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Smith E, Zaro C, Dhingra JK. Salivary Gland Tumors: A 20 Year Review From a Single Community Practice. EAR, NOSE & THROAT JOURNAL 2024:1455613241233085. [PMID: 38445603 DOI: 10.1177/01455613241233085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Objective: Salivary gland tumors are a heterogenous group of lesions with variable pathology and clinical outcomes. Most published data are derived from studies conducted at tertiary care centers. Our study analyzed the experience from a community setting to determine significant differences, if any, in pathological distribution and clinical outcomes compared to the existing literature. Methods: We performed a retrospective analysis of all major salivary gland tumors that presented to a large community practice over a 20 year period. Retrospective chart analysis was performed for demographics, clinical presentation, imaging, cytology, histopathology, and clinical outcome data. Results: Of 806 patients, the parotid gland was the most common site in 683 patients (84.7%), followed by submandibular in 78 (9.7%) and sublingual in 45 (5.6%). A total of 203 patients were managed conservatively with observation without definitive diagnosis or lost to follow-up. A total of 495 patients underwent surgical intervention within the community practice. Twenty-six patients underwent surgical excision at an outside hospital. Eighty-two patients were determined to have a benign diagnosis based on ultrasound-guided fine needle aspiration or excisional biopsy alone. Final histopathology was benign in 505 cases (83.7%), while 98 tumors (16.3%) received a diagnosis of primary or secondary malignancy. For the parotid gland, pleomorphic adenoma (155) and Warthin's tumor (155) were the most common benign diagnoses, while mucoepidermoid carcinoma (13), adenocarcinoma (8), and acinic cell carcinoma (8) were the most common primary malignancies. Conclusions: We found a higher rate of benign tumor pathology compared to the existing literature. While the outcome data on surgical treatment of benign tumors are comparable to the existing literature, the same conclusion cannot be drawn for malignant tumors, given relatively small numbers in our series and likely disparity in the complexity of the surgical cases in tertiary care centers.
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Affiliation(s)
- Emily Smith
- Tufts University School of Medicine, Boston, MA, USA
| | - Christopher Zaro
- University of Massachusetts T. H. Chan Medical School, Worcester, MA, USA
| | - Jagdish K Dhingra
- Tufts University School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA
- ENT Specialists, Inc., Brockton, MA, USA
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Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope 2020; 131:571-579. [PMID: 32678921 DOI: 10.1002/lary.28912] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report descriptive statistics for minor parotidectomy complications. METHODS A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
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Affiliation(s)
- Silvia Lambiel
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pavel Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.,Center for Otorhinolaryngology-Maxillofacial and Head and Neck Surgery, La Tour Hospital, La Tour Medical Group, Meyrin, Switzerland
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3
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Pleomorphic adenoma compared with cystadenolymphoma of the parotid gland: which is more common? Br J Oral Maxillofac Surg 2020; 58:361-363. [DOI: 10.1016/j.bjoms.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/31/2019] [Indexed: 01/11/2023]
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Farahani SJ, Baloch Z. Retrospective assessment of the effectiveness of the Milan system for reporting salivary gland cytology: A systematic review and meta-analysis of published literature. Diagn Cytopathol 2018; 47:67-87. [DOI: 10.1002/dc.24097] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Sahar J Farahani
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania; University of Pennsylvania; Philadelphia Pennsylvania
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania; University of Pennsylvania; Philadelphia Pennsylvania
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Zoulamoglou M, Zarokosta M, Kaklamanos I, Piperos Τ, Flessas I, Kakaviatos D, Kalles V, Bonatsos V, Sgantzos M, Mariolis-Sapsakos T. Anatomic variation of the relation between the facial nerve and the retromandibular vein during superficial parotidectomy: A rare case report. Int J Surg Case Rep 2017; 41:124-127. [PMID: 29073548 PMCID: PMC5655409 DOI: 10.1016/j.ijscr.2017.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 12/04/2022] Open
Abstract
The facial nerve (FN) and the retromandibular vein (RMV) are anatomical structures in close proximity. Anatomic variations of their relationship complicate parotid surgery and increase the potentiality of nerve injury or bleeding. The true prevalence of such kind of variations seems to be underestimated, since the literature is restricted. Novel variations of the relationship of the FN with the RMV are probable. Therefore, surgeons’ knowledge and perpetual awareness are fundamental and essential in order to perform safe parotid surgery.
Introduction Identification and preservation of the facial nerve (FN) is a major challenge when performing parotidectomy. Anatomic variations of the relation between the FN and the retromandibular vein (RMV) pose a high risk of nerve injury and bleeding during the operation. Presentation of case An unusual anatomic variation of the relation between the FN and the RMV was unexpectedly detected during superficial parotidectomy. The operation was uneventful. A meticulous review of the recent literature was conducted as well. Discussion Variations of the relation between the FN and the RMV are mainly identified during the operation, since when performing parotidectomy, surgeons typically detect all the FN branches by locating the RMV. Such kind of variations, are not as rare as considered and their presence complicates parotid surgery and increases the potentiality of nerve injury and hemorrhage. Conclusion Surgeons’ deep knowledge and perpetual awareness concerning the probable anatomic variations of the relation between the FN and the RMV combined with detailed exposure of the operative field and of the relationship between these adjacent anatomical structures lead to safe parotid surgery.
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Affiliation(s)
- Menelaos Zoulamoglou
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Maria Zarokosta
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Greece.
| | - Ioannis Kaklamanos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Τheodoros Piperos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Greece
| | - Ioannis Flessas
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Greece
| | - Dimosthenis Kakaviatos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Vasileios Kalles
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Vasileios Bonatsos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Markos Sgantzos
- Anatomy Laboratory, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Greece
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Koto M, Hasegawa A, Takagi R, Ikawa H, Naganawa K, Mizoe JE, Jingu K, Tsujii H, Tsuji H, Kamada T, Okamoto Y. Definitive carbon-ion radiotherapy for locally advanced parotid gland carcinomas. Head Neck 2016; 39:724-729. [PMID: 28006083 DOI: 10.1002/hed.24671] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/08/2016] [Accepted: 11/04/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to present our evaluation of the safety and efficacy of carbon-ion radiotherapy (C-ion RT) for locally advanced parotid gland carcinomas. METHODS Clinicopathological features and outcomes were evaluated in 46 patients receiving C-ion RT for parotid gland carcinomas. RESULTS Sixteen patients had adenoid cystic carcinoma; 8 had adenocarcinoma, 8 had mucoepidermoid carcinoma, and 14 had other carcinomas. T2, T3, T4a, and T4b diseases were diagnosed in 3, 18, 8, and 17 patients, respectively. C-ion RT was provided to 25 patients as the primary treatment, to 20 patients for local recurrences after surgery, and to 1 patient for residual tumor after surgery. During follow-up (median duration, 62 months), 5-year local control and overall survival (OS) rates were 74.5% and 70.1%, respectively. Of the 30 patients without facial nerve palsy before C-ion RT, 25 showed no radiation-induced facial nerve palsy. CONCLUSION C-ion RT is effective and has acceptable toxicity levels for locally advanced parotid gland carcinomas. © 2016 Wiley Periodicals, Inc. Head Neck 39: 724-729, 2017.
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Affiliation(s)
- Masashi Koto
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | - Azusa Hasegawa
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | - Ryo Takagi
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | - Hiroaki Ikawa
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | - Kensuke Naganawa
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | | | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Hirohiko Tsujii
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | - Hiroshi Tsuji
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy Hospital, National Institute of Radiological Sciences, Chiba, Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Chiba University School of Medicine, Chiba, Japan
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Bensghir M, Elkoundi A, Ahtil R, Meziane M, Haimeur C. Use of sugammadex in parotid surgery: a case report. J Med Case Rep 2016; 10:187. [PMID: 27342645 PMCID: PMC4919844 DOI: 10.1186/s13256-016-0972-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/03/2016] [Indexed: 12/03/2022] Open
Abstract
Background Parotid surgery is a common ear, nose, and throat procedure. Facial nerve paralysis is the main feared complication following this surgery. To avoid this paralysis, intraoperative facial nerve monitoring is often used, but neuromuscular blocking agents interfere with this technique. Therefore, the neuromuscular blocking agent used should have a short duration of muscle relaxation. With the discovery of sugammadex, a steroidal neuromuscular blocking agent has acquired the potential to be used in place of succinylcholine. Case presentation A 41-year-old African woman was scheduled for a parotidectomy at our hospital. Rocuronium-induced neuromuscular block was reversed intraoperatively with sugammadex to facilitate identification of facial nerve function. The facial nerve was identified without incident, and surgical conditions were good for the removal of the tumor. During postoperative follow-up, no evidence of residual paralysis has been noted. Conclusions In parotid surgery, the use of sugammadex allows free use of a steroidal neuromuscular blocking agent for intubation and thus intraoperative facial nerve monitoring can be done safely.
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Affiliation(s)
- Mustapha Bensghir
- Department of Anesthesiology, Military Hospital Med V Rabat, Faculty of Medicine and Pharmacy of Rabat, University of Souissi-Med V, Rabat, Morocco.
| | - Abdelghafour Elkoundi
- Department of Anesthesiology, Military Hospital Med V Rabat, Faculty of Medicine and Pharmacy of Rabat, University of Souissi-Med V, Rabat, Morocco
| | - Redouane Ahtil
- Department of Anesthesiology, Military Hospital Med V Rabat, Faculty of Medicine and Pharmacy of Rabat, University of Souissi-Med V, Rabat, Morocco
| | - Mohammed Meziane
- Department of Anesthesiology, Military Hospital Med V Rabat, Faculty of Medicine and Pharmacy of Rabat, University of Souissi-Med V, Rabat, Morocco
| | - Charki Haimeur
- Department of Anesthesiology, Military Hospital Med V Rabat, Faculty of Medicine and Pharmacy of Rabat, University of Souissi-Med V, Rabat, Morocco
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8
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Lowry TR, Gal TJ, Brennan JA. Patterns of Use of Facial Nerve Monitoring During Parotid Gland Surgery. Otolaryngol Head Neck Surg 2016; 133:313-8. [PMID: 16143172 DOI: 10.1016/j.otohns.2005.03.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE: To determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States. STUDY DESIGN AND SETTING: A questionnaire encompassing surgeon training background, practice setting, patterns of facial nerve monitor usage during parotid gland surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between facial nerve monitor usage and dependent variables were examined by using the χ 2 test. Magnitudes of the associations were determined from odds ratios calculated using logistic regression. RESULTS: A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy employed facial nerve monitoring some or all of the time. Respondents were 5.6 times more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed more than 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertent nerve injury if they performed more than 10 parotidectomies per year. Surgeons who employed monitoring in their practice were 20.8% less likely to have a history of a parotid surgery-associated lawsuit. Additional information regarding surgeon demographics, types of nerve monitors used, and reasons for and against monitor usage are discussed. CONCLUSION: Permanent facial nerve paralysis after parotidectomy occurs in 0-7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.
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Affiliation(s)
- Thomas R Lowry
- Department of Otolaryngology--Head and Neck Surgery, Wilford Hall Medical Center, Lackland AFB, TX 78236-5300, USA.
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9
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Abstract
The branching pattern of the facial nerve varies among individuals. These variations increase the risk of facial nerve injury during parotid surgery. We report a new variation of the facial nerve and an unusual relationship with the retromandibular vein during parotid surgery.Clinicians should recognize this facial anomaly and the unusual relationship with the retromandibular vein to avoid injuring the facial nerve during parotid surgery.
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Affiliation(s)
- Dong Hoon Lee
- From the Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, South Korea
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Ghantous Y, Naddaf R, Barak M, Abd-Elraziq M, Abu Eln-Naaj I. The Role of Fine Needle Aspiration in the Diagnosis of Parotid Gland Tumors. J Craniofac Surg 2016; 27:e192-6. [DOI: 10.1097/scs.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Liu CC, Jethwa AR, Khariwala SS, Johnson J, Shin JJ. Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2016; 154:9-23. [PMID: 26428476 PMCID: PMC4896151 DOI: 10.1177/0194599815607841] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/02/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES (1) To analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease. (2) To determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA. DATA SOURCES Independently corroborated computerized searches of PubMed, Embase, and Cochrane Central Register were performed. These were supplemented with manual searches and input from content experts. REVIEW METHODS Inclusion/exclusion criteria specified diagnosis of parotid mass, intervention with both FNA and surgical excision, and enumeration of both cytologic and surgical histopathologic results. The primary outcomes were sensitivity, specificity, and posttest probability of malignancy. Heterogeneity was evaluated with the I(2) statistic. Meta-analysis was performed via a 2-level mixed logistic regression model. Bayesian nomograms were plotted via pooled likelihood ratios. RESULTS The systematic review yielded 70 criterion-meeting studies, 63 of which contained data that allowed for computation of numerical outcomes (n = 5647 patients; level 2a) and consideration of meta-analysis. Subgroup analyses were performed in studies that were prospective, involved consecutive patients, described the FNA technique utilized, and used ultrasound guidance. The I(2) point estimate was >70% for all analyses, except within prospectively obtained and ultrasound-guided results. Among the prospective subgroup, the pooled analysis demonstrated a sensitivity of 0.882 (95% confidence interval [95% CI], 0.509-0.982) and a specificity of 0.995 (95% CI, 0.960-0.999). The probabilities of nondiagnostic and indeterminate cytology were 0.053 (95% CI, 0.030-0.075) and 0.147 (95% CI, 0.106-0.188), respectively. CONCLUSION FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.
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Affiliation(s)
- C Carrie Liu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonas Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Griffith CC, Pai RK, Schneider F, Duvvuri U, Ferris RL, Johnson JT, Seethala RR. Salivary gland tumor fine-needle aspiration cytology: a proposal for a risk stratification classification. Am J Clin Pathol 2015; 143:839-53. [PMID: 25972326 DOI: 10.1309/ajcpmii6osd2hsja] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Fine-needle aspiration (FNA) is useful in the evaluation of salivary gland tumors, but currently no standard terminology or risk stratification model exists. METHODS FNA smears were reviewed and categorized based on cytonuclear features, stromal characteristics, and background characteristics. Risk of malignancy was calculated for each category. Classifications as benign, neoplasm of uncertain malignant potential (NUMP), suspicious for malignancy, and positive for malignancy were used to aggregate categories into similar risk groups. RESULTS Categorization of salivary gland aspirates into morphologic categories resulted in the expected risk stratification. Grouping of categories maintained risk stratification, providing classes with malignancy risk as follows: benign, 2%; NUMP, 18%; suspicious for malignancy, 76%; and positive for malignancy, 100%. CONCLUSIONS Salivary gland FNA categorization into commonly encountered morphologic categories provides risk stratification, which translates to a simplified classification scheme of benign, NUMP, suspicious, and positive for malignancy similar to the paradigm in other organ systems.
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Affiliation(s)
| | - Reetesh K. Pai
- University of Pittsburgh Medical Center, Department of Pathologyy, Pittsburgh, PA
| | - Frank Schneider
- University of Pittsburgh Medical Center, Department of Pathologyy, Pittsburgh, PA
| | | | | | | | - Raja R. Seethala
- University of Pittsburgh Medical Center, Department of Pathologyy, Pittsburgh, PA
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13
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Stein AP, Britt CJ, Saha S, McCulloch TM, Wieland AM, Harari PM, Hartig GK. Patient and tumor characteristics predictive of primary parotid gland malignancy: A 20-year experience at the University of Wisconsin. Am J Otolaryngol 2015; 36:429-34. [PMID: 25766621 DOI: 10.1016/j.amjoto.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/26/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify patient and tumor characteristics predictive of primary parotid malignancy. MATERIALS AND METHODS Records were reviewed for patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients with primary parotid neoplasms were separated into benign or malignant subgroups. A multivariate logistic regression model was employed to compare categorical (gender, lesion side, nature of presentation, recurrence) and numerical variables (age, tumor size) between the benign and malignant groups. Mean BMI was compared between the groups by univariate analysis. RESULTS 771 patients underwent parotidectomy from 1994 to 2013, and 474 had a primary parotid neoplasm. No relationship existed between malignancy and gender (p=0.610), lesion side (p=0.110), or BMI (p=0.196). Mean age (p=0.015) and tumor size (p=0.011) were significantly different between the benign and malignant groups. Patient presentation was classified into three categories: symptomatic (n=109), palpable and asymptomatic (n=303), and incidentally noted on imaging (n=57). From all patients with symptomatic, asymptomatic or incidentally noted masses, 41.3%, 10.6% and 5.3%, respectively, were diagnosed with malignant disease. There was a significant relationship between the patient's initial presentation and malignancy (p<0.001), and patients with facial nerve dysfunction or skin involvement had the greatest likelihood of malignancy. Finally, there was a significant association between malignancy and recurrence (p=0.001). CONCLUSIONS In this study, age, tumor size, and nature of presentation were all associated with primary parotid malignancy. Understanding the impact of these features on the probability of malignancy is valuable in decision making and counseling of patients presenting with a newly diagnosed parotid neoplasm.
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Schmidt RL, Jedrzkiewicz JD, Allred RJ, Matsuoka S, Witt BL. Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis. Head Neck 2014; 36:1654-61. [PMID: 24114985 DOI: 10.1002/hed.23495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/08/2013] [Accepted: 09/09/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Diagnostic test accuracy (DTA) studies for needle biopsy are frequently published in otolaryngology journals, but this body of literature has not been assessed for verification bias. METHODS We conducted a systematic review of DTA studies on needle biopsy of salivary gland lesions appearing in otolaryngology journals. Studies were assessed by 2 reviewers for verification bias. RESULTS We identified 95 DTA studies for needle biopsy of salivary gland lesions. Eighty-one studies (84%) had verification bias. Five of the biased studies provided sufficient data to estimate the extent of bias. Verification bias was associated with an overestimate of sensitivity and an underestimate of specificity. Studies on core needle biopsy (CNB) had a lower rate of verification bias than fine-needle aspiration (FNA) studies. CONCLUSION Verification bias is common in DTA studies of needle biopsy for salivary gland lesions published in ear, nose, and throat (ENT) journals. Such studies overestimated sensitivity and underestimated specificity.
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Affiliation(s)
- Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah
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15
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Chung MP, Tang C, Chan C, Hara WY, Loo BW, Kaplan MJ, Fischbein N, Le QT, Chang DT. Radiotherapy for nonadenoid cystic carcinomas of major salivary glands. Am J Otolaryngol 2013; 34:425-30. [PMID: 23583094 DOI: 10.1016/j.amjoto.2013.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/10/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To report outcomes in patients treated with postoperative radiotherapy for nonadenoid cystic carcinomas of the major salivary glands. MATERIALS AND METHODS From 1998-2011, 37 patients with nonadenoid cystic carcinomas of the major salivary gland underwent postoperative radiotherapy. The median radiation dose was 60 Gy (range, 45-70 Gy). TNM distribution included T1-2 (n=16, 44%), T3-T4 (n=21, 56%), N0 (n=19, 51%), and N+ (n=18, 49%). Histologies included adenocarcinoma (n=13, 35%), squamous cell carcinoma (n=8, 22%), mucoepidermoid carcinoma (n=8, 22%), and other (n=8, 21%). Median follow-up was 4.7 years for all patients (range, 0.3-14.1 years) and 5.0 years for living patients (range, 1.2-12.2 years). RESULTS Five-year local-regional control, overall survival (OS), and cancer-specific survival (CSS) were 97%, 76%, and 84%. On univariate analysis, OS was significantly worse for patients ≥65 years old (p=0.04). CSS was significantly worse for positive perineural invasion (p=0.02), extraparenchymal extension (p=0.04), and in patients who received no chemotherapy (p=0.02). Doses >60 Gy was significantly worse for OS (p=0.003) and CSS (p=0.003), although these patients had higher TNM (>T2, p=0.01) and trended towards a higher rate of extraparenchymal extension (p=0.08). Four patients (11%) developed ≥grade 2 toxicities; 3 patients developed early toxicities and one patient developed late toxicities. CONCLUSIONS Radiotherapy for salivary gland tumors provides excellent local-regional control when combined with surgery. Distant metastasis is the predominant pattern of failure, although chemotherapy seemed to improve cancer-specific survival.
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Affiliation(s)
- Melody P Chung
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
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16
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Schmidt RL, Hall BJ, Wilson AR, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions. Am J Clin Pathol 2011; 136:45-59. [PMID: 21685031 DOI: 10.1309/ajcpoie0cznat6sq] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The clinical usefulness of fine-needle aspiration cytology (FNAC) for the diagnosis of parotid gland lesions is controversial. Many accuracy studies have been published, but the literature has not been adequately summarized. We identified 64 studies on the diagnosis of malignancy (6,169 cases) and 7 studies on the diagnosis of neoplasia (795 cases). The diagnosis of neoplasia (area under the summary receiver operating characteristic [AUSROC] curve, 0.99; 95% confidence interval [CI], 0.97-1.00) had higher accuracy than the diagnosis of malignancy (AUSROC, 0.96; 95% CI, 0.94-0.97). Several sources of bias were identified that could affect study estimates. Studies on the diagnosis of malignancy showed significant heterogeneity (P < .001). The subgroups of American, French, and Turkish studies showed greater homogeneity, but the accuracy of these subgroups was not significantly different from that of the remaining subgroup. It is not possible to provide a general guideline on the clinical usefulness of FNAC for parotid gland lesions owing to the variability in study results. There is a need to improve the quality of reporting and to improve study designs to remove or assess the impact of bias.
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Chiara J, Kinney G, Slimp J, Lee GS, Oliaei S, Perkins JA. Facial nerve mapping and monitoring in lymphatic malformation surgery. Int J Pediatr Otorhinolaryngol 2009; 73:1348-52. [PMID: 19592118 DOI: 10.1016/j.ijporl.2009.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 05/05/2009] [Accepted: 06/12/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Establish the efficacy of preoperative facial nerve mapping and continuous intraoperative EMG monitoring in protecting the facial nerve during resection of cervicofacial lymphatic malformations. METHODS Retrospective study in which patients were clinically followed for at least 6 months postoperatively, and long-term outcome was evaluated. Patient demographics, lesion characteristics (i.e., size, stage, location) were recorded. Operative notes revealed surgical techniques, findings, and complications. Preoperative, short-/long-term postoperative facial nerve function was standardized using the House-Brackmann Classification. Mapping was done prior to incision by percutaneously stimulating the facial nerve and its branches and recording the motor responses. Intraoperative monitoring and mapping were accomplished using a four-channel, free-running EMG. Neurophysiologists continuously monitored EMG responses and blindly analyzed intraoperative findings and final EMG interpretations for abnormalities. RESULTS Seven patients collectively underwent 8 lymphatic malformation surgeries. Median age was 30 months (2-105 months). Lymphatic malformation diagnosis was recorded in 6/8 surgeries. Facial nerve function was House-Brackmann grade I in 8/8 cases preoperatively. Facial nerve was abnormally elongated in 1/8 cases. EMG monitoring recorded abnormal activity in 4/8 cases--two suggesting facial nerve irritation, and two with possible facial nerve damage. Transient or long-term facial nerve paresis occurred in 1/8 cases (House-Brackmann grade II). CONCLUSIONS Preoperative facial nerve mapping combined with continuous intraoperative EMG and mapping is a successful method of identifying the facial nerve course and protecting it from injury during resection of cervicofacial lymphatic malformations involving the facial nerve.
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Affiliation(s)
- Jospeh Chiara
- Division of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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18
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Lin DS, Chen JJ, Lin YS. Unusual elongation of the facial nerve trunk. Otolaryngol Head Neck Surg 2009; 141:422-3. [PMID: 19716027 DOI: 10.1016/j.otohns.2009.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 03/17/2009] [Accepted: 03/30/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Deng-Shan Lin
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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19
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20
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Abstract
Salivary gland tumors are a rare and clinically diverse group of neoplasms that represent less than 1% of all malignancies. In locoregional recurrent or metastatic disease, systemic therapy is the standard approach. Numerous phase II studies with small sample sizes have assessed the activity of different cytotoxic agents, either alone or in combination. For these agents, the objective response rates are generally modest, ranging from 15% to 50%. Duration of response is typically cited in the range of 6 to 9 months. Further evaluation of novel therapies is mandated in this disease. With the emergence of molecular targeted therapy, these tumors become optimal candidates for trials of investigational drugs and established drugs for new indications. Often, salivary gland carcinomas are indolent. As such, one should wish only to treat patients with progressive disease. Study designs must incorporate stringent inclusion criteria to enable accurate reporting of disease response and stabilization, especially in the evaluation of new drugs and novel combinations. Salivary gland-focused cooperative groups are necessary in order to accrue patients to these clinical trials and establish new treatment guidelines for these patients.
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Affiliation(s)
- Sujani G Surakanti
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
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21
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22
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Basal cell adenoma versus pleomorphic adenoma of the parotid gland: CT findings. AJR Am J Roentgenol 2007; 189:W254-61. [PMID: 17954621 DOI: 10.2214/ajr.07.2292] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Basal cell adenoma is a rare benign epithelial tumor of the salivary gland. The objective of this study is to present the CT findings of parotid basal cell adenoma. We also compare CT findings of basal cell adenoma with those of pleomorphic adenoma, the most common parotid tumor, to determine whether any features on CT can help differentiate these two entities. CONCLUSION Basal cell adenomas of the parotid gland are located chiefly in the superficial lobe. They are generally round, well-circumscribed tumors that show heterogeneous enhancement on CT. The age of the patient and the attenuation on unenhanced and contrast-enhanced CT may help in differentiating basal cell adenoma from pleomorphic adenoma of the parotid gland.
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Upton DC, McNamar JP, Connor NP, Harari PM, Hartig GK. Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol Head Neck Surg 2007; 136:788-92. [PMID: 17478217 DOI: 10.1016/j.otohns.2006.11.037] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 11/16/2006] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review a single surgeon's experience with parotidectomy with an emphasis on examining the appropriate use of partial superficial parotidectomy and the differences in early outcomes observed with the various types and extent of parotidectomy used. STUDY DESIGN AND SETTING A series of 237 patients who underwent parotidectomy over a 10-year period was reviewed. RESULTS Postoperative complications included facial nerve weakness (18%), sialocele (6.3%), wound infection (3.8%), hematoma (3.8%), and symptomatic Frey's syndrome (1.7%). More extensive surgical procedures, including complete superficial or total parotidectomy, were associated with a 2.7 times greater incidence of immediate postoperative facial nerve weakness compared with partial superficial parotidectomy. CONCLUSION Partial superficial parotidectomy is associated with a decreased incidence of transient postoperative facial nerve weakness compared with more extensive procedures such as complete superficial or total parotidectomy. Intraoperative frozen section was an accurate means of selecting patients for the partial superficial parotidectomy procedure. SIGNIFICANCE Partial superficial parotidectomy is an effective method for treating benign tumors confined to the superficial lobe.
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Affiliation(s)
- David C Upton
- Department of Surgery, Division of Otolaryngology, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
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Meier JD, Wenig BL, Manders EC, Nenonene EK. Continuous intraoperative facial nerve monitoring in predicting postoperative injury during parotidectomy. Laryngoscope 2006; 116:1569-72. [PMID: 16954980 DOI: 10.1097/01.mlg.0000231266.84401.55] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess whether the use of continuous intraoperative facial nerve monitoring correlates to postoperative facial nerve injury during parotidectomy. STUDY DESIGN A retrospective analysis. METHODS Forty-five consecutive parotidectomies were performed using an electromyograph (EMG)-based intraoperative facial nerve monitor. Of those, 37 had complete data for analysis. Intraoperative findings and final interpretation of the EMGs were analyzed by a senior neurologist and neurophysiologist. All patients were analyzed, including those with preoperative weakness and facial nerve sacrifice. RESULTS The overall incidence of facial paralysis (House-Brackmann scale > 1) was 43% for temporary and 22% for permanent deficits. This includes an 11% incidence of preoperative weakness and 14% with intraoperative sacrifice. An abnormal EMG occurred in only 16% of cases and was not significantly associated with permanent or temporary facial nerve paralysis (chi, P < 1.0; Fisher's exact P < .68). Of the eight patients with permanent paralysis, only two had abnormalities on the facial nerve monitor. Also, only one of five patients with intraoperative sacrifice of the facial nerve had an abnormal EMG. Factors significantly associated with the incidence of facial paralysis include malignancy, advanced age, extent of parotidectomy, and dissection beyond the parotid gland (chi and Fisher's, P < .05). CONCLUSIONS The results suggest that abnormalities on the intraoperative continuous facial nerve monitor during parotidectomy do not predict facial nerve injury. The incidence of permanent and temporary facial nerve paralysis compare favorably with the literature given that this study includes patients with revision surgery, intraoperative sacrifice, and preoperative paralysis. Standard of care implications will be discussed.
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Affiliation(s)
- Jason D Meier
- Departments of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Evanston Northwestern Healthcare, Evanston, Illinois, USA
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Pannellini T, Spadaro M, Di Carlo E, Ambrosino E, Iezzi M, Amici A, Lollini PL, Forni G, Cavallo F, Musiani P. Timely DNA vaccine combined with systemic IL-12 prevents parotid carcinomas before a dominant-negative p53 makes their growth independent of HER-2/neu expression. THE JOURNAL OF IMMUNOLOGY 2006; 176:7695-703. [PMID: 16751417 DOI: 10.4049/jimmunol.176.12.7695] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Double transgenic mice overexpressing the transforming rat HER-2/neu oncogene and the mutated p53, with both dominant-negative and a gain-of-function properties, display early aggressive and metastasizing parotid tumors. Multiple acinar and ductal hyperplasia foci overexpressing the HER-2/neu gene product are evident at wk 5 and progress to poorly differentiated carcinoma by wk 7. Mice die before wk 18 with invasive carcinomas and multiple metastases that no longer express HER-2/neu. A combination of repeated electroporations of plasmids coding for the extracellular and transmembrane domains of the rat HER-2/neu receptor with systemic IL-12 administrations started when the parotids that present diffuse hyperplasia protected all female and 50% of the male mice until the close of the experiment at wk 40. This combined treatment began when multifocal in situ carcinomas that were already present cured 33% of the females and 25% of the males. The most prominent immunologic features associated with the antitumor protection were the production of high titers of anti-HER-2/neu Abs and the nonappearance of cell-mediated cytotoxic reactivity. In conclusion, anti-HER-2/neu vaccination combined with systemic IL-12 control parotid carcinomas as far as p53 mutation makes their growth independent of HER-2/neu expression.
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Affiliation(s)
- Tania Pannellini
- Aging Research Center, CeSi, G. d'Annunzio University Foundation, Chieti, Italy
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Pather N, Osman M. Landmarks of the facial nerve: implications for parotidectomy. Surg Radiol Anat 2006; 28:170-5. [PMID: 16636775 DOI: 10.1007/s00276-005-0070-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Accepted: 11/05/2005] [Indexed: 01/01/2023]
Abstract
Facial nerve paralysis is a daunting potential complication of parotid surgery and is widely reported. Knowledge of the key landmarks of the facial nerve trunk is essential for safe and effective surgical intervention in the region of the parotid gland. In current practice, wide ranges of landmarks are used to identify the facial nerve trunk, however, there is much debate in the literature about the safety and reliability of each of these landmarks. The aim of this study, therefore, was to evaluate the relation of the surrounding anatomical structures and surgical landmarks to the facial nerve trunk. The anatomical relationship of the facial nerve trunk to the surrounding structures was determined after micro-dissection on 40 adult cadavers. The shortest distances between the facial nerve and the "tragal pointer", attachment of the posterior belly of digastric muscle, tympanomastoid suture, external auditory canal, transverse process of the axis, angle of the mandible and the styloid process were measured. In addition, these distances were compared in the right and left sides, males and females and edentulous and non-edentulous mandibles. The distance of the facial nerve trunk from each of the surrounding landmarks ranged from (mm): tragal pointer, 24.3 to 49.2 (mean 34); posterior belly of digastric, 9.7 to 24.3 (mean 14.6); external auditory canal, 7.3 to 21.9 (mean 13.4); tympanomastoid suture, 4.9 to 18.6 (mean 10.0); styloid process, 4.3 to 18.6 (mean 9.8); transverse process of the axis, 9.7 to 36.8 (mean 16.9); angle of the mandible, 25.3 to 48.69 (mean 38.1). The length of the facial nerve trunk from its point of exit from the stylomastoid foramen to its bifurcation into upper and lower divisions ranged from (mm) 8.6 to 22.8 (mean 14.0). The results demonstrated that the posterior belly of digastric, tragal pointer and transverse process of the axis are consistent landmarks to the facial nerve trunk. However, it should be noted that the tragal pointer is cartilaginous, mobile, asymmetrical and has a blunt, irregular tip. This study advocates the use of the transverse process of the axis as it is easily palpated, does not require a complex dissection and ensures minimum risk of injury to the facial nerve trunk.
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Affiliation(s)
- N Pather
- School of Anatomical Sciences, Faculty of Health Sciences, Medical School, University of Witwatersrand, 7 York Road, 2193 Parktown, South Africa.
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Al Salamah SM, Khalid K, Khan IAR, Gul R. Outcome of surgery for parotid tumours: 5-year experience of a general surgical unit in a teaching hospital. ANZ J Surg 2005; 75:948-52. [PMID: 16336383 DOI: 10.1111/j.1445-2197.2005.03580.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most of the recent reports on the surgical management of parotid gland disorders come from specialist divisions of otolaryngology, head and neck, or faciomaxillary surgery. The aim of the present study was to evaluate the outcome of surgery for parotid tumours in a general surgical unit of a teaching hospital. METHOD A prospective clinicopathological study was undertaken over a 5-year period for consecutive patients operated on for parotid gland tumours in the King Saud University Unit of Riyadh Medical Complex. Parameters analyzed were demographic details, clinical presentation, diagnostic work-up, type of surgery, and outcome in terms of early and late morbidity. RESULTS Thirty seven parotid operations were performed on 36 consecutive patients. All patients presented with parotid gland swelling. Mean age was 51.6 years with a male preponderance. Fine-needle aspiration diagnosed the pathology in 33 out of 37 lesions. Pleomorphic adenoma was the commonest pathology observed in 24 patients (64.9%). Warthin's tumour was more common among male patients and was the only pathology with bilateral involvement. Malignant tumour was found in five patients (13.5%). Superficial conservative parotidectomy was the most frequently performed operation (84%). Overall postoperative morbidity was 13.5%. Transient facial nerve palsy was observed in seven cases (19%). There was no recurrence identified in patients with benign diseases during the mean follow up of 38.5 months. CONCLUSION Parotid gland surgery can still be performed in a general surgery unit with comparable outcome. However, the operation should be performed in units with special interest and experience in surgery for parotid gland disorders.
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Affiliation(s)
- Saleh M Al Salamah
- Department of General Surgery, College of Medicine, King Saud University Unit, Riyadh Medical Complex, Kingdom of Saudi Arabia
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Abstract
The parotid gland is an uncommon site of metastasis from carcinomas arising outside the head and neck region. Involvement of the parotid gland as an initial site of metastasis or presentation is rare. The present case report is the first, to our knowledge, to describe the management and outcome of an elderly man whose first presentation of an asymptomatic squamous cell carcinoma of the lung was that of a rapidly growing fungating left parotid mass.
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Affiliation(s)
- Martin F Borg
- Department of Radiation Oncology, Royal Adelaide Hospital, South Australia, Australia.
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