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Abstract
Accessory parotid gland (APG) tumors account for 1% to 7% of all parotid gland neoplasms but are more likely to be malignant than main parotid gland tumors. Management of APG neoplasms entails surgical excision. Four primary approaches to resection have been described in the literature with varying facial nerve outcomes. We report a case of a 4-cm APG pleomorphic adenoma utilizing a transoral approach for excision without postoperative facial nerve injury. A transoral approach is known to mitigate patients' cosmetic concerns; however, prior reports utilized endoscopic assistance on patients with smaller tumors. We conclude that large APG tumors can be excised through a transoral approach without undue risk to the distal facial nerves, though this transoral approach ultimately may not be appropriate for malignant neoplasms or difficult dissections.
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Affiliation(s)
- Rohith S Voora
- University of California, San Diego School of Medicine, La Jolla, CA, USA
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
| | - Joshua Stramiello
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
| | - Emily Funk
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
| | - Joseph Califano
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
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Wierzbicka M, Bartkowiak E, Pietruszewska W, Stodulski D, Markowski J, Burduk P, Olejniczak I, Piernicka-Dybich A, Wierzchowska M, Amernik K, Chańko A, Majszyk D, Bruzgielewicz A, Gazinska P, Mikaszewski B. Rationale for Increasing Oncological Vigilance in Relation to Clinical Findings in Accessory Parotid Gland-Observations Based on 2192 Cases of the Polish Salivary Network Database. Cancers (Basel) 2024; 16:463. [PMID: 38275903 PMCID: PMC10814580 DOI: 10.3390/cancers16020463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The accessory parotid gland (APG, Vth level) differs in histological structure from main parotid tissue. This gives rise to the hypothesis, mirrored in clinical observations, that the representation of tumours is different than in the rest of the gland. The aim of the study was to analyse the epidemiological and histological differences of parotid tumours located in regions I-V, with particular emphasis on the distinctiveness of region V. To define the epidemiological factors that will indicate the risk of histological malignancy from clinically benign appearance, multicentre prospective studies conducted between 2017-2021 by five Head and Neck Surgery University Departments, cooperating within the Polish Salivary Network Database 1929 patients (1048 women and 881 men), were included. The age, gender, patient occupation, place of inhabitation, tumour size, clinical features of malignancy, histology, and facial nerve (FN) paresis were analysed for superficial (I_II) and deep (III_IV) lobes and with special regard to the tumours affecting region V. Twenty eight tumours were located exclusively in region V (1.45% total) and seventy-two tumours were found in region V exhibiting extensions to neighbouring regions (3.7% total), characterised as significantly younger and less frequent in retirees. In I-IV regions, approximately 90% of tumours were benign, with pleomorphic adenoma (PA) and Whartin tumour (WT) predominance. In region V, PA exceeded 75% but WT were casuistic (2/28). Incidences of malignancies in region V was 40% but clinical signs of malignancy were evident only in tumours > 4 cm or in the presence of FN paresis. In 19% of patients with a benign appearance, imaging revealed malignancy; however, 38% of patients showed false negative results both in terms of clinical and radiological features of malignancy. Logistic regression models in 28 patients with tumours located exclusively in region V vs. 1901 other patients and in 100 patients with V extension vs. 1829 other patients showed no clinical symptoms of malignancy binding with final malignant tumour histology as a single variable or in combination with other variables. The logistic regression models obtained in this study show strong linkage between tumour location and predictors (age, male gender, and tumour diameter) and also aimed to function as a good classifier. Our conclusion is that, despite the very clear image of the mid-cheek tumour which is easily accessible in palpation and ultrasound examination, it is necessary to improve oncological vigilance and preoperative patient preparation.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology, Regional Specialist Hospital Wroclaw, Research & Development Centre, 51-124 Wroclaw, Poland;
- Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland
- Institute of Human Genetics, Polish Academy of Sciences, 01-447 Poznan, Poland
| | - Ewelina Bartkowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Wioleta Pietruszewska
- Department of Otolaryngology, Head Neck Oncology, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Dominik Stodulski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland; (D.S.); (B.M.)
| | - Jarosław Markowski
- Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (J.M.); (A.P.-D.)
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 87-100 Bydgoszcz, Poland; (P.B.); (M.W.)
| | - Izabela Olejniczak
- Department of Otolaryngology, Head Neck Oncology, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Aleksandra Piernicka-Dybich
- Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (J.M.); (A.P.-D.)
| | - Małgorzata Wierzchowska
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 87-100 Bydgoszcz, Poland; (P.B.); (M.W.)
| | - Katarzyna Amernik
- Department of Otolaryngology, Pomeranian University of Medicine, 70-204 Szczecin, Poland; (K.A.); (A.C.)
| | - Alicja Chańko
- Department of Otolaryngology, Pomeranian University of Medicine, 70-204 Szczecin, Poland; (K.A.); (A.C.)
| | - Daniel Majszyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (D.M.); (A.B.)
| | - Antoni Bruzgielewicz
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (D.M.); (A.B.)
| | - Patrycja Gazinska
- Biobank Research Group, Lukasiewicz Research Network—PORT Polish Center for Technology Development, Stabłowicka St., 147, 54-066 Wroclaw, Poland;
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland; (D.S.); (B.M.)
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Liu J, Liu P, Peng L, Wang Z. Low-grade intraductal carcinoma of accessory parotid gland: a case report. Hua Xi Kou Qiang Yi Xue Za Zhi 2022; 40:606-609. [PMID: 38596983 PMCID: PMC9588860 DOI: 10.7518/hxkq.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/19/2022] [Indexed: 04/11/2024]
Abstract
Salivary low-grade intraductal carcinoma (LGIDC) is a rare tumor that mainly occurs in the parotid. Thus far, LGIDC originating from the accessory parotid gland has been rarely reported in domestic and foreign literature. This study reports a case of LGIDC of the accessory parotid gland and a brief summary of its clinical features, diagnostic points, and treatment by reviewing the literature, with the aim of providing a reference for clinical practice and further research.
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Affiliation(s)
- Jianshan Liu
- Dept. of Stomatology, Tianjin Fifth Central Hospital, Tianjin 300450, China
| | - Pan Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology, Hubei Province & Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan University, Wuhan 430072, China
| | - Liwei Peng
- Dept. of Oral and Maxillofacial Surgery, Henan Provincial People's Hospital, The Affiliated People's Hospital of Henan University, Zhengzhou 450003, China
| | - Zhixing Wang
- Dept. of Stomatology, Tianjin Fifth Central Hospital, Tianjin 300450, China
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Huvenne W, De Vriese C, Bogaert J, Vermeersch H. Review of publications on the possible advantages of a direct cheek incision for accessory parotid gland masses. Br J Oral Maxillofac Surg 2020; 58:e248-e253. [PMID: 32847722 DOI: 10.1016/j.bjoms.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
Lesions of the accessory parotid gland (APG) are rare and surgical management is generally under-discussed. The surgical approach should provide complete resection, while minimising complications and aesthetic complaints. The current study reviews recent publications on the surgical management of APG masses, and discusses the advantages, and limitations of, and our experience with, direct cheek incision. Papers on the surgical management of APG masses published in the last 10 years were systematically searched. Information was obtained regarding the surgical approach, type of excision, and postoperative complications. In the included studies, 253 APG masses were selected for analysis, whereof six were treated with the direct cheek incision. Although no local recurrence or postoperative complications were observed after this, the approach was usually not recommended due to a higher reported risk of recurrence and complications in older papers. More recent studies, however, indicate that the direct cheek incision should be considered as a valuable alternative to standard approaches in selected patients.
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Affiliation(s)
- W Huvenne
- Department of Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium
| | - C De Vriese
- Faculty of Medicine, University of Ghent, Ghent, Belgium.
| | - J Bogaert
- Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - H Vermeersch
- Department of Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium; Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Ghent, Belgium
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Abbate V, Romano A, AlQahtani A, Manfuso A, Hirt B, Castelnuovo P, Califano L. Midcheek endoscopic anatomy. Head Neck 2014; 38 Suppl 1:E268-73. [PMID: 25545170 DOI: 10.1002/hed.23984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Surgical approaches to the midcheek area are challenging. Recent clinical reports have proposed minimally endoscopic approach again, in order to obtain to obtain a correct balance between the operation's safety and the cosmetic and minimally invasive outcome, but none of them provides a careful anatomic description of the midcheek area. The purpose of this study was to provide a new anatomic perception of the midcheek area through a detailed anatomic endoscopic-assisted dissection. METHODS Four freshly injected cadaver heads were dissected to illustrate the endoscopic anatomy of the midcheek region. RESULTS An endoscope provided an excellent surgical window that achieved greater exposure for dissection and at the same time improved magnification of the noble key anatomic elements. CONCLUSION This study emphasizes the critical role of the transverse facial artery and the facial retaining ligaments as a fundamental endoscopic landmark that allows the identification of key anatomic structures and the creation of safe surgical corridors. © 2015 Wiley Periodicals, Inc. Head Neck 38: E268-E273, 2016.
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Affiliation(s)
- Vincenzo Abbate
- Department of Maxillofacial Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonio Romano
- Department of Maxillofacial Surgery, University of Naples "Federico II", Naples, Italy
| | - Abdulaziz AlQahtani
- Department of Otorhinolaryngology/Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Alfonso Manfuso
- Department of Maxillofacial Surgery, University of Naples "Federico II", Naples, Italy
| | - Bernhard Hirt
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Tubingen Medical Center, Tubingen, Germany
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Luigi Califano
- Department of Maxillofacial Surgery, University of Naples "Federico II", Naples, Italy
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