Image-guided and sialendoscopy-assisted transoral approach for parotid duct stenosis and megaduct.

OBJECTIVE: The aim of this communication was to introduce a novel combined image (magnetic resonance and computed tomography-guided and sialendoscopy-assisted transoral approach for the treatment of a parotid duct stenosis with megaduct. METHODS: A 46-year-old woman was referred to our department for recurrent infections of the right parotid gland following unsuccessful multiple transoral surgical approaches for a Stensen's duct stricture with megaduct. An image (magnetic resonance and computed tomography)-guided and sialendoscopy-assisted transoral sialodochoplasty was planned and performed. RESULTS: No complications occurred. The patient was discharged 2 days after surgery. No more swelling or infections occurred. The patient is currently symptom-free after a follow up of 11 months. CONCLUSION: Although imaging navigation means more technical effort and costs, this novel approach can be considered a viable surgical opportunity for distal and mid-third parotid duct stenosis with concomitant megaduct, particularly in cases of persistent inflammation or iatrogenic scars due to previous surgery.

Unusual cause of unilateral facial oedema: intramuscular dirofilariasis.

INTRODUCTION: Unilateral facial oedema may occur due to inflammatory, infective, or cystic pathology; patients often seek medical help at an early stage. CASE REPORT: We report one such case caused mimicking a parotid abscess, caused by dirofilariasis. CONCLUSION: Dirofilariasis is an emerging zoonosis and should be considered a differential diagnosis of atypical facial swelling. It is equally important for clinicians, radiologists, and pathologists to be familiar with the diagnostic characteristics to avoid misdiagnosis.

[Surgery for parotid gland cancer-controversial and proven aspects]. / Chirurgie der primären Karzinome der Gl. parotidea ­ Kontroverses und Bewährtes.

BACKGROUND: Due to the rarity of primary parotid malignancies, there are currently only limited clinical study data on the optimal surgical therapy. Parotid malignancies encompass a broad spectrum of more than 20 different histological subtypes with varying biology, which thus represents a challenge for even experienced pathologists and head and neck surgeons with proven expertise in salivary gland surgery. OBJECTIVE: The aim of this review article is to provide an overview of the current literature on surgical therapy of the primary tumor and the cN0 neck as well as treatment of the facial nerve, and to shed light on the various controversial aspects of this topic. RESULTS: In salivary gland oncology there is a trend towards safe (R0) but more conservative surgery. Currently, less-invasive surgical approaches could potentially be applied in a small subgroup with carefully selected caudally located and R0-resected "low-grade tumors" in stages T1-T2 and cN0 in relatively young patients with high compliance and more in the context of structured clinical studies. Elective neck dissection in the case of cN0 status should be carried out if risk factors for occult cervical lymph node metastasis (T3-T4a, "high-grade subtypes," advanced age, lymphangitic carcinomatosis) are present. In cases of small "low-grade parotid carcinomas," narrow resection margins or even microscopic tumor residues on the facial nerve can potentially be adequately compensated with adjuvant radiation therapy. However, due to the lack of solid data, the significance of the actual effect of the radiation in this situation should be viewed with great caution.

Facial Nerve Palsy Secondary to Parotid Abscess: Report of a Rare Case and Review of the Literature.

A parotid lesion with facial nerve involvement almost always indicates malignancy. Facial nerve palsy as a complication of parotid abscess is extremely rare. The postulated mechanisms include ischaemic neuropathy secondary to the compression of the facial nerve by the parotid swelling, local toxic effect and perineuritis from the inflammatory process. Here, we present our experience in managing a case of facial nerve palsy due to a parotid abscess in an otherwise healthy 44-year-old female. The abscess was drained surgically and the facial nerve function returned to normal at two months. Histopathological examination of the parotid tissue showed no features of malignancy. The severity of facial nerve impairment varied from grade II to total palsy. The mainstay of treatment of a parotid abscess is surgical drainage along with medical therapy including broad-spectrum antibiotics, adequate hydration and sialogogues.

Sialodochitis fibrinosa managed with staged bilateral total parotidectomy.

OBJECTIVE: This paper reports a rare case of a 61-year-old man with sialodochitis fibrinosa. METHODS: Clinical case report and review of current literature. RESULTS: Sialodochitis fibrinosa is a diagnosis of exclusion and in many cases can be managed conservatively. Conservative management failed for this patient and he was managed successfully with staged bilateral total parotidectomy. CONCLUSION: Sialodochitis fibrinosa should be considered as a differential diagnosis of painful bilateral facial swelling. While conservative management is successful for many patients, staged bilateral total parotidectomy may be necessary for full remission of symptoms; the timing of this is crucial to reduce the risk of facial nerve palsy.

[Diagnosis and characteristics of parotid region lesions in children].

Objective:To observe the disease spectrum of the parotid region lesions in children, and clarify the outcome and prognosis of the disease by analyzing of clinical data. Method:The basic information, clinical symptoms, diagnosis results, treatment, prognosis and follow-up of 170 cases with parotid region lesions were analyzed. Result:Among 170 cases of the parotid region lesions, 83 cases（48.82%） were congenital disease, 62 cases（36.47%） were vascular mass, 17 cases（10.00%） were benign or malignant tumor, and 8 cases（4.71%） were infectious disease; 108 cases of the patients were treated with surgery, 34 of them were treated with local bleomycin injection while 28 cases were treated with both surgery and local bleomycin injection. Two cases was cured by reoperation after recurrence and 1 case had facial paralysis but recovered after 3 months of follow-up. Conclusion:The most common diseases of parotid region lesions in children were congenital disease and vascular mass. Surgery combined with bleomycin local treatment is the main therapy in parotid area and has achieved remarkable results. Oral propranolol has certain therapeutic value for parotid region hemangioma.

Application of diffusion kurtosis imaging in differential diagnosis of parotid gland disease and diagnosis of parotid adenolymphoma / 中国医学影像技术

Objective To investigate the value of diffusion kurtosis imaging (DKI) in differential diagnosis of parotid gland disease and diagnosis of parotid adenolymphoma (PAL).Methods DKI and DWI data of 57 patients with parotid gland disease were etrospectively analyzed.Totally 57 cases were divided into infectious lesions group (n=10),pleomorphic adenoma group (n=19),PAL group (n=14),other benign parotid tumor group (n=4) and malignant parotid tumor group (n=10).Contralateral normal parotid glands in 19 patients with unilateral parotid gland lesions were treated as control group.The quantitative parameters including kurtosis concerning parameters (K Krad,Kax),diffusivity concerning parameters (D Drad,Dax),fractional anisotropy (FA) and conventional apparent diffusion coefficient (ADC) values were retrospectively reviewed.The binary Logistic regression method was used to confirm parameters with significant difference in diagnosing PAL.And Logistic regression equation was constructed to diagnose PAL.ROC analysis was conducted to evaluate the diagnostic value of the confirmed parameters and the Logistic regression equation.Results Significant difference of the parameters including K Krad,Kax,D Drad,Dax,FA and ADC values were found among different groups (all P＜0.05).ROC analysis demonstrated a higher area under the curve (AUC) for FA+Kax [0.88±0.06 (0.79-0.94)] than Kax[0.80±0.07 (0.70-0.88)] and FA [0.63±0.10 (0.52-0.73)],respectively (both P＜0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 71.43％,95.78％,91.77％,76.92％ and 94.44％.Conclusion DKI showed high diagnostic capacity in differential diagnosis of parotid gland disease.The combination of FA and Kaxcan improve the diagnostic accuracy in diagnosis of PAL.

Use of Botulinum Toxin Type A Injection Under Ultrasonographic Guidance for Management of Parotid Sialocele: A Case Report and Literature Review

Sialocele formation is a recognised complication of parotid surgery. Most cases resolve after conservative therapy consisting of pressure dressing, fasting, and repeated aspiration. However, some cases are resistent to such treatment and require further intervention. In this report, we present the method of botulinum toxin (BTX) injection into the parotid gland under ultrasonographic guidance along with atropine injection. A 63-year-old female underwent excision of a pleomorphic adenoma abutting an accessory parotid gland. Sialocele formation persisted after almost 3 weeks of conservative therapy. BTX A was given under ultrasonographic guidance and the sialocele disappeared after two doses of treatment. BTX injection under ultrasonographic guidance was thus a safe and effective method for treating persistent sialocele.

Real-time Ultrasound Elastography for Differential Diagnosis Between Benign and Malignant Parotid Tumors: A Meta-analysis / 中国医学影像学杂志

Purpose To evaluate the diagnosis value of real-time ultrasound elastography for differential diagnosis between benign and malignant parotid tumors.Materials and Methods A literature retrieval in PubMed,Embase,High Wire Press,Ovid and CNKI as of May 31,2016 in the English and Chinese languages was conducted.Articles and reviews related to discrimination between benign and malignant parotid gland nodules by means of ultrasound elastography scoring were selected.Pooled sensitivity and specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio as well as summary receiver operating characteristic (ROC) curves were analyzed to evaluate the diagnostic accuracy of ultrasound elasticity scoring.Results A final selection of 7 articles involving 486 nodules in 449 patients was included.Pooled sensitivity and specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of benign and malignant parotid tumors were 0.781 (95％ CI 0.702-0.847),0.797 (95％ CI 0.750-0.838),3.753 (95％ CI 2.293-6.124),0.285 (95％ CI 0.147-0.555) and 13.941 (95％ CI 4.571-42.519) respectively according to ultrasound elasticity scoring.Area under summary receiver operating characteristic curves was 0.8638 (index Q*=0.7944).Conclusion Real-time ultrasonic elastography has certain diagnostic value in differentiating benign parotid tumors and malignant ones.It can be used as a complement to conventional sonography for improving the diagnostic accuracy of parotid lesions.

Solitary Fibrous Tumor of the Parotid Gland: A Case Report.

INTRODUCTION: Solitary fibrous tumor is a rare, mesenchymal neoplasm that has been reported in numerous sites. Occurrence in the parotid gland is exceedingly rare. CASE REPORT: A 53-year-old man with a 2 cm solitary fibrous tumor of the left parotid gland, that was observed clinically and operatively and thought to be a neoplasm arising from Stensen's duct, is described. A pre-operative CT scan demonstrated a well-circumscribed, solid, avidly-enhancing nodule superficial to the masseter muscle, deep to the platysma, and intimately associated with the parotid duct. Multiple fine needle aspirations yielded scant fibrous tissue and lymphocytes. A superficial parotidectomy was performed. The histopathological and immunohistochemical findings were in keeping with solitary fibrous tumor, fibrous variant, with a low mitotic rate and a peripherally-entrapped parotid duct surrounded by abundant periductal collagen and lymphocytes. At a 2-year follow up, there was no evidence of tumor recurrence or metastasis. CONCLUSION: Solitary fibrous tumor should be suspected in the context of a slow-growing, well-circumscribed, solid, avidly-enhancing nodule of the parotid gland. Grossly intimate association with the parotid duct may reflect peripheral entrapment. Fine needle aspirations that predominantly yield collagen without spindle cell clusters should be correlated with clinical and radiological findings, as it is expected in tumor sampling of the fibrous variant. Although solitary fibrous tumor of the parotid gland usually exhibits benign behavior, it is best regarded as potentially malignant. Patient management and follow-up should be tailored to each individual and clinicopathological risk assessment of the recurrent/metastatic potential.

Use of steroids for facial nerve paralysis after parotidectomy: A systematic review.

AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating post-parotidectomy facial nerve palsy (FNP). METHODS: We searched the Cochrane library, EMBASE and MEDLINE (from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies. RESULTS: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP post-parotidectomy is transient. Preoperative factors (size of tumour and malignancy), intraoperative factors (extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur. CONCLUSION: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term follow-up are required to increase scientific evidence.

Reversible facial nerve palsy due to parotid abscess.

INTRODUCTION: A facial nerve palsy combined with parotid enlargement usually suggests malignancy. It is highly unusual for facial nerve palsy to result from a benign situation such as inflammation or infection of the gland. PRESENTATION OF CASE: We present a rare case of facial nerve palsy due to parotid abscess. DISCUSSION: A literature search retrieved thirty-two cases of facial nerve palsy due to benign parotid lesions since 1969. Only nine reported the presence of a parotid abscess. The etiology of paralysis remains unknown although certain factors such as the virulence of the offending organisms or perineuritis, have been suggested. Best diagnostic evaluation and management are discussed. CONCLUSION: In clinical practice, exclusion of malignancy is mandatory, as it represents the most common cause of facial palsy in the presence of a parotid lump.

Preoperative prediction of the location of parotid gland tumors using radiographic anatomical landmarks

INTRODUCTION: The location of parotid gland tumors in the superficial or deep lobes can affect the time and difficulty of operations. Therefore, accurate preoperative evaluation of the tumor location is important for surgical outcomes. MATERIALS AND METHODS: A total of 16 patients with parotid gland tumors and who underwent a parotidectomy between April 2003 and March 2011 were retrospectively reviewed in terms of demographic background, tumor location, surgical treatment, and treatment outcomes. Tumor location was estimated by four landmarks on contrast enhanced computerized tomography scans, which were Conn's arc, the facial nerve (FN) line, the Utrecht line, and the retromandibular vein. Tumor location was confirmed by relative position depending on the facial nerve during surgery. It was assumed positive since the tumor lies in the superficial lobe of the parotid gland, the sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of each landmark were evaluated. RESULTS: Our result revealed that the facial nerve line had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71.4%, and efficiency of 87.5%. Some would be more efficient preoperative evaluation methods of the relationship of parotid gland tumors to the facial nerve than others. CONCLUSION: In our study, the FN line was found to be the most reliable analysis method.

Case Report: Parotid Sialolithiasis / 대한이비인후과학회지

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. It most commonly involves submandibular gland (80 to 90%) and less frequently parotid (10 to 20%). The authors report 2 cases of parotid sialolithiasis. The first case involved a 46-year-old male patient complaining of the left parotid area pain and swelling, and presenting with a salivary calculus in the left parotid duct. When the patient was diagnosed, he refused surgical removal. The second case involved a 41-year-old male patient complaining of the right parotid area pain and swelling, and presenting with a salivary calculus in the right parotid duct. The sialolith was surgically removed under general anesthesia. In this paper, we also reviewed a series of concepts related to the etiology, diagnosis and treatment of sialolithiasis.