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1.
Toxins (Basel) ; 15(12)2023 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-38133193

RESUMO

This systematic review investigates the effect of botulinum neurotoxin (BoNT) therapy on cancer-related disorders. A major bulk of the literature is focused on BoNT's effect on pain at the site of surgery or radiation. All 13 published studies on this issue indicated reduction or cessation of pain at these sites after local injection of BoNTs. Twelve studies addressed the effect of BoNT injection into the pylorus (sphincter between the stomach and the first part of the gut) for the prevention of gastroparesis after local resection of esophageal cancer. In eight studies, BoNT injection was superior to no intervention; three studies found no difference between the two approaches. One study compared the result of intra-pyloric BoNT injection with preventive pyloromyotomy (resection of pyloric muscle fibers). Both approaches reduced gastroparesis, but the surgical approach had more serious side effects. BoNT injection was superior to saline injection in the prevention of esophageal stricture after surgery (34% versus 6%, respectively, p = 0.02) and produced better results (30% versus 40% stricture) compared to steroid (triamcinolone) injection close to the surgical region. All 12 reported studies on the effect of BoNT injection into the parotid region for the reduction in facial sweating during eating (gustatory hyperhidrosis) found that BoNT injections stopped or significantly reduced facial sweating that developed after parotid gland surgery. Six studies showed that BoNT injection into the parotid region prevented the development of or healed the fistulas that developed after parotid gland resection-parotidectomy gustatory hyperhidrosis (Frey syndrome), post-surgical parotid fistula, and sialocele. Eight studies suggested that BoNT injection into masseter muscle reduced or stopped severe jaw pain after the first bite (first bite syndrome) that may develop as a complication of parotidectomy.


Assuntos
Toxinas Botulínicas Tipo A , Gastroparesia , Neoplasias , Sudorese Gustativa , Humanos , Toxinas Botulínicas Tipo A/uso terapêutico , Sudorese Gustativa/induzido quimicamente , Sudorese Gustativa/tratamento farmacológico , Gastroparesia/induzido quimicamente , Gastroparesia/tratamento farmacológico , Dor/tratamento farmacológico , Neoplasias/tratamento farmacológico
2.
F1000Res ; 12: 1153, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38106653

RESUMO

Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.


Assuntos
Fraturas Mandibulares , Sudorese Gustativa , Humanos , Fixação Interna de Fraturas/efeitos adversos , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/cirurgia , Prevalência , Fatores de Risco
4.
JAMA Otolaryngol Head Neck Surg ; 149(11): 1003-1010, 2023 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-37768672

RESUMO

Importance: Limited literature exists on surgical outcomes after selective deep lobe parotidectomy (SDLP) with preservation of superficial lobe for patients with benign deep lobe tumors. Objective: To compare the following factors for SDLP vs total parotidectomy for patients with benign tumors in the deep lobe: postoperative complications, including facial nerve paresis or paralysis, Frey syndrome, first bite syndrome, cosmetic defect, sialocele formation, and wound infection; and tumor control and recurrence. Design, Setting, and Participants: This case series included 273 adults who underwent SDLP (n = 177) or total parotidectomy (n = 96) at a single tertiary care institution for benign parotid tumors located in the deep lobe or deep lobe and parapharynx from January 1, 2000, to December 31, 2020. Exposure: Selective deep lobe parotidectomy vs total parotidectomy. Main Outcomes and Measures: Incidence of postoperative complications and tumor recurrence. Results: Among 273 patients (SDLP, 177 [65%]; 122 women [69%]; median age at surgery, 58 years [IQR, 46-67 years]; total parotidectomy, 96 [35%]; 57 women [59%]; median age at surgery, 59 years [IQR, 40-68 years]), the most common tumor was pleomorphic adenoma (SDLP, 128 of 177 [72%]; total parotidectomy, 62 of 96 [65%]). An abdominal dermal fat graft was less commonly performed for patients who underwent SDLP than those who underwent total parotidectomy (2 of 177 [1%] vs 20 of 96 [21%]; difference, -20% [95% CI, -28% to -11%]). The rate of great auricular nerve preservation was higher in the SDLP group than in the total parotidectomy group (84 of 102 [82%] vs 20 of 34 [59%]; difference, 24% [95% CI, 5%-42%]). No meaningful difference in length of hospital stay was found. The percentage of patients with House-Brackmann grade I immediately after surgery was 48% (85 of 177) in the SDLP group and 21% (20 of 96) in the total parotidectomy group (difference, 28% [95% CI, 16%-40%]). There were no clinically meaningful differences in rates of hematoma, sialocele, seroma, ear numbness, wound infection, or unplanned return to emergency department or operating room. The SDLP group reported a lower rate of Frey syndrome than the total parotidectomy group (1 of 137 [1%] vs 12 of 78 [15%]; difference, -15% [95% CI, -23% to -7%]), as well as a lower rate of facial contour defect (28 of 162 [17%] vs 25 of 84 [30%]; difference, -13% [95% CI, -24% to -1%]) and a higher rate of first bite syndrome (34 of 148 [23%] vs 7 of 78 [9%]; difference, 14% [95% CI, 5%-23%]). The percentage of patients with House-Brackmann grade I at their first follow-up visit was 67% (118 of 177) in the SDLP group compared with 49% (47 of 96) in the total parotidectomy group (difference, 17% [95% CI, 4%-30%]). There was no clinically meaningful difference in House-Brackmann grade after 1 year. Conclusions and Relevance: Findings of this case series study suggest that SDLP can be considered an effective and even superior technique for management of benign tumors in the deep parotid lobe. Advantages associated with SDLP include reduction in need for reconstruction for facial contour defect and reduction in complications, such as immediate facial nerve weakness and Frey syndrome. The incidence of first bite syndrome was higher in the SDLP group. Tumor control was not compromised by SLDP.


Assuntos
Cistos , Neoplasias Parotídeas , Sudorese Gustativa , Infecção dos Ferimentos , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Parotídeas/patologia , Sudorese Gustativa/complicações , Sudorese Gustativa/patologia , Estudos Retrospectivos , Recidiva Local de Neoplasia/patologia , Glândula Parótida/cirurgia , Glândula Parótida/patologia , Complicações Pós-Operatórias/epidemiologia , Cistos/patologia , Infecção dos Ferimentos/complicações , Infecção dos Ferimentos/patologia
5.
J Plast Reconstr Aesthet Surg ; 85: 149-154, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37494848

RESUMO

BACKGROUND: Frey syndrome (FS) is a typical late complication following parotidectomy. Parotid surgery without proper coverage or reconstruction of exposed parotid parenchyma may contribute to the development of FS. Therefore, this study compared the closure versus the non-closure of exposed parotid parenchyma in the occurrence of FS. METHODS: This study included 195 patients with parotid lesions who underwent partial or superficial parotidectomy plus closure or non-closure of exposed parotid parenchyma, both with the application of fibrin glue. Two surgical methods of closure and non-closure were allocated to patients without randomization and blinding processes. The primary outcome was FS, and the second outcome was other complication rates. RESULTS: The closure and non-closure of exposed parotid parenchyma were performed in 102 and 93 patients, respectively. Early postoperative complications occurred with temporary events: transient facial weakness, 32 (16.4%); hematoma, 13 (6.7%); and wound infection, 2 (1.0%), without statistical difference between the two groups (P > 0.1). However, sialocele occurred in the non-closure group (n = 19) more than in the closure group (n = 7) (P = 0.005). In the first postoperative year, decreased sensation and local pain were found in 16 patients (8.2%) and 9 patients (4.6%), respectively, with no statistical difference between the two groups (P > 0.1). FS was found more in the non-closure group (n = 19, 20.4%) than in the closure group (n = 4, 3.9%) (P < 0.001). CONCLUSION: The closure of exposed parotid parenchyma and covering fascia is preferred over the non-closure to prevent FS.


Assuntos
Paralisia Facial , Neoplasias Parotídeas , Sudorese Gustativa , Humanos , Neoplasias Parotídeas/cirurgia , Sudorese Gustativa/complicações , Sudorese Gustativa/prevenção & controle , Glândula Parótida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Paralisia Facial/etiologia
6.
Br J Oral Maxillofac Surg ; 61(6): 411-415, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37365064

RESUMO

Surgery is the treatment of choice for tumours in the parotid gland. We evaluated complications following parotid surgery. We conducted a retrospective study on 554 patients undergoing parotid surgery for benign parotid tumours from 2012 to 2021. We analysed complication rates between extracapsular dissection (ECD) and superficial parotidectomy (SP). We found 19 capsular ruptures in patients undergoing ECD (5.34%) and five among those undergoing SP (2.52%) [p < 0,05]; 16 cases of temporary facial paralysis among those undergoing ECD (4.49%) and 35 in patients undergoing SP (17.67%) [p < 0,05]; and eight instances of permanent facial nerve paralysis in patients undergoing ECD (2.25%) [p > 0,05] and 13 in patients undergoing SP (6.56%). Among the mid-term complications described were: 22 salivary fistulas among patients operated with ECD (6.18%) [p > 0,05] and 17 in patients with SP (8.58%) 17 sialoceles in those who underwent ECD (4.77%) and seven with SP (3.53%) [p > 0,05]. Regarding late complications, we found: surgical wound dehiscence, pathological scarring (keloid), Frey's syndrome, and recurrence, which affected 45 patients with ECD (12.64%) and 21 with SP for dehiscence (10.6%) [p < 0,05]; 28 keloids in patients with ECD (7.86%) and 15 in patients with SP (7.57%) [p > 0,05]; 12 cases of Frey's syndrome in patients with ECD (3.37%) and 36 with SP (18.18%) [p < 0,05]; and finally 22 recurrences in patients who underwent ECD (6.18%) and 13 in patients who underwent SP (6.56%) [p > 0,05], including 30 in the 273 patients with pleomorphic adenoma and five in the 214 patients with Warthin's tumour. We can conclude that the onset of the different complications after parotid gland surgery are related to the surgery performed. Our data confirm that there is a tight relationship between type of surgery performed and type of complication.


Assuntos
Adenoma Pleomorfo , Paralisia Facial , Neoplasias Parotídeas , Sudorese Gustativa , Humanos , Glândula Parótida/cirurgia , Glândula Parótida/patologia , Estudos Retrospectivos , Sudorese Gustativa/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Parotídeas/cirurgia , Neoplasias Parotídeas/patologia , Paralisia Facial/complicações , Adenoma Pleomorfo/cirurgia , Recidiva Local de Neoplasia/patologia
8.
BJS Open ; 7(3)2023 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-37151084

RESUMO

BACKGROUND: Parotidectomy is the standard procedure for treatment of many parotid lesions; however, it has several drawbacks. Facial asymmetry and Frey's syndrome are the most annoying complications to patients. Insertion of interpositioning grafts into the parotidectomy bed can decrease these complications significantly. Free dermal fat graft (FDFG) and superficial musculoaponeurotic system (SMAS) flap have very promising results. This RCT aimed to compare these two techniques regarding functional and aesthetic outcomes. METHODS: Between February 2016 and October 2021, adult patients undergoing superficial conservative parotidectomy in a single centre for a benign indication were randomized into two equal groups using a closed envelope method. In one group, FDFG was inserted at the parotidectomy bed, whereas, in the other group, SMAS flap was performed. Preoperative, operative, and postoperative data were recorded and analysed. The primary outcome was the development of Frey's syndrome. RESULTS: Seventy-eight patients were randomized into two equal groups of 39 patients. There was no significant difference between the two groups regarding development of Frey's syndrome. There was no significant statistical difference between study groups regarding demographic data, co-morbidities, parotid pathologies, specimen volumes, total operating time, and postoperative complications. A tendency for over correction was observed in FDFG and under correction in SMAS flap. There was no statistically significant difference between the study groups regarding the patients' aesthetic satisfaction with the majority displaying excellent satisfaction with no poor results. CONCLUSION: FDFG and SMAS flap are simple, rapid, and reliable procedures and are effective in improving both functional and aesthetic outcomes post-parotidectomy. They have comparable results; however, selection of either procedure can be determined according to patient and tumour characteristics. Registration number: NCT05452837 (http://www.clinicaltrials.gov).


Assuntos
Neoplasias Parotídeas , Sistema Musculoaponeurótico Superficial , Sudorese Gustativa , Adulto , Humanos , Sudorese Gustativa/etiologia , Sudorese Gustativa/patologia , Sudorese Gustativa/cirurgia , Sistema Musculoaponeurótico Superficial/cirurgia , Sistema Musculoaponeurótico Superficial/patologia , Neoplasias Parotídeas/cirurgia , Neoplasias Parotídeas/complicações , Neoplasias Parotídeas/patologia , Retalhos Cirúrgicos , Estética
9.
J Craniofac Surg ; 34(5): e531-e533, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37236619

RESUMO

Frey syndrome is still a significant problem in postparotidectomy patients 6 to 18 months after surgery. The most accepted theory of the pathogenesis of Frey syndrome is the aberrant regeneration theory. Creating a barrier between the remnant parotid gland and the overlying skin prevents Frey syndrome. A 51-year-old female patient who developed pleomorphic adenoma in the parotid gland was operated. After superficial parotidectomy, a barrier between the underlying postganglionic parasympathetic nerves in the deep parotid gland and the overlying cutaneous tissue was created with a local skin flap to prevent Frey syndrome. The patient was successfully treated, and she was followed up to 5 years. No postoperative complications were observed. No signs of Frey syndrome were found in follow-up. This case highlights that local skin flaps can be an innovative natural method as it is a quick and simple method to create this barrier in the presence of expanded skin.


Assuntos
Adenoma Pleomorfo , Neoplasias Parotídeas , Sudorese Gustativa , Feminino , Humanos , Pessoa de Meia-Idade , Sudorese Gustativa/etiologia , Sudorese Gustativa/prevenção & controle , Neoplasias Parotídeas/cirurgia , Retalhos Cirúrgicos , Glândula Parótida/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Adenoma Pleomorfo/cirurgia
11.
Am J Otolaryngol ; 44(3): 103818, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36878174

RESUMO

In this paper, we aimed at methodologically presenting a video-case of Frey Syndrome occurred after parotidectomy, assessed by means of Minor's Test and treated with intradermic botulinum toxin A (BoNT-A) injection. Although largely described in the literature, a detailed explanation of both the procedures has not been previously elucidated. In a more original approach, we also highlighted the role of the Minor's test in identifying the most affected skin areas and new insight on the patient-tailored approach provided by multiple injections of botulinum toxin. Six months after the procedure, the patient's symptoms were resolved, and no evident signs of Frey syndrome were detectable through the Minor's test.


Assuntos
Toxinas Botulínicas , Sudorese Gustativa , Humanos , Sudorese Gustativa/diagnóstico , Sudorese Gustativa/tratamento farmacológico , Sudorese Gustativa/etiologia
13.
ANZ J Surg ; 93(3): 561-565, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36754593

RESUMO

Accessory parotid tumours are rare, accounting for less than 10% of parotid neoplasms. Although similar tumours affect both the accessory parotid and parotid, accessory parotid tumours are associated with higher rates of malignancy. Surgery is first line management. Standard surgical management involves a similar approach to superficial parotidectomy, despite the anterior location of these lesions. This approach requires extensive subcutaneous access and facial nerve dissection and therefore, poses significant risk. It can also result in poor cosmetic result due to scarring and Frey's Syndrome. On the contrary, a transoral approach to reduces the risk of cosmetic deformity, reduces recovery time and does not increase risk to the facial nerve. We present a case series of patients with accessory parotid masses, which have been successfully excised transoral and without endoscopic assistance.


Assuntos
Neoplasias Parotídeas , Sudorese Gustativa , Humanos , Neoplasias Parotídeas/cirurgia , Neoplasias Parotídeas/complicações , Glândula Parótida/cirurgia , Sudorese Gustativa/etiologia , Endoscopia/efeitos adversos , Dissecação/efeitos adversos , Complicações Pós-Operatórias
15.
Oral Dis ; 29(1): 188-194, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34739166

RESUMO

OBJECTIVE: Deep lobe parotid tumour is commonly removed with the covering superficial lobe of parotid gland. Total or subtotal parotidectomy leads to an increase in surgical morbidity. This study evaluated recurrence and function after selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for pleomorphic adenoma. MATERIALS AND METHODS: Twenty-eight patients with deep lobe parotid pleomorphic adenomas underwent selective deep lobe parotidectomy with preservation of the superficial lobe and the facial lobe via Roh's incision. Each patient was evaluated with any complications, cosmetic and salivary functions and local recurrence. RESULTS: Superficial lobe-preserving surgery via Roh's incision was successfully applied to all patients without injury to the facial nerve and the Stensen's duct for a median operation time of 65 min. Facial nerve paralysis was found only temporarily in 9 (32%) patients, and other complications were minimal. None of the patients had postoperative Frey's syndrome. Salivary secretory function in the operated side was well preserved. No recurrence was found in the patients for a median follow-up of 94 months. CONCLUSIONS: Selective deep lobe parotidectomy via Roh's incision is a reliable option of treatment for deep lobe parotid pleomorphic adenoma.


Assuntos
Adenoma Pleomorfo , Neoplasias Parotídeas , Ferida Cirúrgica , Sudorese Gustativa , Humanos , Adenoma Pleomorfo/cirurgia , Adenoma Pleomorfo/complicações , Adenoma Pleomorfo/patologia , Complicações Pós-Operatórias/etiologia , Sudorese Gustativa/etiologia , Sudorese Gustativa/patologia , Neoplasias Parotídeas/cirurgia , Glândula Parótida/cirurgia , Glândula Parótida/patologia , Ferida Cirúrgica/complicações , Estudos Retrospectivos , Recidiva Local de Neoplasia/patologia
17.
Stomatologiia (Mosk) ; 101(4): 68-73, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35943503

RESUMO

Operations for neoplasms of the parotid salivary gland require from the surgeon a deep knowledge of the anatomical and topographic features of this area and technical skill, which puts it in a number of «jewelry¼ operations that require patience and concentration. The review is devoted to the topic of specific postoperative complications after parotidectomy or subtotal resection of the gland. These include relapses of tumors, paralysis or paresis of facial muscles, Frey syndrome, salivary fistulas or sialocele, violation of skin sensitivity, soft tissue deformity. The review presents the frequency and causes of complications, mechanisms of their development, methods of prevention and elimination.


Assuntos
Paralisia Facial , Neoplasias Parotídeas , Sudorese Gustativa , Paralisia Facial/etiologia , Paralisia Facial/prevenção & controle , Humanos , Recidiva Local de Neoplasia/complicações , Glândula Parótida/cirurgia , Neoplasias Parotídeas/complicações , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Glândulas Salivares/cirurgia , Sudorese Gustativa/complicações , Sudorese Gustativa/cirurgia
18.
Clin Exp Dermatol ; 47(10): 1878-1879, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35775871

RESUMO

Unilateral gustatory flushing (also known as Frey syndrome) is presumed to be caused by injury to the autonomic component of the auriculotemporal nerve. It is important to distinguish the symptoms from those of food-induced allergy to avoid unnecessary investigation. The signs of Frey syndrome can persist for several years and can cause patients to feel self-conscious.


Assuntos
Hipersensibilidade Alimentar , Sudorese Gustativa , Adolescente , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Humanos , Sudorese Gustativa/diagnóstico , Sudorese Gustativa/etiologia
20.
Ann Ital Chir ; 93: 152-159, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476720

RESUMO

AIM: Parotid gland is the most common location for salivary gland tumors, more commonly pleomorphic adenoma and Warthin's tumor. Types of parotid surgery include superficial parotidectomy (SP), partial superficial parotidectomy (PSP), total conservative parotidectomy (TCP), enucleation (E), extracapsular dissection (ECD), and are related to different incidence of complications. The choice depends on tumors localization, dimension and histology. The aim was to compare complications rate such as facial and great auricular nerve impairment and Frey syndrome according to type of surgery performed. MATERIALS AND METHODS: We retrospectively review the management of 116 benign tumors of the parotid gland treated between January 2004 and January 2020 at our Department. RESULTS: Most frequent complication observed was a GAN deficiency (22.41%), permanent in 13% of cases. Post-operative facial nerve impairment was observed in 19 patients (persistent only in 1 case). Only Frey syndrome (4,31% of cases) seemed to be related to type of surgery (p<0.05) resulting more frequent in the group of patients that underwent "classical" parotidectomy, while facial nerve impairment, even if more frequent in this cases, did not statistically correlated with operative technique (p=0.054). CONCLUSIONS: Once experience is gained, in order to reduce post-operative morbidity extracapsular dissection is a reliable technique in the management of these neoplasms, even if attention has to be paid particularly in the removal of superficial masses "emerging" from the parenchyma. PSP is an alternative to SP, while CTP has to be reserved to selected cases ot tumors arising in the deep lobe. KEY WORDS: Benign tumor, Extracapsular dissection, Enucleation, Facial nerve Parotid gland, Parotidectomy, Superficial parotidectomy.


Assuntos
Neoplasias Parotídeas , Sudorese Gustativa , Humanos , Glândula Parótida/cirurgia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Sudorese Gustativa/epidemiologia , Sudorese Gustativa/etiologia , Sudorese Gustativa/prevenção & controle
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