December 1, 2005 Lester D.R. Thompson, MD
December 1, 2005 Sofia Avitia, MD; Jason S. Hamilton, MD; Ryan F. Osborne, MD
August 31, 2005 S. Alex Kim, MD; Robert H. Mathog, MD
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Abstract
The course of acinic cell carcinoma of the parotid gland following surgical and nonsurgical interventions is variable. The objective of this study was to report our experience in treating this disease and to evaluate the factors that might be involved in the treatment of the tumor and the prog-nosis of the patient. To limit the contributory variables that are usually found in most studies, we included only those patients (n = 11) who had been treated by a single surgeon at a single institution from 1988 through 2003. Hospital and office records were evaluated for demographic information, signs and symptoms, treatment modalities, pathology, and outcomes. Additional follow-up data were obtained through telephone interviews. For the most part, treatment included either superficial parotidectomy or total parotidectomy with facial nerve preservation; 1 patient with coexisting adenocarcinoma underwent a more radical procedure, and 4 patients underwent adjuvant radiation therapy. The most prevalent morphologic pattern of these tumors was microcystic. Follow-up ranged from 1 year and 3 months to 10 years and 9 months (mean: 4 yr and 11 mo). During that time, we found no recurrences of acinic cell carcinoma and no evidence of metastatic disease. Therefore, we conclude that acinic cell carcinoma can be successfully treated with a superficial or total parotidectomy with sparing of the facial nerve. Radiation therapy may provide adjunctive benefit.
July 31, 2005 Akhtar Hussain, FRCS; Daran P. Murray, FRCSI (ORL-HNS)
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Abstract
Deep-lobe parotid tumors are relatively uncommon. Most of these tumors present as external masses. They can also present in the oral cavity or oropharynx. Magnetic resonance imaging and ultrasound-guided fine-needle aspiration for biopsy and cytology have made it possible to establish a definitive diagnosis and identify the exact location of the tumor in almost all cases before surgery. Traditionally, deep-lobe tumors have been managed by a formal superficial parotidectomy and identification and preservation of the facial nerve, followed by removal of the deep lobe that contains the tumor. Superficial parotidectomy is associated in most cases with periauricular depression secondary to a loss of volume, leading to variable aesthetic deformities. A complete parotidectomy is more likely to be associated with a larger aesthetic deficit secondary to a greater loss of tissue volume. The incidence of gustatory sweating is high after superficial parotidectomy, particularly in the early postoperative period. We hypothesize that if the superficial lobe is preserved, there is less likelihood of gustatory sweating because of the interposition of tissue between the skin and the cut ends of the secretomotor fibers. Approximately 80% of parotid tissue volume is made up of the superficial lobe, and therefore preservation of the superficial lobe should be associated with less postparotidectomy depression. Therefore, we decided to preserve the superficial lobe of the gland for deep-lobe tumors. Nine patients underwent deep-lobe parotidectomy with preservation of the superficial lobe over a 6-year period. Patients were studied prospectively with regard to technical difficulty, complications, and cosmetic outcome. Follow-up ranged from 12 months to 6 years. We did not experience any undue technical difficulty, and there were no cases of facial weakness. One patient developed gustatory sweating, which almost completely resolved over a 2-year period. There were no cases of postparotidectomy depression, and both patients and surgeons were satisfied with the cosmetic appearance. We present our technique and experience.
May 31, 2005 Amy E. Cocco, MD; Gregory T. MacLennan, MD; Pierre Lavertu, MD; Jay K. Wasman, MD
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Abstract
Xanthogranulomatous tissue reaction is an uncommon but well-documented process that occurs at many sites in the body. It is most often recognized in the kidney and gallbladder, where its etiology is believed to involve an outflow obstruction. We report the case of a man with a parotid mass that exhibited features consistent with an inflammatory process on fine-needle aspiration biopsy. The mass persisted despite medical management, and the patient subsequently underwent a superficial parotidectomy. Histologic examination of the resected specimen identified a xanthogranulomatous tissue reaction adjacent to a Warthin's tumor. We compare the features of this case with those of the 2 previously reported cases of xanthogranulomatous sialadenitis, and we discuss its possible etiologies.
April 30, 2005 Ryan F. Osborne, MD; Manish R. Purohit, MD; Jason S. Hamilton, MD
April 30, 2005 Robert L. Witt, MD
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Abstract
Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve''defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve''is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved. To test this hypothesis, the author conducted a retrospective study of 30 patients''15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms of morbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.
April 1, 2005 Andres Eraso, MD; Giovanni Lorusso, MD; Enrique Palacios, MD, FACR
March 1, 2005 Korhan Asal, MD; Ahmet Köybasioglu, MD; Erdogan Inal, MD; Ahmet Ural, MD; S. Sabri Uslu, MD; Alper Ceylan, MD; Fikret Ileri, MD
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Abstract
We studied the incidence of Frey's syndrome and facial contour deformity in two groups of patients who had undergone superficial parotidectomy. One group was made up of 12 patients who were randomized to undergo reconstruction of the surgical defect with a sternocleidomastoid muscle flap; the other 12 patients did not receive a flap. All 24 patients were evaluated via a short questionnaire, the starch-iodine test, and a visual examination. On the questionnaire, none of the 24 patients said they experienced abnormal facial sweating, flushing, or warmth while eating, although 6 of the 12 patients in the nonflap group had a mildly positive starch-iodine test. No patient in the flap group had a positive test. The difference between the two groups was statistically significant (p < 0.05). No statistically significant difference was seen between the two groups with respect to cosmetic results.
February 1, 2005 Sofia Avitia, MD; Ryan F. Osborne, MD
December 1, 2004 Jonathan W. Hafner, BS; Thomas H. Costello, MD; Rose Mary S. Stocks, MD, PharmD; Fadi Ibrahim, MD;
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Abstract
Childhood primary parotid non-Hodgkin's lymphoma (NHL) is a rare but well-recognized entity in the literature. Perineural extension of masses between the head and neck and cranium, although rare, has also been well documented. We report the first documented case, to our knowledge, of a left-sided primary parotid NHL in a child with direct intracranial extension through the foramen rotundum. The mass arose in a 1½-month period. Following evaluation by computed tomography and magnetic resonance imaging, diagnostic procedures (first, fine-needle aspiration and, subsequently, an open biopsy) were undertaken. We discuss the case report and briefly review childhood NHL and perineural metastasis.
April 1, 2004 William A. Numa, Jr., MD; Paul K. Foster, MD; Jeffrey Wachholz, MD; Francisco Civantos, MD; Carmen Gomez-Fernandez, MD; Donald T. Weed, MD
