Parotid Gland Lipoma: A Common Tumour at an Uncommon Location

Introduction: Lipoma is the most common benign tumour of mesenchymal origin. They are quiet uncommon in head and neck region, constituting approximately 13% of all lipomas. Parotid gland lipomas are extremely rare with incidence ranging from 0.6% to 4.4%. Case report: We are reporting a rare case of parotid gland lipoma in a 42 year male presented with a slow growing painless swelling on the right side of the neck without any signs and symptoms of facial nerve degeneration. Conclusion: These tumours are seldom diagnosed clinically but imaging methods and fine needle aspiration can help reaching a pre-operative diagnosis. Surgical removal is treatment of choice in symptomatic cases

Facial paralysis after superficial parotidectomy: analysis of possible predictors of this complication / Paralisia facial após parotidectomia superficial: análise de possíveis preditivos dessa complicação

ABSTRACT INTRODUCTION: Salivary gland tumors represent 3-10% of all head and neck neoplasms. These tumors occur predominantly in major salivary glands. The parotid gland is affected most often, ranging from 36.6% to 83%. The pleomorphic adenoma comprises 45-60% of all salivary gland tumors. Several surgical approaches have been described to treat this tumor. Lesion of the facial nerve is one of the most serious complications that can occur after parotid gland surgery. OBJECTIVES: To determine possible predictive factors related to the occurrence of peripheral facial paralysis (PFP) after superficial parotidectomy in the surgical treatment of the pleomorphic adenomas of the parotid gland. METHODS: This was a primary, observational, case-control study performed through the revision of patients' charts and histopathological reports. Data was obtained from 1995 to 2014. The analyzed events were: tumor's length and depth; duration of the disease referred by the patient (more than 1, 5 or 10 years); primary or secondary surgical approach. RESULTS: The analysis showed that tumor lengths equal or superior to 3.0 cm were a risk factor of PFP with an odds ratio of 3.98 (p = 0.0310). Tumor depths equal or superior to 2.0 cm were also a risk factor with an odds ratio of 9.5556 (p = 0.0049). When the tested event was secondary surgery to recurrent tumors we have found an odds ratio of 6.7778 (p = 0.0029). CONCLUSION: Tumors with 3.0 cm or more in length and/or 2.0 cm or more in depth have a significant higher risk of facial nerve injury. Secondary surgery to recurrent tumors also has a much higher risk of evolving with facial palsy after superficial parotidectomy.

Resumo Introdução: Os tumores de glândulas salivares representam de 3 a 10% de todas as neoplasias de cabeça e pescoço. Esses tumores ocorrem predominantemente nas glândulas salivares maiores. A glândula parótida é afetada na maioria das vezes, variando de 36,6 a 83%. O adenoma pleomórfico abrange 45-60% de todos os tumores de glândulas salivares. Diversas abordagens cirúrgicas foram descritas para o tratamento desse tumor. A lesão do nervo facial é uma das complicações mais graves que podem ocorrer após cirurgia de glândula parótida. Objetivos: Determinar possíveis fatores preditivos relacionados à ocorrência de paralisia facial periférica (PFP) após parotidectomia superficial no tratamento cirúrgico de adenomas pleomórficos de glândula parótida. Método: Estudo preliminar, observacional, de caso-controle, realizado por meio de revisão dos prontuários de pacientes e laudos histopatológicos. Os dados foram obtidos no período de 1995-2014. Os eventos analisados foram o tamanho do tumor no maior diâmetro e a profundidade, o tempo de doença referido pelo paciente (mais de 1, 5 ou 10 anos) e a abordagem cirúrgica primária ou secundária. Resultados: A análise mostrou que o tamanho do tumor igual ou superior a 3,0 cm foi um fator de risco para PFP, com uma razão de chance de 3,98 (p = 0,0310). A profundidade do tumor igual ou superior a 2,0 cm também foi um fator de risco, com uma razão de chance de 9,5556 (p = 0,0049). Quando o evento testado foi cirurgia secundária para tumores recorrentes, encontramos uma razão de chance de 6,7778 (p = 0,0029). Conclusão: Os tumores de 3,0 cm ou mais de comprimento e/ou 2,0 cm ou mais de profundidade apresentam um risco significativamente maior de lesão do nervo facial. A cirurgia secundária para tumores recorrentes também apresenta um risco maior de evoluir com paralisia facial após parotidectomia superficial.

A Rare Case of a Dermoid Cyst of Parotid Gland

Dermoid cysts are benign lesions containing tissues of ectodermal and mesodermal germ layers. The incidence of dermoid cyst in head and neck region is only 7% while in parotid gland only 18 cases have been reported in the literature. An 18-year-old male presented with a slow growing, painless and soft swelling in the right pre-auricular region. According to the patient, he had this swelling since birth. Ultrasonography was suggestive of a 3X3 cm cystic lesion within the right parotid gland. Fine needle aspiration cytology (FNAC) showed predominantly anucleate squames and keratinous debris indicating towards the possibility of a dermoid cyst of parotid. The lesion was surgically excised with superficial parotidectomy, preserving the facial nerve. Histopathology confirmed the diagnosis. Post-operative period was uneventful and patient recovered well. Owing to the rarity of dermoid cysts in the head and neck region and more so within the parotid gland, this case is being reported here.

Recurrent Pleomorphic Adenoma of the Parotid Gland

Pleomorphic adenoma is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Because of its propensity for invasion, pleomorphic adenoma of the parotid requires superficial parotidectomy or total parotidectomy to minimize the risk of tumor recurrence. We report a case of pleomorphic adenoma of the parotid gland with repeated recurrences. A 23-year-old male patient presented with a protruding neck mass. Six years prior to this presentation, the patient had undergone superficial parotidectomy for the removal of pleomorphic adenoma of the right parotid gland at our institution. The patient experienced recurrence at 17 months after the initial resection, which required a total parotidectomy with partial resection of the facial nerve. Pathologic examination revealed histologic findings consistent with pleomorphic adenoma across the surgical specimen from all three of the operations. The patient suffered from facial nerve paralysis, with facial expressions partially recovered over a year.

Partial Superficial Parotidectomy via Retroauricular Hairline Incision

OBJECTIVES: The purpose of this study was to evaluate the usefulness of retroauricular hair line incision (RAHI) in partial superficial parotidectomy by comparison with modified Blair incision or facelift incision. METHODS: Medical records of 73 patients with benign parotid tumor who underwent partial superficial parotidectomy were retrospectively reviewed. Size and location of tumors, operative time, occurrence of facial nerve paralysis and Frey's syndrome, and cosmetic outcomes were compared among RAHI, facelift incision (FLI), modified Blair incision (MBI) groups. RESULTS: RAHI group showed better cosmetic results than FLI group or MBI group compared with other type of incisions (P0.999), occurrence of temporary or permanent facial nerve paralysis (P=0.745) and Frey's syndrome (P=0.940). CONCLUSION: Partial superficial parotidectomy can be done safely by RAHI in most cases of benign parotid tumor. Compared with MBI or FLI, RAHI has better cosmetic outcome with no increase of operative time or postoperative complications.

Conservative Parotidectomy for Benign Parotid Tumors / 대한이비인후과학회지

Superficial parotidectomy is the most widely accepted form of the treatment for benign parotid tumors. But the risk of postoperative complications for the treatment of a benign condition cannot be ignored. Recent studies suggest that conservative parotidectomy (partial superficial parotidectomy or extracapsular dissection) might be the reliable option for the resection of benign parotid tumors. Conservative parotidectomy showed similar recurrence rate and lesser post operative complications than superficial parotidectomy.

Effectiveness of Botulinum Toxin A in Treatment of Frey's Syndrome

PURPOSE: Several therapeutic approaches have been introduced and tried to treat Frey syndrome following parotidectomy. However they were not proved as an effective treatment. A new therapeutic modality using botulinum toxin injections was presented previously by several study groups. But, the duration of the demonstrated positive effect was essentially unknown so far. The purpose of this clinical investigation is to demonstrate the effectiveness of Botulinum toxin type A(BTXA) in patients with Frey syndrome. METHODS: For this study, 12 patients were treated, They were assessed with the Minor's iodine-starch test and interviewed before and after treatment. Botulinum toxin is injected with 1.0cm2 apart into the skin where symptoms of Frey's syndrome has manifestated. The patients were classified according to the concentration of botulinum toxin and dosage of botulinum toxin. RESULTS: The outcome measures were the time of reappearance of gustatory sweating(subjective study), and the results of an Minor's iodine-starch test(objective study) of 3 weeks, 3 months, 6 months, 9 months, 12 months after treatment. This treatment was effective in all groups of patients. The concentrations and the amount of dosages did not affect the treatment. But high concentration produced faster effectiveness in subjective. CONCLUSION: Botulinum toxin type A(BTXA) for Frey syndrome is easy, convenient and effective withouts severe complication. And the patients has no difficulty and limitation in their life.

Effectiveness of Botulinum Toxin A in Treatment of Frey's Syndrome

PURPOSE: Several therapeutic approaches have been introduced and tried to treat Frey syndrome following parotidectomy. However they were not proved as an effective treatment. A new therapeutic modality using botulinum toxin injections was presented previously by several study groups. But, the duration of the demonstrated positive effect was essentially unknown so far. The purpose of this clinical investigation is to demonstrate the effectiveness of Botulinum toxin type A(BTXA) in patients with Frey syndrome. METHODS: For this study, 12 patients were treated, They were assessed with the Minor's iodine-starch test and interviewed before and after treatment. Botulinum toxin is injected with 1.0cm2 apart into the skin where symptoms of Frey's syndrome has manifestated. The patients were classified according to the concentration of botulinum toxin and dosage of botulinum toxin. RESULTS: The outcome measures were the time of reappearance of gustatory sweating(subjective study), and the results of an Minor's iodine-starch test(objective study) of 3 weeks, 3 months, 6 months, 9 months, 12 months after treatment. This treatment was effective in all groups of patients. The concentrations and the amount of dosages did not affect the treatment. But high concentration produced faster effectiveness in subjective. CONCLUSION: Botulinum toxin type A(BTXA) for Frey syndrome is easy, convenient and effective withouts severe complication. And the patients has no difficulty and limitation in their life.

A Case of Bilateral Warthin's Tumor

Warthin's tumor is a benign neoplasm that most frequently occurs in the parotid gland. Warthin's tumor shows a tendency of bilateral occurrence, but most of bilateral tumors occur at different time. It usually affects older man and grows slowly. Surgical excision is appropriate treatment for patients with Warthin's tumor and rarely recurs after removal. We report a rare case of bilateral Warthin's tumor which detected at the same time. A 54-year-old man had painless, slowly growing masses on the both mandibular angles. The masses were detected ten years ago. CT scan, ultrasonographic evaluation and fine needle biopsy was performed for preoperative diagnostic study. Superficial parotidectomy was done one after the other at ten-day intervals. After excision, histological examination revealed a mixture of ductal epithelium and a lymphoid stroma. The overlying surface of lymphoid tissue was covered with epithelial cells that was abundant of eosinophilic cytoplasm. Both masses were diagnosed as Warthin's tumor. Postoperatively, the patient did well and had no evidence of recurrence of tumor for 2 years follow-up period. Authors experienced a rare case of bilateral Warthin's tumor which detected at the same time. We recommend stepwise superficial parotidectomy at one or two-week intervals as treatment of bilateral Warthin's tumor.

Huge pleomorphic adenoma of the parotid gland: report of a case

A Case Report Of Bilateral Warthin's Tumor

The Surgical Treatment of The Benign Parotid Tumors / 昆明医科大学学报

The paper reports 214 cases of the bening parotid tumors which were treated by the parotidectomy of preserving the facial nerves during 1970-1987. Superficial parotidectomy was done in 30 cases, and total parotidectomy in 184 cases. The result of the follow-up survey of 176 cases was gained. No permanent facial paralysis and recurrence occured after the parotidetomy.