Extracapsular dissection and minimally invasive procedures of primary benign parotid tumours: Case series

Extracapsular dissection is an old technique use for the removal of benign parotid tumours, which is not generally chosen as the first treatment option due to the association of recurrences in the past but is currently considered again accord to the aesthetic requirements of the patients. The general trend in the last decade is to return to minimally invasive procedures for this type of lesions, which are mainly conditioned by the pleomorphic adenoma and its positive margins in its capsule. By this, the purpose of this case series study is to analyze those patients diagnosed with benign parotid tumors and treated by extracapsular dissection in a tertiary hospital in Chile between 2018-2020.

Quiste epidermoide en región parotídea. Reporte de caso y revisión de la literatura / Epidermoid cyst in the parotid region. A case report and review of the literature

Los quistes epidermoides son lesiones quísticas benignas que se desarrollan de componentes epiteliales anormales de tejido ectodérmico formado durante el periodo fetal (congénito) o por epitelio implantado después de una cirugía o trauma (adquirido). El quiste epidermoide es considerado una lesión benigna que afecta la región del pericráneo, cara, cuello, espalda y torso, el 7% de estos quistes ocurren en la región de la cabeza y el cuello y solo el 1,6% representa la cavidad oral. A continuación, se presenta un caso clínico con diagnóstico histopatológico de quiste epidermoide en la región parotídea, el cual no presentó un compromiso del parénquima glandular, el cual fue tratado mediante escisión quirúrgica completa, sin alteración o daño al nervio facial, con seguimiento postoperatorio de tres años sin recidiva.

Epidermoid cysts are benign cystic lesions that develop from abnormal epithelial components of ectodermal tissue formed during the fetal period (congenital) or from epithelium implanted after surgery or trauma (acquired). The epidermoid cyst is considered a benign lesion that usually affects the scalp, face, neck, back, and torso. 7% of these cysts occur in the head and neck, whereas the oral cavity represents only 1.6%. A clinical case is presented with a histopathological diagnosis of an epidermoid cyst in the parotid region, which did not present compromise of the glandular parenchyma, that was treated with complete surgical excision, without alteration or damage to the facial nerve, with a three-year postoperative follow-up without recurrence.

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection

Abstract: Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

The prognostic importance of parotid involvement by head and neck squamous cell carcinoma - Case report

Abstract Squamous cell carcinoma (SCC) is the second-most common malignant cutaneous cancer, with 60% occurring in the head and neck region. Metastases are uncommon and imply a more conservative prognosis. This report describes a case of parotid-invasive, facial squamous cell carcinoma, highlighting the importance of its prognostic and therapeutic management. The patient is an 81-year-old female, exhibiting extensive tumoral lesions in the pre-auricular region, affecting the parotid parenchyma and implying the metastatic involvement of the intra-parotid lymph node. Parotid involvement caused by SCC in specificity tumors is discussed herein. Parotid invasion is currently recognized as an isolated variable. It affects survival rates and determines certain changes in case management, such as the broadening of resection areas and adjuvant radiotherapy.

Comparação da incisão ritidectomia modificada versus cervicomastóideofacial para tumores benignos da glândula parótida / Cervicomastoidfacial versus modified rhytidectomy incision for benign parotid tumors

Aincisão tipo ritidectomia modificada para a abordagem da glândula parótida mostrou-se uma alternativa à clássica incisão cervicomastóideofacial, permitindo-se camuflar a cicatriz em áreas pouco visíveis com melhor resultado estético. Todavia, ainda existem poucos estudos comparando os resultados funcionais e a incidência de complicações em pacientes submetidos à parotidectomia utilizando-se essas diferentes vias de acesso. OBJETIVO: Comparar a incidência de complicações e os resultados funcionais de pacientes com neoplasias benignas da parótida abordados pela incisão clássica ou ritidectomia modificada. MÉTODO: Estudo de casos tipo coorte histórica longitudinal incluindo sessenta pacientes submetidos à parotidectomia e igualmente distribuídos entre as duas formas de incisão avaliadas, comparando-se os dados de idade, sexo, tempo de internação, volume drenado, tamanho tumoral, volume da parótida ressecada, ocorrência de disfunção de motricidade facial e fístula salivar pós-operatória. RESULTADOS: Não foram observadas diferenças significativas para complicações e resultados funcionais entre os dois grupos, exceto pela menor ocorrência de disfunção da motricidade facial imediata em pacientes submetidos à cirurgia via ritidectomia modificada, com a chance desta ocorrência ser 86% menos frequente neste grupo. CONCLUSÃO: A incisão tipo ritidectomia modificada apresenta incidência de complicações comparáveis à abordagem clássica, associada a menor ocorrência de disfunção da motricidade facial imediata.

The modified rhytidectomy incision is an alternative to the classic cervicomastoidfacial approach for parotid surgery, camouflaging the scar in barely visible areas, resulting in better cosmesis. However, there are very few studies comparing the incidence of complications and functional results of patients submitted to parotidectomy through these two different approaches. OBJECTIVE: Compare the incidence of complications and functional results of patients with benign parotid neoplasms submitted to surgery through the classical incision versus the modified rhytidectomy approach. METHOD: Retrospective cohort study evaluating the demographics, surgical and post-operative characteristics of an equally distributed group of sixty patients submitted to parotidectomy via cervicomastoidfacial incision or modified rhytidectomy approach. RESULTS: There were no significant differences in complications rates and functional results between the groups, except for a lower incidence of early facial movement dysfunction for the modified rhytidectomy approach - which was 86% lower in this group of patients. CONCLUSION: Modified rhytidectomy incision has shown comparable complication rates to those of the classic approach and a lower incidence of immediate facial movement impairment.

Consideraciones anatómicas en la parotidectomía: revisión de la literatura a propósito de un caso / Anatomical considerations in parotidectomy: review of the literature and case report

La parotidectomía es un procedimiento quirúrgico habitualmente realizado por Cirujanos Maxilofaciales y Cirujanos de Cabeza y Cuello, en el cual se remueve parcialmente o en su totalidad a la glándula parótida. Las indicaciones más comunes para éste procedimiento son las neoplasias de la glándula. Aproximadamente el 80% del total de los tumores de glándulas salivales ocurren en la parótida. De estos, el 75-80% son de naturaleza benigna. Sin embargo, la parotidectomía es un procedimiento sumamente complejo debido a la anatomía regional y por la íntima relación de la glándula parótida con el nervio facial. Siendo la clave de este procedimiento la preservación funcional de éste nervio y de sus ramos. Por lo tanto el conocimiento acabado de la anatomía de la glándula parótida y de sus estructuras anexas es necesario para el éxito quirúrgico. Esta revisión y reporte de caso discutirá las consideraciones anatómicas que deben tenerse durante la parotidectomía para disminuir la posibilidad de alguna complicación.

Parotidectomy is a surgical procedure usually performed by Oral and Maxillofacial Surgeons and Head and Neck Surgeons, in which the parotid gland may be removed partially or totally. The most common indications for this procedure are the neoplasms of the gland. Approximately 80% of total salivary gland tumors occur in the parotid gland. Of these, 75-80% are benign. However, the parotidectomy is a highly complex procedure because of the regional anatomy and the close relationship of the parotid gland with the facial nerve. The most important aspect of this procedure is the functional preservation of the facial nerve and its branches. Therefore, the thorough knowledge of the anatomy of the parotid gland and related structures is necessary for surgical success. This review and case report will discuss the anatomical considerations that must be taken during parotidectomy to reduce the possibility of complications.

Tumor de Warthin da glândula parótida: estudo de 70 casos / Warthin's tumor of the parotid gland: study of 70 cases

OBJETIVO: Relatar as características clínicas, tratamento e complicações.dos tumores de Warthin. MÉTODOS: Estudo retrospectivo com 70 pacientes submetidos à ressecção de cistoadenoma papilífero linfomatoso,. Variáveis analisadas: idade, sexo, etnia, presença ou não de tabagismo, sítio primário do tumor, tamanho do tumor em centímetros, presença de bilateralidade, tipo de operação, multicentricidade, complicações do tratamento, presença de recidiva no seguimento e tempo de seguimento.. RESULTADOS: Quarenta e quatro pacientes (62,8 por cento) eram do sexo masculino e 26 (37,2 por cento), do sexo feminino, com média etária de 56,7 anos, O tabagismo estava presente em 55 (78,6 por cento) pacientes, (94,3 por cento) dos tumores eram unilaterais e quatro (5,7 por cento) bilaterais, com tamanho médio de 4,1cm ao exame físico. As complicações foram 14 (19 por cento) casos de paresia e/ou paralisia facial, seroma em 10 (13,8 por cento), síndrome de Frey em três (4 por cento), hematoma em dois (2,7 por cento) e infecção de ferida operatória em um (1,5 por cento) caso. CONCLUSÃO: O tumor de Warthin tem maior incidência no sexo masculino, em tabagistas e localização unilateral predominante na glândula parótida. A parotidectomia superficial com preservação do nervo facial mostrou-se eficaz em 100 por cento casos. As complicações encontradas foram paresias ou paralisias transitórias, seroma, síndrome de Frey, hematoma e infecção de ferida operatória.

OBJECTIVE: To report the clinical characteristics, treatment and complication of Warthin tumors. METHODS: we conducted a retrospective study of 70 patients undergoing resection of papillary lymphomatous cystadenoma. Variables: age, sex, ethnicity, presence or absence of smoking, primary site of tumor, tumor size in cm, presence of bilateral tumor, type of operation, multicentricity, treatment complications, recurrence and follow up. RESULTS: Forty-four patients (62.8 percent) were male and 26 (37.2 percent) female, with a mean age of 56.7; smoking was present in 55 (78.6 percent) patients; 66 (94.3 percent) tumors were unilateral and four (5.7 percent) bilateral, with an average size of 4.1 cm on physical examination. The complications were 14 (19 percent) cases of facial paresis and / or paralysis, seroma in 10 (13.8 percent), Frey's syndrome in three (4 percent), hematoma in two (2.7 percent) and wound infection in one (1.5 percent) case. CONCLUSIONS: Warthin tumors have a higher incidence in male smokers and predominantly unilateral location of the parotid gland. Superficial parotidectomy with preservation of facial nerve was effective in 100 percent cases. Complications were transient paresis or paralysis, seroma, Frey syndrome, hematoma and wound infection.

Target volume determination of postoperative 125I seeds interstitial brachytherapy in parotid gland carcinoma / 中华放射医学与防护杂志

Objective To explore the method of target volume determination of postoperative 125I seeds interstitial brachytherapy in parotid gland carcinoma.Methods A total of 31 cases( 14 males and 17 famales) with primary parotid carcinoma who were treated in Peking University Hospital of Stomatology from Oct 2002 to Nov 2006.The patients' average age was 38.2 years.All patients underwent tumor resection and postoperative 125I seeds interstitial brachytherapy with 60 Gy matched peripheral dose.The spiral CT was performed for treatment plan and quality verification before and after the brachytherapy.The bone and muscle landmarks surrounding parotid were selected as reference for target volume determination.D90 of target volume and dose of organs at risk were calculated,while the target volume and D90 of target volume of verification were compared with that of treatment plan through quality verification.Results The target volume or D90 of target volume before and after treatment was not statistically different.D90 of target volume was more than 60 Gy.During 3 -7 years of follow-up,all patients had no recurrence.ConclusionsAccording to the follow-up results,the method used for target volume determination in this paper might be satisfied.

Infección de región parotídea por Mycobacterium abscessus / Mycobacterium abscessus infection of the parotid region

Mycobacterium abscessus es una de las micobacterias de crecimiento rápido asociadas a infecciones localizadas de heridas post traumáticas y quirúrgicas, infecciones crónicas pulmonares e infecciones cutáneas diseminadas en pacientes inmunosuprimidos. Raramente han sido descritos infecciones en región parotídea por micobacterias de crecimiento rápido. Aquí se reporta el caso de una infección en lóbulo superficial de la glándula parótida de pacientesin compromiso inmune, sin cirugías previas ni traumas aparentes, causado por Mycobacterium abscessus. Estas micobacterias deben ser consideradas en el momento de realizar el diagnóstico tanto clínico como laboratorial, ya que son bacterias emergentes y pueden presentarse de manera inusual, de modo a no demorar el diagnóstico del agente etiológico, debido a que requieren prolongada antibioticoterapia y son bastante resistentes a los antibióticos, especialmente el M. abscessus, que es una de las más resistentes

Mycobacterium abscessus is one of the fast-growing mycobacteria associated to localized infections of post-traumatic injuries, surgical wounds, pulmonary chronic infections and disseminated cutaneous infections in immunosupressed patients. Fast-growing mycobacteria infections of the parotid region have been rarely described. We report the case of a Mycobacterium abscessus infection of the superficial lobe of the parotid gland without immune compromise, previous surgeries or apparent trauma. Thesemycobacteria should be considered at the time of clinical and laboratory diagnosis, as they are emerging bacteria and could present in an unusual manner, in order not to delay the diagnosis of the etiological agent because they require long antibiotic therapy and are pretty resistant to antibiotics specially M. abscessus which is one of the most resistant

Infección de región parotídea por Mycobacterium abscessus / Mycobacterium abscessus infection of the parotid region

Mycobacterium abscessus es una de las micobacterias de crecimiento rápido asociadas a infecciones localizadas de heridas post traumáticas y quirúrgicas, infecciones crónicas pulmonares e infecciones cutáneas diseminadas en pacientes inmunosuprimidos.Raramente han sido descritos infecciones en región parotídea por micobacterias de crecimiento rápido. Aquí se reporta el caso de una infección en lóbulo superficial de la glándula parótida de paciente sin compromiso inmune, sin cirugías previas ni traumasaparentes, causado por Mycobacterium abscessus. Estas micobacterias deben ser consideradas en el momento de realizar el diagnóstico tanto clínico como laboratorial, ya que son bacterias emergentes y pueden presentarse de manera inusual, de modo a nodemorar el diagnóstico del agente etiológico, debido a que requieren prolongada antibioticoterapia y son bastante resistentes a los antibióticos, especialmente el M. abscessus, que es una de las más resistentes.

Mycobacterium abscessus is one of the fast-growing mycobacteria associated to localized infections of post-traumatic injuries, surgical wounds, pulmonary chronic infections and disseminated cutaneous infections in immunosupressed patients. Fast-growing mycobacteria infections of the parotid region have been rarely described. We report the case of a Mycobacterium abscessus infection of the superficial lobe of the parotid gland without immune compromise, previous surgeries or apparent trauma. These mycobacteria should be considered at the time of clinical and laboratory diagnosis, as they are emerging bacteria and could present in an unusual manner, in order not to delaythe diagnosis of the etiological agent because they require long antibiotic therapy and are pretty resistant to antibiotics specially M. abscessus which is one of the most resistant.

Platysma myocutaneous flap with posterior based pedicle for defects in the region of parotid gland and masseter muscle / 中国耳鼻咽喉头颈外科

OBJECTIVE To assess the method and reliability of the platysma myocutaneous flap with posterior based pedicle for defects in the region of parotid gland and masseter muscle.METHODS The clinical data of 6 patients who were reconstructed with platysma myocutaneous flap with posterior based pedicle for defects in the region of parotid gland and masseter muscle from 2006 to2007 were studied. The blood supply and design of the flap,the keys in operation and the outcome after operation were also discussed.RESULTS All the patients were followed up from 2 months to one year.The color of the platysma myocutaneous flap was matched with the facial skin.All the operation results were satisfied. CONCLUSION Platysma myocutaneous flap has abundant blood supply.The operation is easy and reliable.It is suitable for reconstruction of the defects in parotid gland and masseter muscle region.