Parotid

Sarcoidosis presenting as a solitary parotid mass

September 30, 2006     James T. McCormick, DO; E. Douglas Newton, MD; Stanley Geyer, MD; Philip F. Caushaj, MD
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Abstract
We describe an unusual case of sarcoidosis in which the patient presented with a discrete solitary parotid mass and no other manifestation of the disease. The diagnosis was based on the unexpected pathologic findings during examination of a superficial parotidectomy specimen. To the best of our knowledge, no such presentation has been previously reported in the English-language literature.

Toxoplasmosis lymphadenitis presenting as a parotid mass: A report of 2 cases

September 30, 2006     Ron G. Shashy, MD; Daniel Pinheiro, MD, PhD; Kerry D. Olsen, MD
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Abstract
Toxoplasmosis manifesting as a parotid mass is rare; our review of the literature found only 6 previously reported cases. We report 2 new cases. Both patients presented with a small, mobile left parotid mass, and both were successfully treated with a diagnostic superficial parotidectomy. In both cases, the patient had been regularly exposed to cats and had recently eaten undercooked meat. When evaluating a parotid mass, otolaryngologists should be aware of the infectious causes of parotid swelling and lymphadenopathy and consider the possibility of toxoplasmosis when the history and pathologic findings are not suggestive of more common diseases.

Polymorphous low-grade adenocarcinoma of the parotid gland

September 30, 2006     Ashli K. O'Rourke, MD; Christine G. Gourin, MD; Zane K. Wade, MD; Richard B. Hessler, MD
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Abstract
Polymorphous low-grade adenocarcinoma (PLGA) of the parotid gland is rare. We describe a new case in which the patient underwent parotidectomy only to experience an extensive recurrence 2 years later. The recurrence was treated with radical surgical excision and radiation therapy, and the patient remained disease-free at 5 years of follow-up. We also review the literature on primary parotid PLGA.

Primary carcinoid tumor of the parotid gland: A case report and review of the literature

July 31, 2006     Irvin M. Modlin, MD, PhD; Michael D. Shapiro, BS; Mark Kidd, PhD
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Abstract
Salivary gland tumors account for 3 to 6% of all head and neck neoplasms in adults. Some 70 to 85% of these lesions are found in the parotid. Carcinoid tumors, which represent a distinct and relatively uncommon subset of neuroendocrine tumors, are most commonly found in the gastrointestinal tract, although in rare cases they are known to occur in extragastrointestinal locations, including the larynx, middle ear, and pancreas. Malignancies of the parotid gland are uncommon (approximately 25% of parotid neoplasms), and to the best of our knowledge, a primary carcinoid tumor of the parotid has not been previously described in the literature. Reports of parotid carcinoid tumors during the past 30 years have described the presence of nonparotid primary carcinoid tumors (usually gastrointestinal) that had been diagnosed and treated several years prior to the presentation of the parotid lesion. Under such circumstances, the parotid lesion may be assumed to have been a metastatic rather than a primary carcinoid. This report documents what we believe is the first case of a primary carcinoid tumor of the parotid gland. We detail the clinical, surgical, radiologic, immunologic, and histochemical findings associated with its diagnosis, and we describe our management of this case. Although a primary carcinoid in this location is exquisitely rare, knowledge of such lesions is important because their management is substantially different from that of other parotid tumors. In particular, it is important to differentiate them from metastatic tumors from other sites.

Malignant peripheral nerve sheath tumors of the head and neck: Two cases and a review of the literature

May 31, 2006     Pablo Martinez Devesa, FRCS (Edin); Timothy E. Mitchell, MA, FRCS (ORL-HNS); Ian Scott, FRCPath; David A. Moffat, BSc, FRCS
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Abstract
Malignant peripheral nerve sheath tumors are uncommon lesions that occasionally affect the head and neck. We describe 2 new cases of head and neck pathology. One tumor involved the parotid gland and resulted in erosion of the temporal bone, and the other affected the lower lip. A rapid diagnosis has significant implications for management because of the tumor's potential for aggressive behavior and its high rate of recurrence. To the best of our knowledge, lip involvement is rare and temporal bone involvement has not been previously described.

Reconstruction of a massive facial cutaneous defect with a bilobed transposition flap

April 30, 2006     Doug Iddings, DO; Babak Azzizadeh, MD; Ryan Osborne, MD, FACS
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Oncocytoma of the parotid gland

January 1, 2006     Enrique Palacios, MD, FACR
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Designing a bipedicled sternocleidomastoid muscle flap for parotidectomy contour deformities

January 1, 2006     Jason Hamilton, MD; Sofia Avitia, MD; Ryan F. Osborne, MD, FACS
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Mucoepidermoid carcinoma

December 1, 2005     Lester D.R. Thompson, MD
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Epithelial-myoepithelial carcinoma

December 1, 2005     Sofia Avitia, MD; Jason S. Hamilton, MD; Ryan F. Osborne, MD
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Acinic cell carcinoma of the parotid gland: A 15-year review limited to a single surgeon at a single institution

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.

Preservation of the superficial lobe for deep-lobe parotid tumors: A better aesthetic outcome

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.
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