The impact of radical parotidectomy with immediate facial nerve reconstruction: a quality-of-life measure.

OBJECTIVE: Immediate facial nerve reconstruction is the standard of care following radical parotidectomy; however, quality of life comparisons with those undergoing limited superficial parotidectomy without facial nerve sacrifice is lacking. METHOD: Patients who underwent parotidectomy were contacted to determine quality of life using the University of Washington Quality of Life and Parotidectomy Specific Quality of Life questionnaires. A total of 29 patients (15 in the radical parotidectomy and 14 in the limited superficial parotidectomy groups) completed and returned questionnaires. RESULTS: Using the University of Washington Quality of Life Questionnaire, similar quality of life was noted in both groups, with the radical parotidectomy group having significantly worse speech and taste scores. Using the Parotidectomy Specific Quality of Life Questionnaire, the radical parotidectomy group reported significantly worse speech, eye symptoms and eating issues. CONCLUSION: Those undergoing radical parotidectomy with reconstruction had comparable overall quality of life with the limited superficial parotidectomy group. The Parotidectomy Specific Quality of Life Questionnaire better identified subtle quality of life complaints. Eye and oral symptoms remain problematic, necessitating better rehabilitation and more focused reconstructive efforts.

Health-related quality of life of parotid carcinoma patients-a comparative study with parotid adenoma patients and assessment of the influence of demographic, treatment, and pathological factors.

The aim of this study was to compare the health-related quality of life (HRQoL) of patients treated for parotid carcinoma (PC) and parotid adenoma (PA). The impact of demographic, treatment, and pathological factors was analyzed within the PC group. The EORTC QLQ-C30 and QLQ-H&N35 questionnaires were completed by 45 PC patients and 46 PA patients. A number of HRQoL domains were significantly worse in the PC group than in the PA group: global health status, pain, insomnia, loss of appetite, mouth opening, swallowing problems, dry mouth, sticky saliva, problems with senses and speech, social eating, and cognitive functioning (P<0.05). In the PC group, significantly worse scores were found for age >55years, radical parotidectomy, neck dissection, radiotherapy, recurrence of the disease, pT3/T4 stage, pN+ status, and high-grade tumour (P<0.05). Worse results were related to global health status, social contact, mouth opening, weight and appetite loss, physical, role, emotional, and social functioning, fatigue, speech problems, social eating, and financial difficulties. The study results demonstrate worse HRQoL in PC patients in comparison to PA patients. Older age, radical parotidectomy, neck dissection, radiotherapy, T3/T4 stage, pN+, high-grade tumours, and recurrence had a significant influence on HRQoL in PC patients.

Electroconvulsive Therapy as a Powerful Treatment for Delirium: A Case Report.

OBJECTIVE: The aim of the study was to describe the successful treatment of delirium with electroconvulsive therapy (ECT). METHODS: The method of the study was a case report. RESULTS: A 75-year-old man, with a recently diagnosed carcinoma of the parotid gland, was admitted with a fluctuating psychiatric syndrome. Delirium was diagnosed, although an acute underlying somatic cause could not be readily established. Antipsychotics and benzodiazepines were not effective. After 7 sessions of ECT, all symptoms ceased. This enabled him to receive radiotherapy for his tumor and enjoy a good quality of life for the remaining 8 months of his life. CONCLUSIONS: Electroconvulsive therapy is not only a powerful treatment for catatonia, neuroleptic malignant syndrome, and delirious mania but also for the most commonly occurring fluctuating psychiatric syndrome--delirium.

Long term quality of life in pediatric patients surviving parotid tumors.

OBJECTIVE: To evaluate the long term quality of life in pediatric patients who have survived parotid tumors. METHODS: A quality of life instrument, based on the principles of the University of Washington Quality of Life questionnaire, was specifically created for this study and sent to pediatric patients who had undergone a parotidectomy between 2000 and 2008. RESULTS: The mean general health score was 3.45, which was deemed good to very good. The highest overall score in the group was 99.24. These results indicated that almost no patients complained of pain. Initially, 10 patients had reported that sensation was affected, but six of these cases recovered. Three (9.1%) patients reported a change in their appearance. Two patients (6.1%) reported surgical site depression and a further two (6.1%) reported scarring depression. Six (18.2%) patients reported facial nerve impairment during the early postoperative period, and four of these cases recovered. Two patients reported fistula during the early postoperative period, and but the symptoms were resolved after intervention. Frey's syndrome was reported by three (9.1%) patients. CONCLUSION: Parotidectomy has a limited negative impact on pediatric patients' quality of life.

Large carcinoma ex pleomorphic adenoma of the parotid gland: a case report and review of literature.

Pleomorphic adenoma (PA) is one of the most common benign tumors of the parotid gland. PA usually grows slowly and is painless. Surgery is necessary for treating PA. Facial palsy, salivary fistula, and Frey syndrome have been reported as complications of tumor resection. PA can transform into a carcinoma ex pleomorphic adenoma (CXPA) over time and as it enlarges. This report describes a case of a large CXPA that transformed from a PA that had developed over 17 years and caused withdrawal from social contact because fear of surgery made the patient refuse treatment. The tumor gradually enlarged without any pain for a decade, but rapid growth and bleeding began a year before admission. Postoperative facial function and local control of the tumor were excellent, but the patient required adjuvant chemotherapy for lung and mediastinum lymph node metastasis leading to dyspnea from tracheal stenosis. This case indicates the importance of adequate explanation and advice when choosing therapy for PA, especially given the risk of a PA transforming to a CXPA.

[Development and validation of the Parotidectomy Outcome Inventory 8 (POI-8). Measurement of quality of life after parotidectomy in benign diseases]. / Entwicklung und Validierung des Parotidectomy Outcome Inventory 8 (POI-8): Messung der Lebensqualität nach Parotidektomie bei benignen Erkrankungen.

BACKGROUND: To date, no validated instrument for measuring health-related quality of life (QOL) in patients after parotidectomy for benign disease has been available. METHODS: In our retrospective study we included patients who had undergone parotidectomy for benign disease between 2003 and 2006. A group of experts identified single items with a potential impact on postoperative complaints (alpha version). After the patients had filled out the questionnaire item reduction was performed by sequential statistical analysis. The beta version of the instrument resulting from this procedure was then validated by the evaluation of reliability and validity. RESULTS: We included 199 patients in the study, of which 70 (35%) returned the completed questionnaires. The alpha version of the instrument contained 20 items (Parotidectomy Outcome Inventory-20, POI-20), while the beta version consisted of 8 items (POI-8). Cronbach's alpha was 0.84, indicating good internal consistency. The test-retest reliability score for POI-8 in 49 patients was highly correlated (r=0.91). Furthermore, we found a good concurrent validity with a global disease specific question (r=0.78). CONCLUSIONS: The POI-8 is the first reliable and valid instrument for measuring health-related QOL in patients after parotidectomy for benign disease.

Impact of lateral parotidectomy for benign tumors on quality of life.

CONCLUSION: This study supports the use of lateral parotidectomy as a safe and standardized type of surgery for benign parotid gland disease. OBJECTIVE: To assess quality of life in patients with benign salivary gland tumors who underwent lateral parotidectomy. PATIENTS AND METHODS: Fifty-one patients suffering from benign parotid gland disease were included in this prospective study. Using the EORTC QLQ-C30 and EORTC-QLQ-H&N35 questionnaire, surgery-affected changes in quality of life were assessed in 34 patients who completed this survey. RESULTS: Overall results show no alterations in quality of life 1 year after lateral parotidectomy.

Quality of life after great auricular nerve sacrifice during parotidectomy.

OBJECTIVE: To determine the impact of great auricular nerve (GAN) sacrifice during parotidectomy on patients' quality of life. DESIGN: Historical cohort survey of patients who had undergone GAN sacrifice during parotidectomy. SETTING: Tertiary academic otolaryngologic practice. PATIENTS AND METHODS: Fifty-three patients who had undergone GAN sacrifice during parotidectomy completed an 8-item quality-of-life survey with a 7-point response scale designed to measure outcome after GAN sacrifice during parotidectomy. RESULTS: Thirty patients (57%) reported experiencing at least 1 abnormal symptom, but the mean number of symptoms decreased significantly with time, from a mean of 2.3 during the first year to 0.2 after 5 years (P<.001). Even among patients experiencing symptoms, 23 (77%) reported only a little or no bother caused by the symptoms, and 27 (90%) reported no interference or almost none with their daily activities. The degree of bother or interference reported had a moderate positive correlation with the number of abnormal sensations reported. CONCLUSIONS: The results suggest that, while many patients experienced sensory deficits, the overall quality of life was not significantly affected after GAN sacrifice during parotidectomy. Patients who report multiple abnormal sensations, however, would benefit from additional counseling and from reassurance that the number of sensations will diminish with time. Further study evaluating the effect of preservation of the posterior branch of the GAN during parotidectomy on patients' quality of life is needed.