Reconstrucción de partes blandas faciales con colgajos cervicales. Presentación de dos casos / Reconstruction of facial soft parts with cervical flaps. Two cases presentation

La reconstrucción de importantes defectos de partes blandas en la región órbito-maxilo-malar continúa siendo un gran reto para el cirujano. En cirugía reconstructiva, por su parte, hay que abordar dos problemas fundamentales: la recuperación estética y la funcional. Por supuesto que ni el criterio estético ni funcional debe anteponerse al oncológico. En este trabajo se presentaron dos pacientes operados de carcinoma de la glándula parótida, reconstruidos con colgajos cervicales. El primero, con el cérvico-pectoral, y el segundo, con el fascio-cérvico-pectoral. Estos colgajos deberían ser considerados como una de las primeras opciones para reconstruir los defectos en la región maxilofacial, dado su predictibilidad, versatilidad y fácil disección.

The reconstruction of important defects of soft parts in the orbital-maxillary-malar region is still a great challenge for the surgeon. Thus, in reconstructive surgery we have to approach two main problems: esthetic and functional recuperation. Of course, neither the esthetic nor the functional criteria should be placed before the oncological one. In this work we presented the cases of two patients operated of parotid gland carcinoma, reconstructed with cervical flaps; the first one, with the cervico-pectoral flap, and the second with the fascia-cervico-pectoral flap. These flaps should be considered one of the first options for reconstructing the defects of the maxilla-facial region, due to their predictability, versatility and easy dissection.

Accuracy of fine needle aspiration biopsy in diagnosing parotid gland malignancy

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Restrospective Chart Review<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB. <br /><strong>RESULTS:</strong> The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%.<br /><strong>CONCLUSION:</strong> FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretation of FNAB in our institution.<br /><br /> </p>

Estudio de diez años sobre variedades de tumores de parótida en pediatría / Ten-year study on varieties of parotid tumors in pediatrics

Los tumores de parótida en pediatría son infrecuentes, pues constituyen aproximadamente el 0,5 % de todos los cánceres. Se presentan, generalmente, como un aumento de volumen local y asintomático, otras veces se acompañan de dolor y signos inflamatorios. Se realizó un estudio retrospectivo, longitudinal y descriptivo, para determinar la frecuencia y formas de presentación de los tumores de parótida diagnosticados en pacientes con edades comprendidas de 0 a 18 años, que han sido ingresados en el servicio de oncocirugía del Hospital "William Soler", entre febrero del año 2001 y diciembre de 2010, teniendo en cuenta: sexo, las formas de presentación, respuesta al tratamiento, así como las variantes histológicas presentadas, con el objetivo de dar a conocer estas variantes de tumores de parótida en pediatría, que, a pesar de ser infrecuentes, cuando se presentan constituyen un grupo de alto riesgo. Se diagnosticaron 7 pacientes, de los cuales 3 fueron adenomas pleomorfos, un adenocarcinoma, un carcinoma mucoepidermoide de la glándula, un linfoma de Hodgkin parotídeo y un tumor mixto con células atípicas de la glándula. El inicio de todos fue la presencia de una masa parotídea, en 6 de los casos asintomáticos, y en un caso con dolor local. Se le realizó ultrasonido de la glándula y biopsia aspirativa con aguja fina a todos los pacientes. El sexo masculino predominó sobre el femenino en una proporción 5 a 2, la edad media de presentación fue 12,3 años. La cirugía es el arma terapéutica principal en la mayoría de los casos. Se recomienda el seguimiento estrecho de los pacientes por el alto índice de recurrencia local.

Parotid tumors are uncommon because they account for 0.5 % of all types of cancer in pediatrics. They generally occur as increased local asymptomatic volume, occasionally accompanied by pain and inflammatory signs. A retrospective, longitudinal and descriptive study was carried out to determine the frequency and forms of presentation of parotid tumors diagnosed in 0-18 years-old patients, who had been admitted to the oncological surgery service of "William Soler" pediatric hospital from February 2001 to December 2010. The variables taken into account were sex, forms of presentation, response to treatment as well as the histological variants presented, with the objective of giving information about these variants of parotid tumors in pediatrics, which, despite their rareness, represent a high risk group when occur. Seven patients were diagnosed, of whom 3 were pleomorphic adenomas, one adenocarcinoma, one mucoepidermoid carcinoma of the gland, one parotid Hodgkin lymphoma and one mixed tumor with atypical cells of the gland. The onset of all the tumors was the presence of a parotid mass in 6 asymptomatic cases and in one case suffering local pain. They were all performed gland ultrasound and aspiration fine needle biopsy. Males prevailed over the females (ratio of 5:2) and the average age of presentation was 12.3 years. Surgery is the main therapeutic weapon in most of cases. It was recommended to closely follow the patients because of their high rate of local recurrence.

Flow Cytometric Analysis of DNA Content in Parotid Tumor and Its Contiguous Acini / 华中科技大学学报（医学）（英德文版）

To investigate the relationship between proliferative capacity of salivary gland cells in contiguous acini of parotid tumors and recurrent neoplasma, DNA contents of 30 fresh specimens of parotid were studied by using cytometry in tumors, normal and shallow or deep lobe acini of the masses. The results showed that the DI was 1.369, S % 16.95, PI 26.18 in malignant tumors;DI was 1.171, S % 12.41, PI 15.54 in recurrent pleomorphic adenoma; DI was 1.141, S % 12.74, PI 13.07 in pleomorphic adenoma, DI was 0.999, S % 5.10, PI 8.00 in normal acini. Analysis of variance showed there was a significant difference (P＜0.01). The average DNA contents of shallow on deep lobe of contiguous tumors was 1.08 in DI, 10. 65 in S %, 13.49 in PI in malignant tumor, 1.06 in DI, 8.96 in S % and 9.85 in PI in pleomorphic adenoma, which were all higher than in normal acini (P＞0.05). It was concluded that the levels of DI and S % of parotid tumor and its contiguous acini are related to degree of malignancy or recurrent condition of the tumors, suggesting contiguous acini of parotid tumors had the strong capacity of proliferation,which might play an important role in recurrent or malignant change of the parotid tumors.

Flow Cytometric Analysis of DNA Content in Parotid Tumor and Its Contiguous Acini / 华中科技大学学报（医学）（英德文版）

To investigate the relationship between proliferative capacity of salivary gland cells in contiguous acini of parotid tumors and recurrent neoplasma, DNA contents of 30 fresh specimens of parotid were studied by using cytometry in tumors, normal and shallow or deep lobe acini of the masses. The results showed that the DI was 1.369, S % 16.95, PI 26.18 in malignant tumors;DI was 1.171, S % 12.41, PI 15.54 in recurrent pleomorphic adenoma; DI was 1.141, S % 12.74, PI 13.07 in pleomorphic adenoma, DI was 0.999, S % 5.10, PI 8.00 in normal acini. Analysis of variance showed there was a significant difference (P＜0.01). The average DNA contents of shallow on deep lobe of contiguous tumors was 1.08 in DI, 10. 65 in S %, 13.49 in PI in malignant tumor, 1.06 in DI, 8.96 in S % and 9.85 in PI in pleomorphic adenoma, which were all higher than in normal acini (P＞0.05). It was concluded that the levels of DI and S % of parotid tumor and its contiguous acini are related to degree of malignancy or recurrent condition of the tumors, suggesting contiguous acini of parotid tumors had the strong capacity of proliferation,which might play an important role in recurrent or malignant change of the parotid tumors.

The predictive value of frozen section in the diagnosis of parotid tumors

A total of 38 patients with frozen section slides who underwent parotidectomy from January 1980 to December 1993 were retrieved from the Department of Pathology. The permanent section slides of the resected specimens were used as the gold standard. The frozen section and permanent section slides were reviewed by two independent pathologists and were labeled either as benign or malignant. If malignant, the tumor grade was determined as either high grade or low grade. Kappas correlation of agreement was used to determine inter-observer variability. Of the 38 slides, 16 were correctly labeled as malignant and 20 as benign. One slide was incorrectly labeled as malignant and 1 as benign. Sensitivity was 94.1 and specificity was 95.2 percent. The prevalence of malignant parotid tumors was 44.7 per cent, with a positive predictive value of 94.1 per cent and a negative predictive value of 95.2 per cent. Kappa statistic for the permanent section was 100 per cent, and 85 per cent for the frozen section. Tumor grading revealed that only 35.2 per cent were labeled correctly as high grade or low grade. This study showed that frozen section could reliably diagnose a malignant parotid tumor but could not reliably determine tumor grade. (Author)

Benign parotid tumors: 31 year experience at MDACC.

From 1954-1984 at M.D.Anderson Cancer Center (MDACC), 81 cases of benign parotid tumor were identified among more than 400 parotidectomized patients who were retrospectively reviewed. The ate of the patients ranged from 3-84 years with a median of 52 years. Twenty two out of 81 cases were previously treated patients from elsewhere. Benign mixed tumor and Warthin’s tumor were the 2 most common tumors which were found in 50 and 20 cases respectively. Superficial, total, superficial and partial deep lobe parotidectomy, total deep and partial superficial parotidectomy and excision were done in 49, 16, 14, 1 and 1 cases respectively. Facial nerves were sacrificed in 14 (main trunk = 1, branches of facial nerve = 13) and immediate nerve repair was accomplished in 10. Upper neck dissection was performed in 22 cases. The follow up time ranged from 4 to 34 years with a median of 10 years. There were no postoperative deaths. Only 5 cases (6% of the series) developed local recurrences. All of them were those who had been previously treated elsewhere, had benign missed tumor, and the recurrence developed in scar and soft tissue and were salvageable by further surgery. There was no recurrence among all 59 previously untreated patients. Adequate parotidectomy with facial nerve preservation is the treatment of choice for most benign parotid tumor. Enucleating or excision of the tumor not only causes an unacceptable high recurrent rate, but also makes the subsequent surgery (if necessary) more difficulty ad the facial nerve more vulnerable to injury.

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.