Elective parotidectomy and neck dissection are not beneficial in cutaneous squamous cell carcinoma of the head

Abstract Objective Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. Methods We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. Results We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. Conclucion Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. Level of evidence How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series)

Programa de entrenamiento de parotidectomía en modelo cadavérico perfundido

Introducción: La parotidectomía es una cirugía infrecuente y técnicamente compleja determinada por la dificultad de disección del nervio facial, cuya lesión produce alto grado de morbilidad en los pacientes. Los modelos de simulación animales no logran reproducir las características de la anatomía regional, por lo que se hace necesario explorar otras alternativas para el entrenamiento de estas habilidades. Nuestro objetivo es evaluar un programa de entrenamiento de técnicas de parotidectomía en un modelo cadavé-rico perfundido. Métodos: Se diseñó un programa educacional de Kern de entrenamiento de residentes de Cirugía de Cabeza y Cuello para la realización de parotidectomía total en un modelo cadavérico perfundido. La evaluación se realizó mediante el modelo de Kirkpatrick, en los niveles 1 (reacción), 2A (cambio de actitudes) y 2B (adquisición de conocimientos y habilidades). Resultados: Se elaboró un programa teórico-práctico basado en cátedras y simulación de alta fidelidad. En su mayoría los participantes: recomendarían el curso (Nivel 1); tuvieron mayor motivación para el aprendizaje (Nivel 2) y presentaron mejores indicadores sobre conocimientos, habilidades y percepción de mejoría de sus competencias (Nivel 2B). Conclusión: La utilización de un programa de parotidectomía simulado en un modelo de alta fidelidad basado en modelos cadavéricos humanos perfundidos es una alternativa que mejora la calidad de entrenamiento y es útil y factible para el aprendizaje de técnicas de parotidectomía en residentes de Cirugía de Cabeza y Cuello.

Introduction: The parotidectomy is an infrequent and technically complex surgery due to a difficult dissection that may affect the facial nerve, generating high degree of morbidity in patients. Animal simulation models may not reproduce the human characteristics of cervical anatomy. Therefore, it is necessary to explore other alternatives for training dissection skills. Our objective is to evaluate a parotidectomy's techniques training program in a perfused cadaveric model. Methods: A Kern educational program was designed to train Head and Neck Surgery residents to perform total parotidectomy in a perfused cadaveric model. The evaluation was performed using Kirkpatrick model, at levels 1 (reaction), 2A (change of attitudes) and 2B (acquisition of knowledge and skills). Results: A theoretical-practical program based on lectures and high-fidelity simulation was developed. Most of the participants would recommend the course (Level 1); had greater motivation for learning (Level 2) and showed better indicators of knowledge, skills and perception of improvement in their competencies (Level 2B). Conclusion: The use of a simulated parotidectomy program in a high-fidelity model based on perfused human cadaveric models is an alternative that improves the quality of training and is useful and feasible for learning parotidectomy techniques in residents of Head and Head Surgery.

Clinical analysis of 22 cases of lymphoepithelial carcinoma of parotid gland / 口腔疾病防治

Objective @# To investigate the diagnosis, treatment and prognosis of lymphoepithelial carcinoma of the parotid gland. @*Methods@#Data from 22 patients with parotid lymphoepithelial carcinoma from 2012 to 2019 were collected, and their clinical manifestations, imaging examinations, treatment methods and follow-up results were retrospectively analyzed.@*Results@# Among the 22 patients, 8 were males and 14 were females. The patients ranged from 26 to 61 years old, with a complaint duration ranging from 3 days to 18 years. One patient had multiple unilateral lumps in the parotid gland, and the other 21 patients had single unilateral lumps in the parotid gland. All patients underwent preoperative spiral CT examination. CT showed a soft tissue lump in the parotid tissue, the internal density shadow was not uniform, the CT value ranged from 26 to 81 Hu, and 15 patients presented elliptical lesions with clear boundaries. Seven patients presented nodular lesions, and the boundary was not clear. The diagnosis of all cases was ultimately based on pathological examination. Hematoxylin-eosin (HE) staining images showed active epithelial cell growth with atypia, mitotic figures could be seen, and abundant lymphocyte and plasma cell infiltration could be seen in the tumor stroma. All 22 patients received surgical treatment; 9 patients did not undergo cervical lymph node dissection. Twenty patients received adjuvant radiotherapy after surgery, and 10 of them received adjuvant chemotherapy at the same time. One patient only received chemotherapy after surgery, and one patient did not receive any other adjuvant therapy after surgery. All patients received follow-up visits. One patient died of liver metastasis 16 months after the operation, and the remaining patients survived without tumors for periods of 13 months to 8 years until the present. @*Conclusion @#Parotid lymphoepithelial carcinoma is a rare malignant tumor clinically. Pathology is still the gold standard for the diagnosis of lymphoepithelial carcinoma of the parotid gland. Radical resection of the tumor is the first choice of treatment. Selective neck lymph node dissection and postoperative adjuvant radiotherapy and chemotherapy can obtain better therapeutic effects according to clinical examination, imaging examination and neck conditions.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases

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.

Removal of benign tumor in the lower pole of the parotid gland through concealed incision in the retroauricular sulcus / 口腔疾病防治

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.

Clinical application of midpiece facial nerve dissection in regional parotidectomy / 华西口腔医学杂志

OBJECTIVE@#To propose and evaluate the clinical effect of midpiece facial nerve dissection through transparotid approach in regional parotidectomy.@*METHODS@#A total of 136 patients with benign parotid tumors were categorized into three groups according to the way of facial nerve dissection: anterograde dissection from main trunk (anterograde, n=70), retrograde dissection from distal branches (retrograde, n=34), and midpiece dissection through transparotid approach (middle dissection, n=32). Surgery duration, facial nerve injury, salivary fistula, earlobe sensation, Frey's syndrome, and aesthetic evaluation were compared.@*RESULTS@#The surgery duration in the middle dissection group was significantly shorter than that in the other two groups. The proportion of salivary fistula was higher in the anterograde group (9 cases, 12.9%; P<0.05) compared with that in the other groups. Postoperative facial nerve injury was similar between the middle dissection (1 case, 3.1%) and anterograde groups (3 cases, 4.3%) with lower injury rate compared with the retrograde group (7 cases, 20.6%). The anterograde group had more cases of hypoesthesia of the earlobe (12 cases, 17.1%; P<0.05) than the other two groups. Aesthetic score was higher in the anterograde and middle dissection groups compared with that in the retrograde group (P<0.05).@*CONCLUSIONS@#Midpiece facial nerve dissection is technically feasible and clinically viable in regional parotidectomy.

A Novel Technique for Protection of Facial Nerve during Parotidectomy

Identification and protection of Facial Nerve is of prime importance during surgery of parotid glands. Several techniques are available in literature to identify and preserve FN. We present here a case series with dissection of FN in a novel technique during parotidectomy which has significantly lowered the morbidity due to injury of the FN. Methods: All data, from all the patients who underwent Parotidectomy in our unit (conducted or supervised by a single surgeon) in the Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, between March 2014 to March 2019, using our novel technique for identification and protection of FN, was retrospectively analysed. Outcome measurement was expressed in terms of type of surgery, duration, estimated blood loss, any intra-operative or post-operative complications, length of hospital stay, duration of drain in place, Histopathological (HPE) reports, size of the tumour, margin and lymph node status, Facial Nerve weakness and other complications. Results: Total 13 patients underwent Parotidectomy (Total or Superficial) following our technique of identifying and protecting Facial Nerve (FN). Four of them had temporary FN paresis in immediate post-op period. None of the patients had FN paresis on follow-up at 1 year. Conclusion: The novel technique described in our study for identification and protection of FN is a promising technique for Parotid Surgery.

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

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy / A punção aspirativa com agulha fina é confiável no diagnóstico de tumoresde parótida? Comparação dos resultados pré e pós-operatórios e fatores que afetam sua precisão

Abstract Introduction: Fine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. Objective: We aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. Methods: Patients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. Results: 217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5 ± 15.88 (7-82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ = 0.52). The sensitivity was 54.54% in tumors less than 2 cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. Conclusion: Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2 cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.

Resumo Introdução: A punção aspirativa com agulha fina é uma ferramenta valiosa na avaliação pré-operatória de tumores de cabeça e pescoço. No entanto, sua precisão no tratamento de tumores de glândulas salivares é discutível. Objetivo: Nosso objetivo foi investigar a eficácia e precisão da punção aspirativa com agulha fina nos tumores da glândula parótida. Método: Pacientes submetidos à parotidectomia entre janeiro de 2008 e junho de 2017 por tumor de glândula parótida foram examinados retrospectivamente. Foram incluídos pacientes com punção aspirativa com agulha fina pré-operatória e histopatologia cirúrgica pós-operatória. A punção aspirativa com agulha fina pré-operatória foi categorizada como benigna, maligna ou com suspeita de malignidade. O histopatológico cirúrgico foi agrupado como benigno ou maligno. Os exames histopatológicos foram comparados com a punção aspirativa com agulha fina e a sensibilidade, especificidade, acurácia e concordância entre os dois testes foram investigadas. Resultados: Foram avaliados 217 casos e excluídos 23 porque o diagnóstico da punção aspirativa com agulha fina não foi conclusivo ou estava indisponível. Portanto, foram incluídos 194 casos. A média de idade dos pacientes foi de 47,5 ± 15,88 (7-82). Havia 157 casos benignos, 37 malignos na punção aspirativa com agulha fina e 165 benignos e 29 malignos na histopatologia. O tumor benigno mais comum foi o adenoma pleomórfico (43,3%) e o tumor maligno mais comum foi o carcinoma mucoepidermoide (4,13%). A acurácia diagnóstica da punção aspirativa com agulha fina na detecção de malignidade foi de 86,52%. A sensibilidade e especificidade foram de 68,96% e 89,63%, respectivamente. O valor preditivo positivo foi de 54,05% e o valor preditivo negativo foi de 94,23%. Houve concordância moderada entre a punção aspirativa com agulha fina e histopatológico (κ = 0,52). A sensibilidade foi 54,54% em tumores menores do que 2 cm e 77,77% em tumores maiores. Nos tumores que se estendiam até o lobo profundo, a sensibilidade foi de 80%. Conclusão: A punção aspirativa com agulha fina é uma importante ferramenta diagnóstica na avaliação dos tumores da glândula parótida. É mais precisa na detecção de tumores benignos. Em tumores maiores do que 2 cm que se estendem até o lobo profundo, a sensibilidade da punção aspirativa com agulha fina é alta. O uso dessa ferramenta em conjunto com a avaliação clínica e radiológica pode ajudar a reduzir os resultados falso-positivos e falso-negativos.

A Case of Quadriplegia after Parotidectomy in a Patient with Asymptomatic Cervical Spondylosis / 대한이비인후과학회지

Cervical spondylosis is a common degenerative disease of the cervical spine affecting the cervical vertebral bodies and intervertebral discs. During parotidectomy, the patient is placed in a supine position with the neck extended and head rotated to the contralateral side. This position could exacerbate pre-existing cervical spondylosis and cause cervical myelopathy. We present a case of postoperative quadriplegia secondary to cervical myelopathy after parotidectomy. A 68-year-old man without symptoms of cervical spondylosis underwent partial parotidectomy for a right parotid mass and subsequently developed quadriplegia 8 hours postoperatively. Magnetic resonance imaging revealed severe cervical myelopathy. Emergency laminoplasty was performed, and steroid therapy was initiated. He showed near-complete recovery six months later.

Tumores de glándula parótida: experiencia quirúrgica Hospital Guillermo Grant Benavente / Parotid gland tumors: surgical experience Hospital Guillermo Grant Benavente

RESUMEN Introducción: La glándula parótida es el sitio más común de tumores de glándulas salivales, correspondiendo al 75%-85% de éstos y al 3% de todos los tumores de cabeza y cuello. Ochenta por ciento de ellos corresponden a tumores benignos. Objetivos: Analizar la experiencia quirúrgica en tumores parotídeos operados en el Hospital Guillermo Grant Benavente. Material y método: Revisión de todos los pacientes con tumores parotídeos operados en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, del Hospital Guillermo Grant Benavente entre enero del año 2011 y abril del año 2016. Las cirugías fueron realizadas por el mismo equipo quirúrgico. Se registraron datos demográficos, clínicos, quirúrgicos, histológicos y resultados posoperatorios. Resultados: En el periodo descrito se operó un total de 94 pacientes. 84,3% correspondieron a tumores benignos y 15,7% a tumores malignos. El 62,9% corresponde a pacientes de sexo femenino y 37,1% de sexo masculino, representando una relación de 1,69:1. La incidencia de parálisis facial transitoria fue de 16,1%, y de ellos solo un paciente mantuvo una parálisis permanente. Conclusión: Los tumores malignos representaron el 15,7%, siendo menor a lo reportado en la literatura. Se presenta una gran serie de tumores parotídeos tratados quirúrgicamente a nivel nacional, con una baja tasa de complicaciones.

Abstract Introduction: Parotid gland is the most common site of salivary gland tumors, corresponding to 75-85% of these and 3% of all head and neck tumors. 80% of them correspond to benign tumors. Aim: To analyze the surgical experience in parotid tumors operated in the Guillermo Grant Benavente Hospital. Material and Method: Review of all patients with parotid tumors operated in the Otorhinolaryngology and Head and Neck Surgery Unit of Hospital Guillermo Grant Benavente between January 2011 and April 2016. All surgeries were performed by the same surgical team. Demographic, clinical, surgical, histological and postoperative results were recorded. Results: In the period described, a total of 94 patients were operated on. 84.3% corresponded to benign tumors and 15.7% to malignant tumors. 62.9% corresponds to female patients and 37.1% male, representing a ratio of 1.69:1. The incidence of transient facial paralysis was 16.1%, and of these, only one patient maintained permanent paralysis. Conclusions: Malignant tumors represented 15.7% of cases, being less than reported in the literature. This article presents a large series of parotid tumors treated surgically in our country, with a low associated complication rate.

Different cosmetic incision selection in parotidectomy / 中华整形外科杂志

Objective@#Based on the nature, location and size of parotid tumor, different incisions were chosen and method of selecting the best cosmetic incision for parotid gland tumor operation would be discussed.@*Methods@#33 cases of parotid benign tumor patients that received by Department of Oral and Maxillofacial surgery of First Affiliated Hospital of Nanchang University during 2015-2017 were included in this study. According to the size of the tumor location, different incisions, mainly pretragal vertical, pretragal crutch and rhytidectomy incision were selected. The facial nerve and the great auricular nerve were protected during the operation. In 1-month and 3-month follow-up, clinical examination of temporary facial paralysis, salivary fistula, especially the cosmetic outcome after the surgery were evaluated.@*Results@#The satisfaction rate of parotid cosmetic incision was significantly higher than that of the traditional group, the incidence of transient facial paralysis, salivary fistula was not statistically significant compared with the traditional incision.@*Conclusions@#According to the location of parotid tumor, we should choose the proper cosmetic incision approach, which is better than the traditional surgical incision.

A better facial contour accomplished by parotid duct preserving superficial parotidectomy

Depression of facial contour after parotidectomy is still challenging to many of surgeons. A 68-year-old man presented with a 4-month history of a painless swelling in both parotid area. The mass was multiple and fixed at the parotid region. We conducted a parotid duct preserving bilateral superficial parotidectomy by one-stage operation to remove the multiple tumors. A lazy S incision was made in both preauricular area and the peripheral branches of the facial nerve were identified using surgical landmark. After dissecting the branches of the facial nerve and parotid duct, main parotid duct was preserved but only small fine ductules from the superficial lobe were ligated. Parotid gland was excised from its anterior aspect with about 1 cm of normal parotid tissue margin. The patient was followed up for 6 years to evaluate postoperative parotid gland function and the computed tomography (CT) was taken. Patient was satisfied with no significant complication such as sunken changes in facial contour, facial nerve function. As far as we know, it is the first study to compare long-term soft tissue contours of soft tissue of duct preserving superficial parotidectomy with duct sacrificing superficial parotidectomy by means of CT findings.

Postoperative Complications of Different Incisions of Parotidectomy in Benign Parotid Tumor and the Impact on Life Quality / 现代生物医学进展

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.

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients: A case report

During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department.

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients: A case report

During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department.

Tactile Sensation Recovery after Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: One of the common complications after parotidectomy is a decrease in skin sensation around the parotid gland. This is known to be associated with damage to the great auricular nerve (GAN). The purpose of this study was to investigate the pattern of tactile sensory recovery after parotidectomy and the difference in sensory recovery according to the preservation or sacrifice of the GAN. SUBJECTS AND METHOD: Fifty-two patients who underwent parotidectomy were enrolled in this study. The Touch Test Sensory Evaluator was used to measure the minimum tactile threshold value at 6 sites around the auricle before surgery and at 1 week, 1, 3, 6 and 12 months after surgery. RESULTS: The tactile threshold was the highest at 1 month after parotidectomy in all 6 sites. After 1 month, the threshold value gradually decreased until 12 months after surgery. However, the threshold was not completely recovered to the preoperative threshold level. At least one branch and the main trunk of GAN were preserved in 39 patients; one of GAN branches was preserved but the main trunk of GAN was partially injured in 3 patients, and the main trunk of GAN was completely injured in 10 patients. The tactile sensory recovery showed no significant differences in relation to the GAN status. CONCLUSION: The tactile sensory value kept decreasing up to one month following parotidectomy and then gradually recovered. However, the tactile sensory did not recover completely even one year after surgery. The GAN preservation did not affect tactile sensory recovery.

Adenoma pleomorfo parotídeo gigante: a propósito de un caso clínico / Giant parotid pleomorphic adenoma: a case report

El adenoma pleomorfo es el tumor benigno más frecuente de las glándulas salivales, con mayor predilección por la glándula parótida. Se presenta un caso clínico de paciente femenino de 53 años de edad, con aumento de volumen en región parotídea y geniana derecha de15 × 12 centímetros, de ocho años de evolución, la tomografía simple de la región presenta tumoración parotídea bien delimitada, la cual afecta lóbulo superficial y profundo de la glándula parótida derecha, la biopsia incisional confi rmó el diagnóstico histopatológico de adenoma pleomorfo por lo cual se realiza parotidectomía total sin preservación del nervio facial.

Pleomorphic adenoma is the most common benign tumor of the salivaryglands, with greater predilection for the parotid gland. We presentthe case of a 53-year-old female patient with a 15 x 12 cm increasein volume in the parotid and right genial region with eight years ofevolution. A simple CT scan of the region revealed a well-defi ned parotidtumor aff ecting the superfi cial and deep lobe of the right parotidgland. An incisional biopsy confi rmed the histopathological diagnosisof pleomorphic adenoma, for which reason a total parotidectomy wasperformed without preservation of the facial nerve.

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.