: a systematic review and meta-analysis. F1000Res 2023; 12:1153. [PMID: 38106653 PMCID: PMC10721962 DOI: 10.12688/f1000research.140994.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.
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Affiliation(s)
- Evangelos Kostares
- Microbiology, National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
| | - Michael Kostares
- National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
| | - Georgia Kostare
- National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
| | - Maria Kantzanou
- Microbiology, National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
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Wu Y, Lan Y, Mao J, Shen J, Kang T, Xie Z. The interaction between the nervous system and the stomatognathic system: from development to diseases. Int J Oral Sci 2023; 15:34. [PMID: 37580325 PMCID: PMC10425412 DOI: 10.1038/s41368-023-00241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
The crosstalk between the nerve and stomatognathic systems plays a more important role in organismal health than previously appreciated with the presence of emerging concept of the "brain-oral axis". A deeper understanding of the intricate interaction between the nervous system and the stomatognathic system is warranted, considering their significant developmental homology and anatomical proximity, and the more complex innervation of the jawbone compared to other skeletons. In this review, we provide an in-depth look at studies concerning neurodevelopment, craniofacial development, and congenital anomalies that occur when the two systems develop abnormally. It summarizes the cross-regulation between nerves and jawbones and the effects of various states of the jawbone on intrabony nerve distribution. Diseases closely related to both the nervous system and the stomatognathic system are divided into craniofacial diseases caused by neurological illnesses, and neurological diseases caused by an aberrant stomatognathic system. The two-way relationships between common diseases, such as periodontitis and neurodegenerative disorders, and depression and oral diseases were also discussed. This review provides valuable insights into novel strategies for neuro-skeletal tissue engineering and early prevention and treatment of orofacial and neurological diseases.
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Affiliation(s)
- Yuzhu Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yanhua Lan
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiajie Mao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiahui Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Ting Kang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
| | - Zhijian Xie
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
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Ameen M, Lynch F, Sadlier M. Unilateral gustatory facial flushing in a child. JAAD Case Rep 2023; 38:163-165. [PMID: 37600737 PMCID: PMC10433283 DOI: 10.1016/j.jdcr.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Mohammed Ameen
- Department of Dermatology, University Hospital Limerick, Co. Limerick, Ireland
| | - Fiona Lynch
- Department of Dermatology, University Hospital Limerick, Co. Limerick, Ireland
| | - Muriel Sadlier
- Department of Dermatology, University Hospital Limerick, Co. Limerick, Ireland
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Yaşar EK, Polat B, Alagöz MŞ. Brief Clinical Study: An Alternative Method to Prevent Frey Syndrome After Resection of Huge Masses in Parotis: De-epithelialized Skin Flap Use. J Craniofac Surg 2023; Publish Ahead of Print:00001665-990000000-00736. [PMID: 37236619 DOI: 10.1097/scs.0000000000009417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 05/28/2023] Open
Abstract
Frey syndrome is still a significant problem in postparotidectomy patients 6 to 18 months after surgery. The most accepted theory of the pathogenesis of Frey syndrome is the aberrant regeneration theory. Creating a barrier between the remnant parotid gland and the overlying skin prevents Frey syndrome. A 51-year-old female patient who developed pleomorphic adenoma in the parotid gland was operated. After superficial parotidectomy, a barrier between the underlying postganglionic parasympathetic nerves in the deep parotid gland and the overlying cutaneous tissue was created with a local skin flap to prevent Frey syndrome. The patient was successfully treated, and she was followed up to 5 years. No postoperative complications were observed. No signs of Frey syndrome were found in follow-up. This case highlights that local skin flaps can be an innovative natural method as it is a quick and simple method to create this barrier in the presence of expanded skin.
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Affiliation(s)
- Emrah Kağan Yaşar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kocaeli University Faculty of Medicine Plastic, Kocaeli, Turkey
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Forehead and scalp gustatory sweating after temporomandibular joint surgery: an atypical presentation of Frey's syndrome. Clin Auton Res 2023; 33:201-203. [PMID: 36843185 DOI: 10.1007/s10286-023-00931-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/31/2023] [Indexed: 02/28/2023]
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Martínez-Ruiz-Coello MDM, Hernández-García E, Miranda-Sánchez E, García-García C, Arenas-Brítez Ó, Plaza-Mayor G. Tratamiento quirúrgico de la patología tumoral de la glándula parótida. Estudio descriptivo de 263 parotidectomías. REVISTA ORL 2022. [DOI: 10.14201/orl.29831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introducción y objetivo: Los tumores salivales representan el 3-10% de los tumores de cabeza y cuello, siendo el 75-80% de origen parotídeo y en su mayoría benignos. La parotidectomía es una técnica quirúrgica que consiste en la exéresis de la glándula parótida. Existen diversos tipos; parotidectomía superficial (PS), parotidectomía superficial parcial (PSP) y parotidectomía total (PT). En esta última, al no respetarse el nervio facial (NF), las complicaciones son más frecuentes. Nuestro objetivo es analizar el resultado (tasa de recidiva y complicaciones) de la parotidectomía como técnica quirúrgica empleada en el manejo de la patología parotídea, así como evaluar qué prueba complementaria es la más eficaz en el diagnostico prequirúrgico de la patología parotídea tumoral. Material y método: Se realiza un estudio retrospectivo incluyendo 263 pacientes tratados mediante PS o PT entre enero de 2004 y diciembre de 2020 en el Hospital Universitario de Fuenlabrada. Se registraron datos demográficos, tiempo de evolución de la lesión, pruebas complementarias, protocolo quirúrgico y complicaciones postoperatorias. Se analiza principalmente la correlación positiva entre las pruebas realizadas prequirúrgicas (PAAF, ecografía, TC y RMN), con el diagnóstico definitivo anatomopatológico obtenido tras examinar la pieza quirúrgica. También se describe la tasa de paresia y parálisis facial y otras complicaciones habidas. Resultados: Se incluyeron 263 pacientes tratados mediante parotidectomía. El tiempo de evolución medio de las lesiones parotídeas fue de 15 meses (DE 19.88). La sensibilidad de la PAAF en nuestro estudio fue de 68.7%. Se realizó ecografía en un 44.10% de los pacientes, TC en un 77.94% y RMN en un 15.20%, mostrando una sensibilidad de 18.05%, 31.21% y 45%, respectivamente. La cirugía más frecuente fue la PS (43.3%, 114/263), seguida por la PSP (41.1%, 108/263) y, por último, la menos habitual fue la PT (15.58%, 41/263). Los tumores benignos fueron más frecuentes (84.79%, 223/263), siendo el adenoma pleomorfo el más frecuente, 45.73% (102/223). Dentro del grupo de tumores malignos (15.20%, 40/263), el más habitual fue el carcinoma mucoepidermoide (17.5%, 7/40) y las metástasis (17.5%, 7/40). La paresia facial, según la escala de House-Brackmann, fue leve (grado I y II) y transitoria en la mayoría de los casos, apareciendo en un 31.55%. Tras un periodo medio de seguimiento de 6 años no se han encontrado recidivas post parotidectomía por ningún tipo tumoral en nuestro estudio. Conclusión: En nuestra muestra, los tumores benignos representaron la gran mayoría de la patología parotídea. Dentro de este grupo, el adenoma pleomorfo fue el más frecuente. La PAAF fue la prueba complementaria con mejor correlación con el diagnostico anatomopatológico definitivo, seguida por la RMN. La paresia facial leve (grados I y II) y transitoria fue la complicación postquirúrgica mas habitual.
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Golding CN, Larsen DG. The incidence of Frey syndrome and treatment with botulinum toxin in the Central Denmark Region. Laryngoscope Investig Otolaryngol 2022; 7:1814-1819. [PMID: 36544974 PMCID: PMC9764752 DOI: 10.1002/lio2.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/19/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Frey syndrome (FS) is a common complication to large salivary glands surgery. This study primarily aims to describe the incidence of FS among parotid surgery patients in the Central Denmark Region. The secondary aim is to describe predisposing characteristics to syndrome development and the effect of treatment with botulinum toxin (Botox) injection. Methods This is a retrospective qualitative study spanning the years 2015-2020. Data on patients diagnosed with FS after parotid surgery with symptoms severe enough to require Botox was extracted from electronic patient records. Incidence of FS development was calculated using data from all parotid gland surgeries in the same period and region. Results The incidence of treatment-requiring FS was 2.6% (20/775), with an annual incidence ranging from 0.8% (1/125) in 2017 to 4.5% (5/112) in 2016. Difference in FS development for men and women was not statistically significant (p = .07), although it was significantly more common after total parotidectomy compared to superficial resection (p = .003), and after malignant compared to benign diagnosis (p = .01). Complications in the postoperative period arose for 30% of FS patients. Repeated treatment with Botox was necessary after 6-12 months and at a median interval of 11 months. Forty-five percent of patients received only one injection. The average dose per injection was 48.3 IU. Conclusion This study revealed a rather low incidence of FS in the Central Denmark Region compared to current international literature. Total parotidectomy and malignant diagnosis predisposed to syndrome development. Botox injection had a wide-ranging effective duration but typically lasted for around 1 year. Level of evidence Level IV.
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Affiliation(s)
- Christian N. Golding
- Department of Otorhinolaryngology, Head and Neck SurgeryAarhus University HospitalAarhusDenmark
| | - Dalia G. Larsen
- Department of Otorhinolaryngology, Head and Neck SurgeryAarhus University HospitalAarhusDenmark
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15
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Pleomorphic adenoma of the parotid gland. JAAPA 2022; 35:54-56. [DOI: 10.1097/01.jaa.0000854504.04227.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yin S, Han Y, Liu Y, Chen B, Fu Z, Sheng S, Wang J, Shen C, Wang X, Jia Y. Comparison of various surgical incisions in parotidectomy: A systematic review and network meta-analysis. Front Oncol 2022; 12:972498. [PMID: 35992792 PMCID: PMC9389557 DOI: 10.3389/fonc.2022.972498] [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: 06/18/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background This network meta-analysis aimed to comprehensively compare the operative and postoperative outcomes of different parotidectomy incisions. Methods Embase, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials were searched up to April 2022. A complete Bayesian network meta-analysis was performed using the Markov Monte Carlo method in OpenBUGS. Results Seventeen studies with 1609 patients were included. Thirteen were retrospective cohort studies, three were prospective cohort studies, and one was a randomized controlled study. The quality of evidence was rated as very low in most comparisons. The incision satisfaction score of the modified facelift incision (MFI), retroauricular hairline incision (RAHI), V-shaped incision (VI) were higher than that of the modified Blair incision (MBI) (MBI vs. MFI: mean difference [MD] -1.39; 95% credible interval [CrI] -2.23, -0.57) (MBI vs. RAHI: MD -2.25; 95% CrI -3.40, -1.12) (MBI vs. VI: MD -2.58; 95% CrI -3.71, -1.46); the tumor size treated by VI was smaller than that by MBI (MD 5.15; 95% CrI 0.76, 9.38) and MFI (MD 5.16; 95% CrI 0.34, 9.86); and the risk of transient facial palsy in the MFI was lower than that in the MBI (OR 2.13; 95% CrI 1.28, 3.64). There were no differences in operation time, drainage volume, wound infection, hematoma, salivary complications, Frey syndrome, or permanent facial palsy between incision types. Conclusion The traditional MBI is frequently used for large tumor volumes, but the incision satisfaction score is low and postoperative complication control is poor. However, emerging incisions performed well in terms of incision satisfaction scores and control of complications. More randomized controlled trials are needed to compare the different parotidectomy incisions. Patients should be fully informed about the characteristics of each incision to make the most informed decision, along with the physician’s advice. Systematic Review Registration PROSPERO, identifier CRD42022331756
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Affiliation(s)
- Siyue Yin
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Medical University, Hefei, China
| | - Yanxun Han
- Anhui Medical University, Hefei, China
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuchen Liu
- Anhui Medical University, Hefei, China
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bangjie Chen
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Medical University, Hefei, China
| | - Ziyue Fu
- Anhui Medical University, Hefei, China
| | | | | | | | | | - Yiwen Jia
- Department of Gastroenterology, The Third Affiliated Hospital of Anhui Medical University (Hefei first people’s Hospital), Hefei, China
- *Correspondence: Yiwen Jia,
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17
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Salingar O, Borghol K, Wu E, Thomas S, Gahir D. BEAVERTAIL modification of the radial forearm free flap in primary Parotidectomy reconstruction: Technique and outcomes. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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Effectiveness of the Fibrinogen-Thrombin-Impregnated Collagen Patch in the Prevention of Postoperative Complications after Parotidectomy: A Single-Blinded, Randomized Controlled Study. J Clin Med 2022; 11:jcm11030746. [PMID: 35160200 PMCID: PMC8836986 DOI: 10.3390/jcm11030746] [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: 01/17/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/10/2022] Open
Abstract
We investigated whether a fibrinogen-thrombin collagen sponge patch reduces postoperative complications of parotid gland surgery. This single-blinded, randomized controlled study included 165 patients who underwent parotid surgery for benign tumors (2018–2019) at a tertiary center. Primary outcomes were postoperative drain amount, days until drain removal, and discharge. Patients were scheduled for follow-up at 1 and 4 weeks, and 3 months after surgery. Complications including surgical site infection, pain, seroma, sialocele, salivary fistula, facial nerve palsy, Frey’s syndrome with subjective symptoms, and facial asymmetry were analyzed. After identifying confounding variables, multivariate approaches were used. Histologic analysis was performed in a mouse model of salivary gland surgery. In total, 162 patients (77, fibrinogen-thrombin collagen patch group; 85, controls) were included, with no significant between-group differences other than resected tissue. Among postoperative total drain amount and days until drain removal and discharge, the only postoperative total drain was significantly lower in the patch group than in the control group in the adjusted model. Additionally, although validation through robust trials with longer follow-up is needed, we found the potential benefit of the fibrinogen patch on Frey’s syndrome and facial asymmetry. In conclusion, fibrinogen-thrombin-impregnated collagen patches in parotidectomy can reduce postoperative drainage and improve outcomes.
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19
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Auriculotemporal Frey syndrome not associated with surgery or diabetes: systematic review. Eur J Pediatr 2022; 181:2127-2134. [PMID: 35182195 PMCID: PMC9056449 DOI: 10.1007/s00431-022-04415-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
Patients who undergo salivary gland, neck, or facelift surgery or suffer from diabetes mellitus often develop Frey syndrome (also known as auriculotemporal syndrome or gustatory sweating). Frey syndrome has been occasionally reported to occur in subjects without history of surgery or diabetes but this variant of Frey syndrome has not been systematically investigated. We searched for original articles of Frey syndrome unrelated to surgery or diabetes without date and language restriction. Article selection and data extraction were performed in duplicate. Our systematic review included 76 reports describing 121 individual cases (67 males and 54 females) of Frey syndrome not associated with surgery or diabetes. The age at onset of symptoms was ≤ 18 years in 113 (93%) cases. The time to diagnosis was 12 months or more in 55 (45%) cases. On the other hand, an allergy evaluation was performed in half of the cases. A possible cause for Frey syndrome was detected in 85 (70%) cases, most frequently history of forceps birth (N = 63; 52%). The majority of the remaining 22 cases occurred after a blunt face trauma, following an auriculotemporal nerve neuritis or in association with a neurocutaneous syndrome. The cause underlying Frey syndrome was unknown in 36 cases. Conclusion: Frey syndrome not associated with surgery or diabetes almost exclusively affects subjects in pediatric age and is uncommon and underrecognized. Most cases occur after forceps birth. There is a need to expand awareness of this pseudo-allergic reaction among pediatricians and allergists. What is Known: • Pre-auricular reddening, sweating, and warmth in response to mastication or a salivary stimulus characterize Frey syndrome. • It usually occurs after salivary gland surgery and in diabetes. What is New: • In children, Frey syndrome is rare, and most cases occur after a forceps-assisted birth. • In childhood, this condition is often erroneously attributed to food allergy.
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20
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Patel S, Ziai K, Lighthall JG, Walen SG. Biologics and acellular dermal matrices in head and neck reconstruction: A comprehensive review. Am J Otolaryngol 2022; 43:103233. [PMID: 34537508 DOI: 10.1016/j.amjoto.2021.103233] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Acellular dermal matrices (ADMs) have been studied extensively in the literature and have gained popularity for various reconstructive and aesthetic purposes. ADMs are composed of a basement membrane and acellular dermal layer of collagen and provide a platform for mucosal epithelization and neovascularization. Combining dermal collagen and essential growth factors allows ADMs to support adequate wound healing and bolster soft-tissue repairs. These dermal matrices can be derived from human cadaveric donor skin (allogenic) or mammalian donor sources (xenogeneic). These dermal substitutes provide the benefit of reducing or eliminating the need for autologous tissue grafts and subsequently minimize donor site morbidity. Many ADMs are currently available in the market, each with variations in processing, manufacturing, storage, preparation, and use. The literature validating ADMs in the head and neck for both cosmetic and reconstructive purposes is evolving rapidly. This review aims to provide an up-to-date and comprehensive overview of the principles of acellular dermal matrices (ADMs), the different types of ADMs, and evaluate common indications, techniques, and outcomes pertaining to select anatomic sites in the head and neck reconstruction.
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Affiliation(s)
- Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Scott G Walen
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
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21
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Ştefănescu EH, Mogoantă CA, Căluianu EI, Predescu OI, Florou C, Chercotă V, Iovănescu G. Benign tumors of the superficial lobe of the parotid gland. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:563-567. [PMID: 36588495 PMCID: PMC9926149 DOI: 10.47162/rjme.63.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tumors of the parotid gland are a rare occurrence among head and neck tumors (only 3-8%), and the vast majority are benign. Most benign tumors of the parotid gland are pleomorphic adenoma (PA), followed by Warthin's tumor (WT) and they occur in the superficial lobe. The only reasonable treatment is considered to be total tumor removal, but the appropriate surgical approach remains a matter of controversy. Over time, it went from enucleation to superficial parotidectomy (SP) and then to extracapsular dissection (ECD). SP is often considered to be the "gold standard"; however, the risk of intraoperative damage to the facial nerve (FN) cannot be ignored. Lately, ECD - which does not expose the main trunk of the FN - has been regarded as a safe technique for the treatment of small benign parotid tumors. PATIENTS, MATERIALS AND METHODS The study retrospectively reviewed all parotidectomies for benign parotid tumors of the superficial lobe performed in the Department of ENT, Municipal Emergency Clinical Hospital, Timişoara, Romania, between January 2014 and December 2018. The following patient data were collected: age; sex; follow-up duration; extension of the resection; use of FN monitoring and lesion features, including position, pathology, and size. Preoperative investigation protocol included a computed tomography (CT) scan to assess the size and location of the tumor helping the treatment planning. The same surgical team performed both standard SP and ECD for the treatment of these tumors. All cases were confirmed as benign parotid tumors. Recurrences of any kind and tumors involving the deep lobe of the gland were excluded from the study. All patients underwent a macroscopically complete resection of the tumor. The main outcome was the postoperative complications in the two groups. Data regarding these complications were recorded on follow-up visits at one, six, 12 and 24 months. RESULTS Ninety-five patients with benign parotid tumors were operated by the same surgical team at the Department of ENT, Municipal Emergency Clinical Hospital, Timişoara, between January 2014 and December 2018 but only 89 (38 men and 51 women) met the follow-up criteria and were included in the study. Sixteen (18%) patients underwent ECD, and 73 (82%) patients underwent SP as a primary intervention. The mean lesion size for ECD group was 2.0±0.9 cm and 4.2±1.7 cm in the SP group, and it was statistically significant (p<0.05). As expected, the most common type of tumor was PA but the distribution between the groups was different: in the SP group, PA represents 83% (61∕73) of cases but only 44% (7∕16) of cases in the ECD group. Median follow-up time was comparable in the two groups - 33±8 months for the ECD group and 39±11 months for the SP group. There were also differences between the two groups regarding the postoperative complication rate. There were significantly more transient and permanent FN paralysis, transient and permanent great auricular nerve (GAN) dysfunctions and Frey's syndrome (FS) in the SP group. CONCLUSIONS A comparison between ECD and SP as surgical procedures for the treatment of benign tumors of the parotid seems inappropriate as their indications do not overlap. ECD showed similar effectiveness and fewer side effects than SP and can be considered the treatment of choice for small, superficial and/or marginal tumors located in the lateral lobe of the parotid gland.
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Affiliation(s)
- Eugen Horaţiu Ştefănescu
- Department of ENT, Department of Nursing Surgery, University of Medicine and Pharmacy of Craiova, Romania; ;
| | | | - Elena Irina Căluianu
- Department of Nursing Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Octavian Ion Predescu
- Department of Nursing, Faculty of Nursing, Târgu Jiu Subsidiary, Titu Maiorescu University, Bucharest, Romania
| | - Charoula Florou
- Department of Forensic Medicine, General University Hospital of Larissa, Greece
| | - Vlad Chercotă
- Department of Ophthalmology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Gheorghe Iovănescu
- Department of ENT, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
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22
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Mantelakis A, Lafford G, Lee CW, Spencer H, Deval JL, Joshi A. Frey's Syndrome: A Review of Aetiology and Treatment. Cureus 2021; 13:e20107. [PMID: 34873562 PMCID: PMC8638782 DOI: 10.7759/cureus.20107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/05/2022] Open
Abstract
First described by Polish Neurologist Łucja Frey in 1923, Frey's syndrome (FS), or auriculotemporal syndrome, is a rare condition characterised by gustatory sweating, typically encountered as sequelae following invasive head and neck surgery. The pathophysiology of FS can be described by aberrant reinnervation of postganglionic parasympathetic neurons to the surrounding denervated sweat glands and cutaneous blood vessels. Multiple invasive procedures have been associated with FS ranging from salivary gland surgery to burn reconstruction and thoracoscopic sympathectomies. Rarely, FS can be secondary to trauma or non-surgical aetiologies, including diabetes and infection. Physical symptoms vary based on the severity and surface area affected by FS and range from mild symptoms to severe psychosocial morbidity for patients. Surgeons operating in the head and neck, including otolaryngologists, maxillofacial surgeons, and plastic surgeons, should be aware of this potential complication and be up to date with diagnosis and treatment strategies for FS. This review article summarises the literature relating to FS focusing on its aetiologies, symptomatology, prevention, and available treatments, aiming to provide an up-to-date review of this condition for surgeons operating in the head and neck region. Although various treatment options have been suggested, these are often limited to topical agents that require life-long administration for symptom control. Further research is recommended to identify the optimal treatment for this condition and the role of surgery as a treatment for severe or refractory cases.
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Affiliation(s)
- Angelos Mantelakis
- Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
| | - George Lafford
- Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
| | - Chang Woo Lee
- Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, GBR
| | - Harry Spencer
- Plastic and Reconstructive Surgery, St. George's University Hospitals NHS Foundation Trust, London, GBR
| | - Jean-Luc Deval
- Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Anil Joshi
- Otolaryngology - Head and Neck Surgery, Lewisham and Greenwich NHS Trust, London, GBR
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23
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Loke WL, Rahimi S, Brennan PA. An update on extracapsular dissection for the management of parotid gland pleomorphic adenoma. J Oral Pathol Med 2021; 51:219-222. [PMID: 34697837 DOI: 10.1111/jop.13251] [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: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
Superficial parotidectomy has been the gold standard for surgical removal of benign mobile parotid gland tumours. The comparatively newer technique of extracapsular dissection, which involves careful dissection of the tumour itself without the need for formal gland excision, has gained popularity in recent years. Tumours can be removed via smaller incision, and the technique reduces the risk of Frey's syndrome (gustatory sweating) and hollowing at the site of surgery. The risk of facial nerve damage can also be lower with extracapsular dissection. If done carefully, the incidence of tumour recurrence, particularly for pleomorphic adenomas, is comparable with formal parotidectomy. We provide a brief update overview of the current evidence for extracapsular dissection in the treatment of benign parotid tumours and include several meta-analyses which provide evidence for the safety of the technique. We have also included our audited results of over 100 recent extracapsular dissections, with 0% incidence of permanent facial nerve weakness, reported Frey's syndrome and recurrence rates over the last 5 years.
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Affiliation(s)
- Wee Lee Loke
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, UK
| | - Siavash Rahimi
- Department of Histopathology, IDI-IRCCS, Rome, Italy.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, UK
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24
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Grijsen ML, van Zuuren EJ. Gustatory Hyperhidrosis. JAMA Dermatol 2021; 157:1497. [PMID: 34668927 DOI: 10.1001/jamadermatol.2021.3303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marlous L Grijsen
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England
| | - Esther J van Zuuren
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
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25
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Abstract
Although a rare sequala of soft tissue injury, salivary gland trauma may result in significant morbidity. Salivary gland injury can involve the major as well as the minor glands. Because of the proximity of adjacent vital structures, a thorough history and physical examination are mandatory during patient evaluation. Trauma to the major salivary glands may involve the parenchyma, duct, or neural injury. Treatment requires adherence to primary principles of soft tissue management. Ductal and neural injury should be repaired primarily. Sialocele and fistula are potential complications of repaired and unrepaired salivary gland injury.
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Affiliation(s)
- Raymond P Shupak
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, 1500 South Main Street, Fort Worth, TX 76104, USA.
| | - Fayette C Williams
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, 1500 South Main Street, Fort Worth, TX 76104, USA
| | - Roderick Y Kim
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, 1500 South Main Street, Fort Worth, TX 76104, USA
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26
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Hignett SM, Judd O. Frey's syndrome: A review of the physiology and possible role of neurotrophic factors. Laryngoscope Investig Otolaryngol 2021; 6:420-424. [PMID: 34195362 PMCID: PMC8223467 DOI: 10.1002/lio2.559] [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] [Received: 01/13/2021] [Revised: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Frey's syndrome (FS) describes the phenomenon of gustatory sweating and is a cause of significant social embarrassment for sufferers. It has been attributed to aberrant growth of parasympathetic salivatory fibers in the auriculotemporal nerve toward overlying sweat glands. However, the exact mechanism behind this growth is unknown. This review aims to expand and elucidate the theory of aberrant regeneration in FS. METHODS A review of the recent literature on nerve regeneration was conducted in order develop further insights into the etiology of both adult onset and pediatric FS. RESULTS Neurturin, a neurotrophic factor released by both salivary and sweat glands, was identified as a possible key player in the etiology of FS. CONCLUSION Further research into the role of neurturin could help to elucidate the pathogenic mechanisms underlying the condition and might reveal neurturin to be a potential target for pharmacological intervention. LEVEL OF EVIDENCE NA (Basic Science Review).
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Affiliation(s)
| | - Owen Judd
- Department of OtolaryngologyRoyal Derby HospitalDerbyUK
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27
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Chowdhury R, Roy D, Roy A. Management of parotid fistula and Frey's syndrome with Botulinum neurotoxin type A. Natl J Maxillofac Surg 2021; 12:106-108. [PMID: 34188411 PMCID: PMC8191560 DOI: 10.4103/njms.njms_72_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/15/2020] [Accepted: 07/09/2020] [Indexed: 11/13/2022] Open
Abstract
The common cause of parotid fistula is parotid gland surgery and is frequently due to injury to the gland rather than to the duct. The frequency of postparotidectomy fistula is 14%. Other causes include facial trauma, congenital anomalies of the parotid gland, malignancies originating from the parotid gland and infections. Although there are several options for the treatment of parotid fistula and Frey's syndrome, very few treatment options are deemed optimal. The use of Botulinum A neurotoxin as a conservative method of treatment for parotid fistula and Frey's syndrome is a recent and evolving concept.
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Affiliation(s)
- Ripon Chowdhury
- Department of Oral and Maxillofacial Pathology, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Dev Roy
- Department of ENT, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Abhimanyu Roy
- Department of ENT, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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Tunca M, Süslü NS, Karaosmanoğlu AA. Fat transfer after parotidectomy: fat resorption rates, aesthetic and functional outcomes of en-bloc fat graft versus lipofilling technique. Eur Arch Otorhinolaryngol 2021; 278:3933-3940. [PMID: 33471168 DOI: 10.1007/s00405-020-06570-y] [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: 11/09/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Reconstruction of parotidectomy involves the correction of facial contour abnormalities and prevention from Frey Syndrome. Reconstruction of parotidectomy field with autologous fat has not been popular among head and neck surgeons due to unclear predictability of fat resorption rates. The aim of this paper is to compare the fat resorption rates between different fat transfer techniques using radiologic measurements and reviewing the aesthetic and functional outcomes. METHODS We retrospectively reviewed medical records of patients, who underwent parotidectomy in Hacettepe University Hospital between 2015 and 2018. The aesthetic and functional outcomes of en-bloc fat graft and lipofilling techniques were compared among themselves, as well as with patients who had no reconstruction, using objective parameters. Fat resorption rates were compared using calculation of fat volumes obtained by MRI scans, 1 year after surgery. RESULTS Among 77 patients, 26 underwent reconstruction with en-bloc fat graft (P-EBFG); 21 patients reconstruction with lipofilling technique (P-LFT), whereas 30 patients had no reconstruction of parotidectomy field (P-NR). In three groups, there was no statistically significant difference in mean resected parotid tissue volumes (mean 18 ± 10.8 cm3, p = 0.754). We found a significant difference in decreased presence of Frey Syndrome and increased satisfation rates of cosmetic appearance in P-EBFG and P-LFT, in comparison to P-NR (p < 0.001). There was no significant difference in fat resorption rates between P-EBFG (50.75 + 21.20%) and P-LFT (48.59 + 17.93%) (p = 0.771). CONCLUSION Both en-bloc fat graft and lipofilling techniques have been found to be safe and to have similar fat resorption rates for reconstruction after parotidectomy.
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Affiliation(s)
- Merve Tunca
- Department of Otorhinolaryngology-Head and Neck Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey
| | - Nilda Sütay Süslü
- Department of Otorhinolaryngology-Head and Neck Surgery, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey.
| | - Ayça A Karaosmanoğlu
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ganesan A, Rao B. Frey's syndrome: A misdirected reflex action!! – A case report. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2021. [DOI: 10.4103/jiaomr.jiaomr_207_21] [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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30
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Sahoo A, Patro S, Swain N, Mohapatra K, Barik H, Pattnayak P. Posterior belly of digastric muscle transposition flap in preventing frey's syndrome after superficial parotidectomy- A prospective study. Ann Maxillofac Surg 2021; 11:266-269. [PMID: 35265496 PMCID: PMC8848698 DOI: 10.4103/ams.ams_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/23/2021] [Accepted: 07/10/2021] [Indexed: 11/04/2022] Open
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Deschler DG, Kozin ED, Kanumuri V, Devore E, Shapiro C, Koen N, Sethi RK. Single-surgeon parotidectomy outcomes in an academic center experience during a 15-year period. Laryngoscope Investig Otolaryngol 2020; 5:1096-1103. [PMID: 33364399 PMCID: PMC7752052 DOI: 10.1002/lio2.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered. MATERIALS AND METHODS All patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed. RESULTS A total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, P < .0001). Among patients with intact FN, post-operative short- and long-term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short- and long-term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes. CONCLUSION This is the largest single-surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long- and short-term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Daniel G. Deschler
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
| | - Elliott D. Kozin
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
| | - Vivek Kanumuri
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
| | - Elliana Devore
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
| | - Chandler Shapiro
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of OtolaryngologyMassachusetts Eye and EarBostonMassachusettsUSA
| | - Nicholas Koen
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Rosh K.V. Sethi
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
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Kriegsman B, Harrison S, Sobin L. Women and Minorities in Otolaryngology: A Historical Perspective and Analysis of Current Representation. Otolaryngol Clin North Am 2020; 54:233-238. [PMID: 33153735 DOI: 10.1016/j.otc.2020.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the course of the last century, otolaryngology-head and neck surgery has made significant medical and surgical advancements. Several of these efforts are credited to women and minorities despite their having faced systemic barriers to entering medical schools and the medical professions. This article highlights some of these pioneering doctors and their contributions to the field. Additionally, the current representation of women and minorities in otolaryngology residency programs and the gender and racial disparities in academic positions are reviewed. The need for mentorship during undergraduate medical education to improve diversity and inclusion within this surgical subspecialty is reinforced.
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Affiliation(s)
- Barry Kriegsman
- University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Scott Harrison
- Boston Architectural College, Boston, 320 Newbury Street, Boston, MA 02115, USA
| | - Lindsay Sobin
- Department of Otolaryngology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Mlees MA, Elbarbary AH. Superficial or partial superficial parotidectomy for the treatment of primary benign parotid tumors. J Surg Oncol 2020; 122:1315-1322. [DOI: 10.1002/jso.25970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Mohamed Ali Mlees
- Surgical Oncology Unit, General Surgery Department Tanta University Hospitals Tanta Egypt
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Zou HW, Gao J, Liu JX, Qu ZL, Du ZS, Zhao H, Zhao M, Chen HY. Feasibility and advantages of endoscope-assisted parotidectomy: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2020; 59:503-510. [PMID: 33845989 DOI: 10.1016/j.bjoms.2020.08.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/10/2020] [Indexed: 02/01/2023]
Abstract
The object of this paper was to explore the feasibility and advantages of endoscope-assisted parotid tumour resection. Three databases (PubMed, Web of Science, and Cochrane) were used to search for all related randomised controlled trials or controlled trials (up to November 2019). The key parameters for assessment included 'Endoscope', 'Endoscopes', 'Cancer of Parotid', and 'Parotid Cancer'. To evaluate the feasibility and advantages of endoscope-assisted resection of parotid tumours, the data for each parameter were pooled, based on patients who received endoscope-assisted surgery and those who received conventional surgery. This meta-analysis included seven studies, involving 170 patients in the endoscopy group and 270 patients in the control group. The analysis using the pooled data showed that there were no significant differences in the operating times between the two groups; however, the endoscopy group had significantly shorter incisions and less intraoperative bleeding. In addition, the patients who received endoscope-assisted surgery had lower incidences of temporary facial paralysis and Frey's syndrome after surgery. Patients in the endoscopy group had greater postoperative satisfaction. Endoscope-assisted parotid tumour resection results in only a small, concealed incision wound and fewer postoperative complications. Therefore, it is promising for the surgical treatment of parotid tumours.
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Affiliation(s)
- H-W Zou
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; School of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - J Gao
- Department of Stomatology, Xintai Hospital of Traditional Chinese Medicine, Taian, China
| | - J X Liu
- Department of Pediatrics, Rongcheng Municipal Traditional Chinese Medicine Hospital, Rongcheng, China
| | - Z-L Qu
- Department of Stomatology, Shandong Medical College, Jinan, China
| | - Z-S Du
- Xihu Xixi Community Health Service Center, Hangzhou, China
| | - H Zhao
- School of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - M Zhao
- Department of Emergency, Qilu Hospital, Shandong University.
| | - H-Y Chen
- School of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China.
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35
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Mantelakis A, Spencer H, Duval JL, Joshi A. Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Petrides GA, Subramaniam N, Pham M, Clark JR. Reducing the morbidity of parotidectomy for benign pathology. ANZ J Surg 2020; 90:2315-2321. [PMID: 32483863 DOI: 10.1111/ans.16008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conservative surgical approaches, reconstructive techniques and technology are increasingly used in parotid surgery. The aim of this study was to determine the surgeon-modifiable factors which impact the rates of post-operative complications following parotidectomy for benign pathology. METHODS A retrospective cohort study of patients undergoing parotidectomy for benign pathology by or under the supervision of the senior author between 2006 and 2019 was performed. Clinicopathological variables, operative techniques and post-operative complications were recorded using standardized templates. Multivariable logistic regression models were used to obtain odds ratios (ORs) whilst adjusting for the effect of other clinically relevant covariates. RESULTS In total, 357 parotidectomies were performed. Independent factors associated with post-operative facial paresis were re-operative surgery (OR 3.51, 95% CI 1.19-10.33, P = 0.023), nerve integrity monitoring (OR 0.50, 95% CI 0.26-0.99, P = 0.046) and operation type, with focused tumour dissection (FTD) having the lowest rate of paresis (OR 0.19, 95% CI 0.040-0.92, P = 0.038) compared to limited parotidectomy. Factors associated with reduced wound complications on adjusted analysis were dermofat grafting (OR 0.10, 95% CI 0.01-0.72, P = 0.023), lesion size (OR 0.68, 95% CI 0.50-0.92, P = 0.01) and FTD (OR 0.16, 95% CI 0.05-0.59, P = 0.005) compared to limited parotidectomy. CONCLUSION FTD, nerve integrity monitoring and dermofat grafting are surgeon-modifiable variables associated with lower rates of post-operative complications following parotidectomy for benign pathology. However, the benefit of these operative techniques relies on their appropriate utilization by performing surgeons.
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Affiliation(s)
- George A Petrides
- Department of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Narayana Subramaniam
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - My Pham
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Mandic R, Agaimy A, Pinto-Quintero D, Roth K, Teymoortash A, Schwarzbach H, Stoehr CG, Rodepeter FR, Stuck BA, Bette M. Aberrant Expression of Glyceraldehyde-3-Phosphate Dehydrogenase (GAPDH) in Warthin Tumors. Cancers (Basel) 2020; 12:cancers12051112. [PMID: 32365590 PMCID: PMC7281563 DOI: 10.3390/cancers12051112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 11/16/2022] Open
Abstract
The Warthin tumor represents the second most frequent benign tumor of the parotid gland and is characterized by the presence of oncocytes rich in structurally and functionally altered mitochondria. Next to its role in metabolism, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is also implicated in cellular mitophagy. Immunohistochemistry was carried out on Warthin tumor and normal control (parotid gland with striated ducts) tissues, using anti-GAPDH specific antibodies followed by digital image analysis. Laser capture microdissection was used to isolate the oncocytic tumor cell and normal control striated duct compartments for RNA extraction and qPCR. Warthin tumor oncocytes exhibited a markedly spotted GAPDH staining pattern exhibiting cells with cytoplasmic and nuclear, only nuclear or none GAPDH staining. A significantly lower (p < 0.0001) total GAPDH signal was detected in Warthin tumor oncocytes. Similarly, significantly lower (p < 0.005) GAPDH mRNA levels were seen in oncocytes compared with normal ductal cells. To exclude the possibility of this GAPDH staining pattern being a general feature of oncocytic neoplasms of different organs, we tested a cohort of renal oncocytoma and oncocytic chromophobe carcinoma; none showed this type of staining. The observed progressive GAPDH loss in Warthin tumor oncocytes could be implicated in the pathogenesis of Warthin tumors.
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Affiliation(s)
- Robert Mandic
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, 35033 Marburg, Germany; (D.P.-Q.); (A.T.); (B.A.S.)
- Correspondence: ; Tel.: +49-6421-5861400; Fax: +49-6421-5862421
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital, 91504 Erlangen, Germany; (A.A.); (C.G.S.)
| | - Daniel Pinto-Quintero
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, 35033 Marburg, Germany; (D.P.-Q.); (A.T.); (B.A.S.)
| | - Katrin Roth
- Cellular Imaging Core Facility, Center for Tumor Biology and Immunology (ZTI), Philipps-Universität Marburg, 35043 Marburg, Germany;
| | - Afshin Teymoortash
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, 35033 Marburg, Germany; (D.P.-Q.); (A.T.); (B.A.S.)
| | - Hans Schwarzbach
- Institute of Anatomy and Cell Biology, Philipps-Universität Marburg, 35037 Marburg, Germany; (H.S.); (M.B.)
| | - Christine G. Stoehr
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital, 91504 Erlangen, Germany; (A.A.); (C.G.S.)
| | - Fiona R. Rodepeter
- Institute of Pathology, University Hospital Marburg, 35043 Marburg Germany;
| | - Boris A. Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, 35033 Marburg, Germany; (D.P.-Q.); (A.T.); (B.A.S.)
| | - Michael Bette
- Institute of Anatomy and Cell Biology, Philipps-Universität Marburg, 35037 Marburg, Germany; (H.S.); (M.B.)
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Talmadge J, Nayak JV, Yao W, Citardi MJ. Management of Postsurgical Empty Nose Syndrome. Facial Plast Surg Clin North Am 2020; 27:465-475. [PMID: 31587766 DOI: 10.1016/j.fsc.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Empty nose syndrome (ENS) is a controversial condition associated with disruption of nasal airflow caused by excessive loss of turbinate tissue. ENS arises after total or near-total inferior turbinate resection. Patients present with intense fixation on the perception of nasal obstruction. Diagnostic tools to assess for empty nose syndrome include a validated patient questionnaire and the office cotton test. Treatment involves topical moisturization, behavioral/psychiatric assessment/treatment, and surgical reconstruction. Current data show promising long-term efficacy after surgical intervention. Postprocedural ENS is best prevented by minimizing inferior and middle turbinate tissue loss.
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Affiliation(s)
- Jason Talmadge
- Department of Otolaryngology, Medical College of Wisconsin, 3400 Market Lane, Kenosha, WI 53144, USA
| | - Jayakar V Nayak
- Department of Otolaryngology, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - William Yao
- Department of Otolaryngology, Medical College of Wisconsin, 3400 Market Lane, Kenosha, WI 53144, USA
| | - Martin J Citardi
- Department of Otorrhinolaryngology, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street, MSB 5.036, Houston, TX 77030, USA.
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Use of Botulinum Toxin in Orofacial Clinical Practice. Toxins (Basel) 2020; 12:toxins12020112. [PMID: 32053883 PMCID: PMC7076767 DOI: 10.3390/toxins12020112] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine’s release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT’s efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. Aim: This study’s aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT’s efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. Materials and methods: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. Results: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). Discussion: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.
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Chen CY, Chen PR, Chou YF. Intra-auricular modification of facelift incision decreased the risk of Frey syndrome. Tzu Chi Med J 2019; 31:266-269. [PMID: 31867256 PMCID: PMC6905232 DOI: 10.4103/tcmj.tcmj_117_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/25/2018] [Accepted: 08/09/2018] [Indexed: 11/04/2022] Open
Abstract
Objective Frey syndrome is a complication followed by parotidectomy which caused gustatory sweating and facial flush. There were several methods for the prevention of Frey syndrome, but most of them had no obvious effects. In this study, we compare the intra-auricular modification of facelift incision with the traditional lazy-S incision to see if it can decrease the risk of Frey syndrome. Materials and Methods This is a retrospective study. From 2003 to 2009, a total of 61 patients with benign parotid tumor who received parotidectomy at Hualien Tzu Chi Hospital and were followed at outpatient department for at least 5 years were enrolled. Patients were divided into two groups according to the type of incisions during operation: (1) Group M: intra-auricular modification of facelift incision or (2) Group S: traditional lazy-S incision. All patients received the partial thickness sternocleidomastoid muscle flap. Clinical data including age, gender, pathologic result, presentation of Frey syndrome, size of tumor, length of operation, blood loss from surgery, length of placement of drain, total amount of drainage, and length of stay were collected and analyzed. Results Sixty-one patients were enrolled. Eighteen patients were in Group M and forty-three were in Group S. There was no significant difference of age, gender, and size of tumor between the two groups. The pathologic results included parotitis, pleomorphic adenoma, Warthin's tumor, and others. No significant difference of pathologic results, blood loss from surgery, length of placement of drain, total amount of drainage, and length of stay between two groups was obtained. The length of operation was longer in Group M (P = 0.001) and the incidence of Frey syndrome was lower in Group M than Group S (P < 0.05). Conclusions The use of intra-auricular modification of facelift incision can decrease the incidence of Frey syndrome.
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Affiliation(s)
- Chih-Ying Chen
- Department of Otolaryngology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Peir-Rong Chen
- Department of Otolaryngology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Fu Chou
- Department of Otolaryngology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Ozturk K, Ozturk A, Turhal G, Kaya I, Akyildiz S, Uluoz U. Comparative outcomes of extracapsular dissection and superficial parotidectomy. Acta Otolaryngol 2019; 139:1128-1132. [PMID: 31560243 DOI: 10.1080/00016489.2019.1669821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Retrospective analysis of extracapsular dissection (ECD) and superficial parotidectomy (SP).Aims/objectives: Comparing the outcomes of ECD and SP in surgery of benign parotid masses.Material and methods: Total of 136 patients included in the study. The inclusion criteria were pathologically proven benign FNA biopsy, lack of deep lobe invasion and single tumour diameter lower than 4 cm, absence of radiologically and clinically malignant lesion and facial paralysis at the time of diagnosis.Objectives: Drain volumes and seroma presence, clinical evaluation of face nerve function; signs of infective complications were collected from patients' clinic chart. Complications and recurrence rates were obtained from follow-up forms.Results: The mean follow-up period was 42.53 ± 14.88 months. In SP group, three patients with disease recurrence were found, 8 (10.2%) had early facial nerve paralysis (grade 2 and 3) and 11 (14.1%) had Frey's syndrome. No postoperative complication, early facial paralysis and recurrence were observed in ECD group.Conclusion and significance: ECD procedure was found to be as successful as SP in the selected patient group in approach to the pathologically proven and single benign parotid masses with similar recurrence and lower complication rates compared to the SP.
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Affiliation(s)
- Kerem Ozturk
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Arin Ozturk
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Goksel Turhal
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Isa Kaya
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Serdar Akyildiz
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Umit Uluoz
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
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Kim J, Kim M, Kim Y, Lee HL. A Case of Frey's Syndrome Diagnosed and Followed Up Using the Quantitative Sudomotor Axon Reflex Test. J Clin Neurol 2019; 15:585-587. [PMID: 31591854 PMCID: PMC6785473 DOI: 10.3988/jcn.2019.15.4.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jaehwan Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Minkyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - YeEun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Lim Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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43
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Thompson JD, Avey GD, Wieland AM, Harari PM, Glazer TA, McCulloch TM, Hartig GK. Auriculotemporal Nerve Involvement in Parotid Bed Malignancy. Ann Otol Rhinol Laryngol 2019; 128:647-653. [PMID: 30894024 DOI: 10.1177/0003489419837574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify and evaluate patients with parotid bed malignancy demonstrating radiographic findings of auriculotemporal (AT) nerve involvement. METHODS A retrospective review of patients with parotid bed malignancy was performed to identify patients with imaging findings of AT nerve involvement and record associated clinical findings, symptoms, and pathology information. Independent, blinded review of radiographic images by a senior neuroradiologist was performed to identify imaging characteristics and categorize patients into highly likely or possible involvement groups. RESULTS Of 547 patients identified with parotid bed malignancy, 23 patients exhibited radiographic findings suggestive of AT nerve involvement. Thirteen patients met criteria for highly likely involvement, and 10 patients met criteria for possible involvement. Cutaneous malignancy with metastasis to the parotid bed accounted for 11 of 23 patients, and the most common histology was squamous cell carcinoma (9 patients). Primary parotid malignancy accounted for 12 of 23 patients, and the most common histology was salivary ductal carcinoma (3 patients). All 13 highly likely patients reported periauricular pain, and 11 of 13 demonstrated facial weakness. Features suggesting advanced disease included radiographic findings of intracranial involvement (10/23 patients), nonsurgical primary treatment (13/23 patients), and positive margins on pathology report (7/10 patients). CONCLUSION AT nerve involvement is an uncommon but important phenomenon that often occurs in the setting of advanced disease and is commonly associated with periauricular pain and coexisting facial weakness. Awareness of the associated clinical features and imaging patterns can allow for appropriate identification of this pattern of spread and help to optimize treatment planning.
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Affiliation(s)
- James D Thompson
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory D Avey
- 2 Department of Radiology-Division of Neuroradiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron M Wieland
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Paul M Harari
- 3 Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tiffany A Glazer
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Timothy M McCulloch
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory K Hartig
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Wang C, Wu D, Mao C, Lu M, Cai Z, Lai Y, Chen W. The preventive effect of decellularized pericardial patch against Frey's syndrome following the superficial parotidectomy. J Craniomaxillofac Surg 2019; 47:832-836. [PMID: 30738637 DOI: 10.1016/j.jcms.2019.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/19/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study aimed to investigate the feasibility of adopting the ThormalGEN surgical patch (a porcine decellularized pericardial patch) in the superficial parotidectomy to prevent postoperative Frey's syndrome in patients with benign parotid tumor. MATERIALS AND METHODS A total of 59 patients with benign parotid tumor undergoing superficial parotidectomy between April 2016 and January 2017 were enrolled, and divided into the ThormalGEN group (n = 37) and the control group (n = 22) based on their willingness to have the ThormalGEN surgical patch used in the superficial parotidectomy. At 6 months postoperation, the incidences of postoperative complications and Frey's syndrome were assessed by subjective assessment (patient self-assessment) and objective assessment (starch-iodine test), respectively. The risk factor of Frey's syndrome was analyzed by the multivariate logistic regression model. RESULTS The starch-iodine test, for objective assessment, showed that the ThormalGEN group had a significantly lower incidence of Frey's syndrome than the control group (8.11% vs. 40.91%, p = 006). However, in the patient self-assessment, there was no significant difference in the incidence of Frey's syndrome between groups (8.11% [3/37] vs. 13.64% [3/22], p = 0.4968). The incidences of postoperative complications were not significantly different between group (all p > 0.05). Two patients (5.41%) in the ThormalGEN group had salivary fistula. Multivariate logistic regression analysis showed that the ThormalGEN group had a significantly lower risk of Frey's syndrome than the control group (odds ratio = 0.11, 95% confidence interval = 0.02-0.51, p < 0.01). CONCLUSION These results suggest that the ThormalGEN surgical patch can effectively reduce the incidence of Frey's syndrome following superficial parotidectomy in patients with benign parotid tumor, and that this patch has a good safety and biocompatibility profile.
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Affiliation(s)
- Chengyong Wang
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Dong Wu
- The Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Chuanqing Mao
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Meng Lu
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Zhiyu Cai
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Yongzhen Lai
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Weihui Chen
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
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Infante-Cossio P, Gonzalez-Cardero E, Garcia-Perla-Garcia A, Montes-Latorre E, Gutierrez-Perez JL, Prats-Golczer VE. Complications after superficial parotidectomy for pleomorphic adenoma. Med Oral Patol Oral Cir Bucal 2018; 23:e485-e492. [PMID: 29924764 PMCID: PMC6051677 DOI: 10.4317/medoral.22386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022] Open
Abstract
Background The significance of complications after superficial parotidectomy remains unclear, since prospective studies are lacking. The aim of this study was to evaluate facial nerve dysfunction and other postoperative complications after superficial parotidectomy for pleomorphic adenoma of the superficial lobe and to identify the associated risk factors. Material and Methods Prospective and descriptive clinical study on 79 patients undergoing formal superficial parotidectomy with the modified facelift incision, dissection of the facial nerve and reconstruction with the superficial musculoaponeurotic system flap. Function of the facial nerve using the House-Brackmann scale and the intra- and postoperative complications were recorded at 1 week and 1, 3, 6 and 12 months. A descriptive, inferential and binary logistic regression analysis were performed for the variables facial nerve dysfunction, tumor size and location, clinical presentation and duration of surgery. Results 77.2% of the patients presented facial paresis at 1 week, with the marginal-mandibular branch being the most commonly affected (64.5%). 94.9% recovered the facial function at 6 months and 100% at 12 months. A statistically significant relationship was found between the appearance of facial paresis and tumor location in the superior lateral area of the superficial lobe, size >2 cm and prolonged operative time. None of the remaining variables showed significant differences at any study timepoint. At 12 months, 57% of patients had recovered tactile sensitivity in the earlobe. The clinical occurrence of Frey’s syndrome was 11.4%. Conclusions Despite the high incidence of postoperative facial paresis at 1 week, its magnitude was low and the recovery time was short. Tumor location in the parotid superficial lobe upper area, size and prolonged operative time are risk factors that can worsen facial paresis at different study timepoints. The knowledge of these complications is relevant for patient´s counseling and to achieve better long-term outcomes. Key words:Superficial parotidectomy, pleomorphic adenoma, parotid gland, facial nerve paralysis, postoperative complications.
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Affiliation(s)
- P Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Av. Manuel Siurot, 41013-Seville, Spain,
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46
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Henry N, Baker B, Iyer S. Frey's syndrome following a facial burn treated with botulinum toxin. ANNALS OF BURNS AND FIRE DISASTERS 2018; 31:47-48. [PMID: 30174572 PMCID: PMC6116648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Frey's syndrome occurs as a result of damage to the auriculotemporal nerve, which causes inappropriate regeneration of damaged parasympathetic fibres to salivary glands to innervate the sympathetic receptors of sweat glands in the face. The symptoms are pathological flushing and sweating with gustatory stimuli. It most commonly occurs following parotid surgery and has not previously been reported following burn injury. We present a 50-year-old man who sustained 1% TBSA full thickness burn to the right side of his face as a child. This was excised and reconstructed with skin grafts as well as further revision procedures in his adult life. He incidentally reported copious amounts of gustatory sweating over his right temple region that had been present since his initial injury, occurring prior to any reconstruction, consistent with Frey's syndrome. This was confirmed with a starch iodine test, and successfully treated with Botulinum toxin injections post reconstruction. This case is the first report of Frey's syndrome following burn injury. We highlight the potential development of Frey's syndrome following facial burns, even in the reconstructed area. Botulinum toxin treatment remains effective.
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Affiliation(s)
- N. Henry
- Royal Preston Hospital, Preston, UK
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47
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The Effectiveness of Sternocleidomastoid Flap Versus Superficial Musculoaponeurotic System Flap for the Prevention of Frey Syndrome and Facial Depressed Deformity in Parotid Surgery for Pleomorphic Adenoma. Ann Plast Surg 2018; 80:125-129. [DOI: 10.1097/sap.0000000000001233] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Iwanaga J, Watanabe K, Kusukawa J, Fisahn C, Alonso F, Oskouian RJ, Tubbs RS. A novel treatment for keratitis sicca (Dry eye): Anatomical feasibility study. Clin Anat 2017. [PMID: 28631333 DOI: 10.1002/ca.22946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chronic dry eye (keratitis sicca) is a significant problem that in certain populations can result in corneal desiccation and the potential for blindness. Therefore, novel treatments for such disorders might decrease patient morbidity. The present study aimed to investigate a potential treatment for chronic dry eye via a cadaveric feasibility study. On 10 cadaveric sides, the parotid gland branch of the auriculotemporal nerve (ATN) was identified and anastomosed to an anterior superficial temporal branch (STb) of this same nerve. The STb was then transposed anteriorly and sutured to the lacrimal gland. The parotid branch of the ATN was easily identified on all sides. The STb of the ATN was easily identified and mobilized on all sides. This latter nerve had adequate length to be moved to the ipsilateral lacrimal gland on all sides. Rerouting parotid gland secretomotor fibers to the superficial branch of the ATN and then moving this branch to the lacrimal gland is a feasible surgical maneuver based on our cadaveric study. Clinical studies are now necessary to show utility of this procedure in patients with chronic dry eye. Clin. Anat. 30:839-843, 2017. © 2017Wiley Periodicals, Inc.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Watanabe
- Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan
| | - Christian Fisahn
- Seattle Science Foundation, Seattle, Washington.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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Abstract
PURPOSE The objective of this study was to evaluate whether silk fibroin (SF) incorporated into 4-hexylresorcinol (4HR) could increase botulinum toxin-A (BTX-A) activity. MATERIAL AND METHODS In total, 30 rats were used for this study. The animals were divided into 6 groups according to the injected materials (SA: saline only; SF; 4HR; B2: 2 units of BTX-A; B2 + SF + 4HR: combination of B2, SF, and 4HR; B5: 5 units of BTX-A). Serial sonography was used for the evaluation of muscle thickness after injection. Immunohistochemical staining was used for the evaluation of myosin type II (myo2) and Bcl-2 protein expression. RESULTS The relative thickness of the masseter muscle in B2 group was 66.14% ± 4.55% to the preinjection level; in B2 + SF + 4HR group was 54.59% ± 4.83%, and in B5 group was 56.19% ± 8.28%. Any BTX-injected group showed significantly lower value of the relative muscle thickness compared to SA, SF, or 4HR group (P < 0.001 for all). The difference of relative muscle thickness between B2 group and B2 + SF + 4HR group was statistically significant (P < 0.001). The intensity of myo2 immunostaining in B5, B2, and B2 + SF + 4HR group was significantly higher than those in the other groups (P < 0.05). CONCLUSIONS When 2 units of BTX was incorporated to SF and 4HR, combination formula showed similar activity to those of 5 units of BTX.
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50
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Iwanaga J, Bobek SL, Fisahn C, Nakamura K, Miyazono Y, Tubbs RS. An unusual finding of the auriculotemporal nerve: possible risk factor during preauricular skin incisions. Gland Surg 2017; 5:647-649. [PMID: 28149814 DOI: 10.21037/gs.2016.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The auriculotemporal nerve (ATN) is a branch of the mandibular nerve and has been implicated for some migraines and its role in Frey's syndrome is well known. An adult cadaver was found to have a duplicated ATN. The anterior trunk ascended as the superficial temporal artery and gave off the branches to the temporomandibular joint, parotid gland, external acoustic meatus and temporal region and communicated with a posterior trunk of the ATN. The posterior trunk ascended via the subcutaneous tissues 1 mm anterior to the auricle and gave off the branches to the anterior auricular region, temporal region and communicated with the anterior trunk. Such a duplicated ATN might be injured with preauricular skin incisions. Knowledge of such an anatomical variation might assist surgeons in iatrogenic injury of the ATN.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, WA 98122, USA;; Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan;; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Samuel L Bobek
- Swedish Maxillofacial Surgery, Swedish Medical Center, Seattle, WA 98122, USA
| | - Christian Fisahn
- Seattle Science Foundation, Seattle, WA 98122, USA;; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA 98122, USA
| | - Ken Nakamura
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Yoshihiro Miyazono
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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