ABSTRACT
Parotid gland tumors are usually solitary tumors, and multiple tumors of the parotid gland are extremely rare. We present a highly unusual case of bilateral and simultaneous pleomorphic adenoma and basal cell adenoma of the parotid gland. We review the literature and discuss the clinical manifestations, diagnosis, and treatment of these two rare tumors.
Subject(s)
Humans , Adenoma, Pleomorphic , Parotid Gland , Parotid Neoplasms/diagnosisABSTRACT
OBJECTIVES@#This study aimed to evaluate the application value of a modified retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle in the resection of benign parotid gland tumors.@*METHODS@#Forty-eight patients with benign parotid gland tumors were retrospectively analyzed: 19 cases were included in the experimental group with an improved retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle, and 29 cases were assigned in the control group with a modified facelift incision. Operation time, postoperative drainage, postoperative esthetic degree, and incidence of facial nerve paralysis, salivary fistula, and Frey's syndrome were compared.@*RESULTS@#After the esthetic procedure, the average score of the experimental group was higher than that of the control group, and the esthetic effect of the former was better than that of the latter (@*CONCLUSIONS@#The modified retroauricular hairline incision and sternocleidomastoid flap with an inferior pedicle can be applied to resect benign parotid gland tumors safely. It shows a better cosmetic effect and does not cause obvious postoperative complications. Therefore, it should be promoted for tumor treatments.
Subject(s)
Humans , Esthetics, Dental , Parotid Gland/surgery , Parotid Neoplasms/surgery , Postoperative Complications , Retrospective Studies , Sweating, GustatoryABSTRACT
Abstract Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.
ABSTRACT
Objective @#To assess the safety and feasibility of incision in the retroauricular sulcus for removal of benign tumors in the lower pole of the parotid gland and to provide some ideas for aesthetic consideration of parotidectomy.@*Methods@# In total, 18 cases with benign tumors of the lower pole regions of the parotid gland were included in this study, including 9 pleomorphic adenomas, 2 myoepitheliomas, 5 Warthin tumors, 1 basal cell adenoma and 1 oncocytoma. Three months after the operation, facial paralysis and salivary fistula were assessed. A visual analog scale was used to score the cosmetic satisfaction of the surgical incision. Tumor recurrence was followed up 6 ~ 12 months after operation.@*Results@# In 18 patients with benign tumors the lower pole regions of the parotid gland, the tumor diameter ranges from 1.0 to 3.1 cm, with an average value of 2.5 cm. All patients experienced successful complete removal of the parotid mass with the minimally invasive retroauricular approach, and all wounds healed in one stage after operation. No serious complications, such as permanent facial paralysis and tumor recurrence, occurred 3 months after the operation. The patients were satisfied with the appearance of the surgical incision (aesthetic score 9.3 ± 0.4), achieving the expected aesthetic effect. @*Conclusion@#This approach is feasible and safe for most small benign parotid tumors located in the lower pole region of the parotid gland and in the posterior region of the jaw. The scar is located in the retroauricular sulcus, which significantly meets the aesthetic needs of the concealed incision for patients.
ABSTRACT
Pleomorphic adenoma is the most common salivary gland tumor. Pseudopodia are finger-like projections extending beyond the tumor capsule, seen in pleomorphic adenoma. If not resected completely, these pseudopodia may increase the risk of recurrence after excision of pleomorphic adenoma. While performing a total conservative parotidectomy for the pleomorphic adenoma of the parotid gland, we encountered tumor in the Stensen's duct. On pathological examination, the tumor was not involving the wall of the duct but was passing through the lumen, like a pseudopod. During parotidectomy, the surgeon should inspect the lumen of parotid duct for the presence of any tumor. Pseudopodia of pleomorphic adenoma may extend into the lumen and if not addressed adequately may lead to recurrence of the tumor.
ABSTRACT
Mucosa-associated lymphoid tissue (MALT) lymphoma has specific clinical and pathologic features. The most common site MALT lymphomas is the stomach; however, it can also occur in other organs, such as the salivary glands. MALT lymphoma is rare, but its prognosis is good. A 32-year-old man visited Konyang university hospital with parotid mass. Superficial partial parotidectomy was performed to exclude lymphoid neoplasms. IgH gene rearrangement analysis of the surgical specimen led to the diagnosis of MALT lymphoma. The patient underwent esophagogastroduodenoscopy, positron emission tomography-computed tomography, and whole-body bone scan. Regional or distant metastasis was not observed on staging workup. The patient underwent postoperative radiation therapy, there has been no recurrence of MALT lymphoma to date. Here, we report this rare case of parotid MALT lymphoma that was treated with surgery and postoperative radiation therapy.
Subject(s)
Adult , Humans , Diagnosis , Electrons , Endoscopy, Digestive System , Gene Rearrangement , Lymphoid Tissue , Lymphoma , Lymphoma, B-Cell, Marginal Zone , Neoplasm Metastasis , Parotid Gland , Prognosis , Recurrence , Salivary Glands , StomachABSTRACT
OBJECTIVE: The purpose of this study was to determine the diagnostic utility of low-dose CT with knowledge-based iterative model reconstruction (IMR) for the evaluation of parotid gland tumors. MATERIALS AND METHODS: This prospective study included 42 consecutive patients who had undergone low-dose contrast-enhanced CT for the evaluation of suspected parotid gland tumors. Prior or subsequent non-low-dose CT scans within 12 months were available in 10 of the participants. Background noise (BN), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between non-low-dose CT images and images generated using filtered back projection (FBP), hybrid iterative reconstruction (iDose⁴; Philips Healthcare), and knowledge-based IMR. Subjective image quality was rated by two radiologists using five-point grading scales to assess the overall image quality, delineation of lesion contour, image sharpness, and noise. RESULTS: With the IMR algorithm, background noise (IMR, 4.24 ± 3.77; iDose⁴, 8.77 ± 3.85; FBP, 11.73 ± 4.06; p = 0.037 [IMR vs. iDose⁴] and p < 0.001 [IMR vs. FBP]) was significantly lower and SNR (IMR, 23.93 ± 7.49; iDose⁴, 10.20 ± 3.29; FBP, 7.33 ± 2.03; p = 0.011 [IMR vs. iDose⁴] and p < 0.001 [IMR vs. FBP]) was significantly higher compared with the other two algorithms. The CNR was also significantly higher with the IMR compared with the FBP (25.76 ± 11.88 vs. 9.02 ± 3.18, p < 0.001). There was no significant difference in BN, SNR, and CNR between low-dose CT with the IMR algorithm and non-low-dose CT. Subjective image analysis revealed that IMR-generated low-dose CT images showed significantly better overall image quality and delineation of lesion contour with lesser noise, compared with those generated using FBP by both reviewers 1 and 2 (4 vs. 3; 4 vs. 3; and 3–4 vs. 2; p < 0.05 for all pairs), although there was no significant difference in subjective image quality scores between IMR-generated low-dose CT and non-low-dose CT images. CONCLUSION: Iterative model reconstruction-generated low-dose CT is an alternative to standard non-low-dose CT without significantly affecting image quality for the evaluation of parotid gland tumors.
Subject(s)
Humans , Feasibility Studies , Image Processing, Computer-Assisted , Noise , Parotid Gland , Prospective Studies , Radiation Dosage , Signal-To-Noise Ratio , Tomography, X-Ray Computed , Weights and MeasuresABSTRACT
Objective To investigate the CT imaging features of basal cell adenoma in the parotid gland and thus to improve the preoperative diagnostic accuracy.Methods The clinical materials and image findings of 8 cases with parotid basal cell tumor,which were proved by pathology,were retrospectively studied.Results All 8 patients had solitary BCA lesion,which involved both the superficial and deep lobe(n =1) and located at the superficial lobe of parotid gland(n =7).All the 6 tumors were clear boundary and round shape without lobular appearance.The diameters of the max lesions ranged from 10.3-27.6 mm.CT scan showed that all lesions were solid nodules with uniform or uneven density.Cystic degeneration was displayed in 5 lesions,among them,cystic area was ≥90％ in 1 lesion.At enhanced scanning phase,most tumors showed a strong enhancement at the arterial phase and a pattern of persistent strong enhancement or slow decline at the venous phase.Conclusion The multi-slice CT imaging features of BCA in parotid gland are characteristic,which is helpful to make qualitative diagnosis in combination with clinical materials.
ABSTRACT
Objective:To explore the postoperative complications of different incisions of parotidectomy in benign parotid tumor and the impact on life quality.Methods:62 patients with benign parotid ttmor underwent improved parotidectomy in our hospital from January 2010 to January 2015 were selected and randomly divided into group A and group B.The patients in group A were using improved S incision,and the patients in group B were using postauricular concealing incision.Then the perioperative indexes,complications after surgery and the influences to life quality of 2 groups were observed and compared.Results:The surgery time,blood loss,postoperative suction drainage and hospital stays of 2 groups had no great differences (P＞0.05).The early and forward complication rate of group A was 29.03 ％ and 25.81％ respectively,of group B was 19.35 ％ and 12.90 ％ respectively.There were no differences between them (P＞0.05).The scores of pain and emotion after surgery of group A were getting better,and appearance,smell and chewing function was getting worse than before surgery with statistically significance (P＜0.05).The scores of pain and emotion after surgery of group B were getting better than before (P＜0.05).The scores of appearance and emotion of group A were worse than those of group B with statistically significance (P＜0.05).Conclusions:Using postauricular concealing incision can obtain good life quality and safety for the patients with benign parotid tumor,which is superior to improved S incision,worthy of clinical applications.
ABSTRACT
Objective:To evaluate the advantages of function-preserving parotidectomy for benign tumors involving deep parotid lobe. Methods:17 patients with benign tumor involving deep parotid lobe were treated by limited partial parotidectomy.All of the tumors were not more than 3 cm of diameter,12 of them were in the deep lobe and 5 involving both superficial and deep lobes.In the operation fascia glandular flap was made,the tumor with the surrounding gland tissue was thoroughly dissected and the glandular parenchyma was preserved.Results:All the operations were successful and the wounds healed well with symmetrical facial contours.No patient experi-enced salivary fistula.Temporary facial palsy was observed in 2 cases(11.76%).No tumor recurrence was observed.Facial nerve function of all patients completely recovered after a median follow-up of 11 months.Conclusion:Function-preserving parotidectomy for benign tumor involving the parotid deep lobe may improve functional outcomes without compromising local tumor control.
ABSTRACT
El uso del propranolol es una alternativa terapéutica en los hemangiomas de la infancia. Los resultados que se describen en la literatura con su empleo lo colocan en las primeras líneas de elección en el tratamiento de esta enfermedad. Se reportó el caso de una lactante de cuatro meses de edad con hemangioma de la parótida izquierda, diagnosticada y tratada en el Hospital Pediátrico de Cienfuegos, que no tuvo una respuesta satisfactoria con los esteroides, y que con el propranolol presentó regresión completa de la lesión; se mantuvo el tratamiento por un año, no presentó ninguna complicación con su uso.
The use of the propranolol is a therapeutic alternative in the infantile hemangiomas. The results described in the literature regarding their use place this therapy in one of the first election lines in the treatment of this illness. An infant of four years of age with left parotid hemangioma was reported. The patient was diagnosed and treated in Cienfuegos Pediatric Hospital and did not have a satisfactory response with the steroids, and with the use of propranolol a complete regression of the lesion was observed, keeping the treatment for one year, not presenting any complication with its use.
ABSTRACT
Objective To evaluate the clinical,pathological and imaging features of basal cell adenoma in the parotid. Methods The clinical,pathological and CT imaging data of 21 cases with parotid basal cell tumor confirmed by operation and pathology were retrospectively analyzed. Results All 21 patients(5 male,16 female ) had solitary BCA lesion,which located at the superficial lobe of parotid gland(n=17)and involved both the superficial and deep lobe(n=4). Twelve lesions were well-defined and cystic degeneration was displayed in 9 le-sions,3 lesions had punctate calcification at the edge of tumor. All lesions were significantly enhanced,the enhancement of BCA in the ve-nous phase was close to the arterial phase. Conclusion The CT features of BCA in parotid gland are characteristic,which is helpful to make qualitative diagnosis when in combination with clinical features.
ABSTRACT
BACKGROUND AND OBJECTIVES: Modified Blair incision (MBI) and Modified facelift incision (MFI) are mainly used for paroidectomy. MBI can provide a wide surgical view for parotidectomy. MFI was designed for better cosmesis by hiding the incision behind the auricle and hair line. This study was performed to evaluate surgical outcomes, functional and cosmetic results after parotidectomy using MBI and MFI. SUBJECTS AND METHOD: We retrospectively reviewed medical records of 120 patients who underwent parotidectomy from September 2005 to April 2012. Tumor characteristics, operative outcome, and cosmetic outcome according to incision method were investigated. Cosmetic satisfaction was assessed using a questionnaire 12-18 months after surgery. RESULTS: Tumor characteristics such as size, location and pathologic features did not differ between the two groups. The extent of parotidectomy, operation time, amout of drainage, and complications were also not different between the two groups. Cosmetic satisfaction was significantly supeior in the MFI group than that of the MBI group. CONCLUSION: MFI is superior to MBI for parotidectomy for having similar surgical outcome but better esthetical success compared to MBI.
Subject(s)
Humans , Drainage , Hair , Medical Records , Surveys and Questionnaires , Retrospective Studies , RhytidoplastyABSTRACT
To summarize the imaging characteristic of parotid lymphoepithelial carcinoma (LEC) by retrospective analyses of computed tomography (CT) and magnetic resonance imaging (MRI) findings for 6 cases of parotid LEC confirmed by operation and pathology and review the relevant literatures.All lesions were located in unilateral parotid.There were single (n =5) and multi-module fusion (n =1).All were located in superficial lobe of parotid gland.And deep lobe (3/6) was involved.An infiltration of casting shape was found along superficial parotid (4/6).There was an irregular margin with small spines,uniform density and signal and above moderate enhancement.An infiltration of casting shape along superficial lobe,uniform density and signal and rich blood supply suggest a diagnosis of LEC.
ABSTRACT
Objective: To report a case of carcinoma ex pleomorphic adenoma on a young patient. Introduction: Carcinoma ex pleomorphic adenoma typically presents in patients in the sixth decade of life, with a history of parotid tumor of long standing. Alarm symptoms are present in 50 percent of cases and survival is mainly correlated with the degree of differentiation and tumor invasion. Case report: A 33 years old woman with right parotid tumor of five years of evolution with slow growing and no symptoms. During the last year, present accelerated growth and stabbing pain. Total parotidectomy was performed without complications or sequelae. The biopsy confirms carcinoma ex pleomorphic adenoma. Discussion: The long-standing pleomorphic adenoma may present malignant transformation in up to 12 percent. We discuss risk factors, clinical presentation and diagnosis of carcinoma ex pleomorphic adenoma.
Objetivo: Presentar un caso clínico de carcinoma ex adenoma pleomorfo en una paciente joven. Introducción: El carcinoma ex adenoma pleomorfo se presenta típicamente en pacientes en la sexta década de la vida, con historia de tumor de parótida de larga data. Tiene síntomas de alarma en el 50 por ciento de los casos y la sobrevida se correlaciona principalmente con el grado de diferenciación y de invasión del tumor. Caso clínico: Paciente de 33 años con tumor de parótida derecho de 5 años de evolución, de lento crecimiento y asintomático. Que durante el último año de evolución presenta dolor punzante y crecimiento acelerado. Se realiza parotidectomía total sin complicaciones ni secuelas. La biopsia confirma un carcinoma ex adenoma pleomorfo. Discusión: El adenoma pleomorfo de larga data puede presentar malignización en hasta un 12 por ciento. Se discute los factores de riesgo, forma de presentación y diagnóstico del carcinoma ex adenoma pleomorfo.
Subject(s)
Humans , Adult , Female , Carcinoma in Situ/surgery , Carcinoma in Situ/diagnosis , Parotid Neoplasms/surgery , Parotid Neoplasms/diagnosisABSTRACT
1 case of intraductal papilloma of parotid gland was analyzed by means of clinicopathologic data,hematoxylin-eosin and immuno-histochemical staining.Combined with the relevant literature,clinical pathological features,diagnosis and treatment of the salivary gland intra-ductal papilloma were discussed.
ABSTRACT
Sclerosing polycyctic adenosis (SPA) is a rare lesion of unknown etiology morphologically resembling fibrocystic changes of the breast. To our knowledge, 53 cases of SPA have been reported in the literature to date. SPA is well circumscribed, yet not encapsulated. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important in making the correct diagnosis. The differential diagnosis of SPA includes polycystic disease, sclerosing sialadenitis and benign/malignant glandular neoplasias. Although atypia ranging from mild dysplasia to carcinoma in situ can occur in some cases, SPA has a favorable outcome. In this article, we describe a 38-year-old male patient diagnosed with SPA in the parotid gland.
Subject(s)
Adult , Humans , Male , Breast , Carcinoma in Situ , Cystic Duct , Diagnosis , Diagnosis, Differential , Parotid Gland , Recognition, Psychology , SialadenitisABSTRACT
Objective:Facial nerves can be dissected using anterograde and retrograde approaches. The optimal technique for the facial nerve dissection of a patient with benign parotid tumor has not yet been determined. This study focused on facial nerve dysfunc-tion and recovery rate after anterograde and retrograde facial-nerve dissections. Methods:The data of 110 patients with benign carotid adenoma from the Head and Neck Department of this hospital who were hospitalized between January 2011 and January 2013 were col-lected. These patients were divided into groups A (n=52) and B (n=58). Anterograde and retrograde dissections of the facial nerve were performed on group A and group B patients, respectively. Based on the preferential order of dissection, group B was divided into groups B1, B2, and B3 representing the zygomatic, buccal, and marginal mandibular branches, respectively. The patients were postoperatively observed to check for potential symptoms, such as facial paralysis along with its severity and recovery. The House-Brackmann grading system was used to assess all patients. Results:The operation could be successful, with better nerve exposure, using these approaches. Statistical differences were observed in the nerve injury and recovery rates between the groups, with group A better than group B, and group B2 better than the other two groups (P<0.05). Conclusion:Anterograde facial nerve dissection should be routinely used in be-nign parotid tumor, and the buccal branch of facial nerve dissection should be preferentially considered when no other option apart from retrograde dissection is available.
ABSTRACT
Objective To investigate the feasibility,technique and clinical significance of preserving the great auricular nerve in parotid benign tumors surgery during the first postoperative year.Methods Fifty-two patients with parotid benign tumors were randomly divded into 2 groups.24 patients (group sacrificed) underwent classic parotidectomy with sacrifice of the great auricular nerve.The surgeons spare the nerve in the 32 patients with FOCUS ultrasonic harmonic scalpel (group preserved).Results After surgery,both groups showed lower levels of subjective sensation and sensory function test at auricle.These alterations were less pronounced in group preserved.Both groups showed improvement over time.In group preserved the sensory function reached normal level by 12 months after surgery.The recuperation in group sacrificed was partial at 12 months after operation.Conclusion The great auricular nerve preservation during parotidectomy is feasible,It can decrease sensory disturbance in the early postoperative period and avoid the permanent sequelae that occur when the nerve is sacrificed.The FOCUS ultrasonic harmonic scalpel technique can reduce the operation time.
ABSTRACT
Background and purpose:Parotid gland is rich in fat and has obvious contrast with bone and muscle in CT image.The preoperative examination of CT could help to evaluate the scale of tumor invasion and the relationship between tumor and normal tissues so that the proper therapy could be properly designed.The purpose of this study was to evaluate the roles of computer tomography(CT)in differential diagnosis of benign and malignant parotid tumors and to improve the diagnostic accuracy.Methods:CT images of 17 patients with benign parotid tumors and 15 patients with malignant parotid tumors proved by pathology were analyzed retrospectively.All patients underwent CT contrast-enhanced examination preoperatively.Images of all patients were retrospectively reviewed by two experienced radiologists in the diagnosis of head and neck tumors.Results:14 of 17 cases of benign tumors had round shapes and 9 of 15 cases of malignant tumors exhibited lobular or irregular masses(P