Growth rates over time of unoperated parotid benign tumors.

INTRODUCTION: The treatment of parotid benign tumor is in principle surgery, but observation may be necessary in some cases. The purpose of this study was to investigate the growth rates over time of unoperated parotid benign tumors. METHODS: We retrospectively reviewed the medical records of 63 patients with unoperated parotid benign tumors diagnosed at our institution between January 2010 and December 2022. RESULTS: Forty-nine of the 63 patients had a Warthin tumor and 13 patients had a pleomorphic adenoma. On average, the unoperated parotid benign tumors grew 0.02 cm in length and 0.4 cm3 in volume per year. Compared to pleomorphic adenomas, Warthin tumors were more predominant in male patients and in those with a smoking history and a longer duration of smoking history; patients with Warthin tumors were also followed up longer (p < 0.05). However, the length and volume growth rates of unoperated Warthin tumors and pleomorphic adenomas did not significantly differ. CONCLUSION: Surgery is the standard treatment for parotid benign tumors. However, small benign parotid tumors identified during preoperative examination can be observed through close follow-up, taking into account the patient's medical and general condition.

Dermoid Cysts on the Floor of the Mouth.

OBJECTIVE: The authors analyzed the clinical features and treatment results of surgical patients with a final diagnosis of dermoid cyst on the floor of the mouth over 14 years at our hospital. PATIENTS AND METHODS: A total of 5 patients with a final diagnosis of dermoid cyst of the floor of the mouth from January 2010 to December 2023 were enrolled. RESULTS: All patients complained of swelling in the submentum or floor of the mouth. The mean tumor size was 4.2±1.0 cm. All patients underwent complete surgical resection. A transcervical approach was performed in 3 patients, and an intraoral approach was implemented in 2 patients. There were no major complications after surgery with either method. The follow-up period was 71.4±75.7 months. There was no disease recurrence during follow-up. CONCLUSION: Dermoid cysts rarely occur on the floor of the mouth but should be considered in the differential diagnosis of other oral cavity tumors. Dermoid cysts on the floor of the mouth can be safely removed using the current transoral approach without scarring or recurrence.

Lymphadenopathy Secondary to Metastatic Squamous Cell Carcinoma Mistaken for Malignant Lymphoma.

OBJECTIVE: It is difficult to identify disease entities underlying lymphadenopathy in the head and neck region based solely on imaging. This often results in metastatic squamous cell carcinoma (Sqcc)-induced lymphadenopathy being mistaken for lymphoma. This study aimed to analyze clinical characteristics and computed tomographic features that aid in distinguishing between metastatic Sqcc and lymphoma when lymphadenopathy resembles a large solitary lymphoma. METHODS: The authors retrospectively enrolled 5 patients, managed between 2010 and 2024, with metastatic Sqcc mistaken for lymphoma and 9 patients with lymphadenopathy of 2 cm or larger due to lymphoma. RESULTS: Among the 5 patients, 3 exhibited a homogeneous lymphadenopathy phenotype, whereas the remaining 2 displayed heterogeneous enhancement with multiple small necrotic areas within the affected masses. Measurement of the Hounsfield units (HU) for lymphadenopathy, the sternocleidomastoid muscle, and the submandibular gland (SMG) was conducted for each patient. The ratio of lymphadenopathy HU to the average HU of the sternocleidomastoid muscle and the SMG was significantly higher in patients diagnosed with metastatic Sqcc compared with those with lymphoma (P = 0.01). CONCLUSION: In computed tomography scans, heterogeneous lymphadenopathy or enhancement levels that approach or exceed those of the SMG may indicate the likelihood of Sqcc rather than lymphoma.

Comparative analysis of benign and malignant parotid gland tumors: A retrospective study of 992 patients.

OBJECTIVE: We analyzed and compared the clinical characteristics of benign and malignant parotid gland tumors. PATIENTS AND METHODS: A total of 992 patients who underwent surgical treatment for parotid gland tumors from January 2010 to December 2020 were included in this study. This study population was subdivided into benign (n = 812, 81.9 %) and malignant parotid gland tumors (n = 180, 18.1 %). RESULTS: Pleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma is the most common malignant tumor. The patients with malignant parotid gland tumors were older than the patients with benign lesions. The duration of symptoms was longer in patients with benign parotid gland tumors compared to those with malignant lesions. The size of the malignant tumors was larger than that of the benign lesions. Preoperative fine-needle aspiration cytology had a diagnostic sensitivity of 50.3 %, diagnostic specificity of 98.7 %, a positive predictive value of 89.5 %, a negative predictive value of 89.9 %, and accuracy of 89.9 % for diagnosing malignant parotid gland tumors. For benign parotid gland tumors, superficial parotidectomy was most frequently performed, and for malignant parotid gland tumors, total parotidectomy was most frequently performed. Facial palsy was observed in 19.4 % of the patients with malignant parotid gland tumors compared to 5.4 % of those with benign tumors. CONCLUSION: The clinical features of benign and malignant parotid gland tumors showed differences in age, symptoms, duration of symptoms, size and site of the parotid tumors, surgical procedures, and postoperative facial nerve palsy.

Toxoplasmic Lymphadenitis of the Head and Neck Region.

OBJECTIVE: We analyzed the clinical characteristics and treatment results in patients with a final diagnosis of toxoplasmic lymphadenitis after surgery. METHODS: A total of 23 patients with a final diagnosis of toxoplasmic lymphadenitis of the head and neck region after surgery from January 2010 to August 2022 were enrolled. RESULTS: All patients with toxoplasmic lymphadenitis presented with a neck mass and a mean age of over 40. The most common location of toxoplasma lymphadenitis in the head and neck was neck level II in 9 patients, followed by level I, level V, level III, the parotid gland, and level IV. Three patients had masses in multiple regions of the neck. Preoperative diagnosis (based on imaging tests, physical examination, and fine-needle aspiration cytology results) was benign lymph node enlargement in 11 cases, malignant lymphoma in 8 cases, metastatic carcinoma in 2 cases, and parotid tumors in 2 cases. All patients underwent surgical resection and were diagnosed with toxoplasma lymphadenitis based on the final biopsy. There were no major complications after surgery. A total of 10 patients (43.5%) received additional antibiotics after surgery. There was no recurrence of toxoplasmic lymphadenitis during the follow-up period. CONCLUSIONS: It is challenging to assess the diagnostic accuracy of preoperative examination in toxoplasma lymphadenitis; hence, surgical resection is necessary to differentiate it from other diseases.

Mononostril Endoscopic Approach for Bilateral Sphenoid Sinus Lesions.

INTRODUCTION: A mononostril endoscopic approach was attempted for bilateral sphenoid sinus lesions. The objective of this study was to introduce the surgical method along with treatment results for patients. METHODS: We retrospectively analyzed 16 patients who underwent a mononostril endoscopic surgery for bilateral sphenoid lesions from 2018 to 2022. RESULTS: Endoscopic mononostril surgery for bilateral sphenoid lesions was performed for 13 cases under general anesthesia and 3 cases under local anesthesia. The surgical approach to the sphenoid sinus was transnasal approach in 8 cases and transethmoidal in 8 cases. Among those with bilateral sphenoid sinuses lesions, fungal ball and sinusitis were the most common. After surgery, the size of the sphenoid sinus opening remained almost the same in 14 patients. It decreased but maintained in 2 patients. There was no recurrence of sphenoid lesions. CONCLUSION: The mononostril endoscopic approach for bilateral sphenoid lesions is a feasible, safe, effective, and minimally invasive surgical technique.

Natural killer cells have a synergistic anti-tumor effect in combination with chemoradiotherapy against head and neck cancer.

BACKGROUND: The use of natural killer (NK) cells is a promising approach in the field of cancer immunotherapy; however, combination treatments are required to enhance the effects of NK cell immunotherapy. In this study, we assessed the potential of irradiation and cisplatin as a chemoradiotherapy (CRT) regimen to augment the effects of NK cell immunotherapy in head and neck squamous cell carcinoma (HNSCC). METHODS: NK cells were expanded using our recently established K562-OX40 ligand and membrane-bound interleukin (IL)-18 and IL-21 feeder cells in the presence of IL-2/IL-15 from peripheral blood of healthy donors. RESULTS: The results showed an increase in the purity of NK cells and expression of activation markers such as NKG2D and lymphocyte function-associated antigen 1 during the expansion process, which is positively correlated to the NK cell infiltration and overall survival in patients with HNSCC. CRT induced NK cell activation ligand (ULBP2) and adhesion molecules (ICAM-1, -2 and -3) on HNSCC, leading to enhanced cytotoxicity of NK cells against HNSCC. CONCLUSIONS: Our findings suggest that the NK cells have a potent anti-tumor effect in combination with CRT against HNSCC.

Carcinoma ex pleomorphic adenoma of the parotid gland.

INTRODUCTION: Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant tumor of the parotid gland. We analyzed the clinical characteristics and treatment outcomes of CXPA of the parotid gland in patients managed for 11 years at this hospital. METHODS: The study included 17 cases of CXPA of the parotid gland from January 2010 to December 2020. RESULTS: Over 11 years, CXPA was the fourth most common parotid carcinoma, accounting for 9.4% of the 180 cases finally diagnosed as parotid carcinoma. Of the 17 cases of CXPA of the parotid gland, 12 lesions were removed by superficial parotidectomy, four lesions by total parotidectomy, and one lesion by radical parotidectomy. Four patients underwent neck dissection. The most common histopathology type was salivary duct carcinoma (n = 13, 76.5%). Postoperative radiation therapy (RT) was performed in 15 patients. Two patients (11.8%) experienced CXPA recurrence 14 and 19 months after surgery. CONCLUSION: CXPA of the parotid gland was treated without recurrence in about 90% of the patients through surgery and postoperative RT. In the case of frankly invasive or adverse factors in the histopathological examination, more attention is required because CXPA recurrence may occur more frequently.

Spontaneous Fracture of the Maxillary Sinus as a Consequence of Nose-Blowing.

ABSTRACT: Spontaneous fracture of the maxillary sinus without preceding trauma or pathology is extremely rare. Our patient presented with a maxillary sinus fracture related to recurrent nose-blowing, in the absence of any other cause. Although rare, spontaneous fracture of maxillary sinus should be considered in the differential diagnosis of pain and swelling of the cheek and eye in elderly patients.

Long-Term Results of Fibrous Dysplasia of the Paranasal Sinuses.

INTRODUCTION: Fibrous dysplasia (FD) is a benign, idiopathic skeletal disorder, in which the normal bone and marrow are replaced by fibrous tissue and immature woven bone. The authors aim to analyze the long-term results of patients diagnosed with FD of the paranasal sinuses via imaging or surgical biopsy. METHODS: The authors retrospectively enrolled 21 patients with FD of the paranasal sinuses from 2006 to 2021. RESULTS: The mean age at the time of diagnosis of FD of the paranasal sinuses was very high at 45.9 years. The most common site ofoccurrence was the sphenoid sinus (71.4%). During the mean follow-up period of 52.8 months, there was no significant change in the size of FD of the paranasal sinuses, and there was no worsening of symptoms or complications. Endoscopic sinus surgery was performed in 16 patients (76.2%), of which 13 underwent only biopsy and 3 underwent partial resection. CONCLUSIONS: The most common site of FD of the paranasal sinuses was the sphenoid sinus, and the age at diagnosis was higher thanthat of patients with FD at other sites. Observation with serial radiologic examinations is recommended for asymptomatic FD of the para-nasal sinuses.

Surgical Treatment of Parapharyngeal Space Salivary Gland Tumor.

INTRODUCTION: Parapharyngeal space salivary gland tumors are very rare. The authors sought to examine the clinical features, treatment methods, and treatment results of parapharyngeal space salivary gland tumors in our hospital. METHODS: The authors retrospectively enrolled 15 patients who were finally diagnosed as having parapharyngeal space salivary gland tumors from January 2010 to January 2021. RESULTS: All parapharyngeal space salivary gland tumors arose from the prestyloid compartment. This study included 3 males and 12 females. The main symptoms were incidental diagnosis during imaging tests, followed by neck discomfort, oral mass, neck mass, and headache. Surgical methods for parapharyngeal space salivary gland tumors were performed in the following order: transcervical approach (n = 10), transcervical-parotid approach (n = 3), transoral approach (n = 1), and transparotid approach (n = 1). Pleomorphic adenoma was the most common tumor among parapharyngeal space salivary gland tumors. CONCLUSIONS: In the surgery of parapharyngeal space salivary gland tumors, a transcervical or transcervical-parotid approach was mainly used by predicting the origin site through radiologic examinations.

Anatomical Characteristics of the Anterior Jugular Vein and Its Clinical Relevance.

INTRODUCTION: The anterior jugular vein (AJV) is part of the superficial venous drainage system of the head and neck. Recently, interest in AJV is increasing as various surgical procedures have been developed. The authors conducted a cadaveric study to determine characteristics of AJV in Koreans. METHODS: A total of 44 cadavers were dissected. Anatomical characteristics were analyzed for 34 cadavers in which AJV was well observed. RESULTS: In this study, 21 were males and 13 were females. There were 8 cadavers with only 1 AJV from both sides. There was no significant difference in anatomical characteristics according to gender or AJV variation except for a difference in the length of the neck according to gender. However, it was possible to find a safety zone at the main landmark of the neck that could avoid AJV damage. CONCLUSIONS: By using this safety zone, it is possible to prevent damage to the AJV and reduce complications during various surgical procedures on the head and neck.

Inferior Turbinate Mucocele.

OBJECTIVE: In what follows, it is extremely rare for the inferior turbinate to occur with a mucocele. The authors aim to evaluate the characteristics, clinical features, and treatment outcome of the inferior turbinate mucocele in our hospital. PATIENTS AND METHODS: Five patients with radiologically confirmed inferior turbinate mucocele between January 2006 and December 2017 were enrolled in this study. RESULTS: Out of the 5 patients with inferior turbinate mucocele reviewed, 2 out of the 5 patients had symptoms of nasal obstruction and headache respectively, whereas the other 3 remaining patients were found incidentally by radiological examinations without any nasal symptoms. Four patients were performed the surgery by the transnasal endoscopic marsupialization. One patient had a very small size of an inferior turbinate mucocele and had no symptoms, and in that case the authors decided to do a periodic observation without a surgical intervention. There were no major complications resulting from this surgical intervention, and no recurrence of the inferior turbinate mucocele. CONCLUSIONS: The inferior turbinate mucocele is an extremely rare disease and can be diagnosed accurately by the use of radiologic examinations. The prevailing discipline is that endoscopic marsupialization is the best treatment for the inferior turbinate mucocele, which is known for showing very good results without recurrence of the condition.

Endoscopic Surgical Treatment of Maxillary Sinus Organized Hematoma.

OBJECTIVE: The purpose of this study was to analyze the clinical characteristics and treatment outcomes of patients who underwent endoscopic surgery for a maxillary sinus organized hematoma during a 15-year period in our hospital. METHODS: The authors analyzed 25 patients who underwent endoscopic surgery for a maxillary sinus organized hematoma from January 2004 to December 2019. RESULTS: Twenty-five patients with a maxillary sinus organized hematoma underwent endoscopic surgical treatment and complete removal of the maxillary sinus organized hematoma was achieved in all cases. The main symptoms were nasal bleeding in 14 patients, followed by a nasal obstruction in nine, and facial swelling in 2. Of the 25 patients, 13 underwent endoscopic medial maxillectomy and 12 underwent endoscopic sinus surgery. There were no major surgical complications or recurrences. CONCLUSION: The authors demonstrated that endoscopic surgery is a safe and reliable treatment method for a maxillary sinus organized hematoma.

Clinical Difference Between Capillary and Cavernous Hemangiomas of Nasal Cavity.

OBJECTIVE: The authors analyzed the clinical characteristics and treatment results of capillary and cavernous hemangiomas in the nasal cavity. PATIENTS AND METHODS: A total of 14 patients who underwent surgical treatment for sinonasal hemangiomas between January 2010 and May 2020 were analyzed. The study population was subdivided into capillary and cavernous hemangiomas groups. RESULTS: The 14 patients with sinonasal hemangiomas involved 8 (57.1%) capillary hemangiomas and 6 (42.9%) cases of cavernous hemangioma. Clinical features, such as age, gender, medical condition, symptom, duration of symptom, size and site of sinonasal hemangiomas, surgery, anesthesia method, treatment outcomes, and recurrence of capillary and cavernous hemangiomas of nasal cavity showed no statistically significant difference (P > 0.05). A case of relapse involving a patient with cavernous hemangioma of vestibule was observed without recurrence after reoperation. CONCLUSION: The comparison of clinical features of capillary and cavernous hemangiomas of nasal cavity showed no statistical significance. Transnasal endoscopic tumor removal including the surrounding structure is a safe and effective procedure for sinonasal hemangiomas.

Surgical treatment of frontal sinus osteoma.

OBJECTIVE: The purpose of this study was to describe our experience in the surgical treatment of frontal sinus osteomas. METHODS: This study involved 18 patients who underwent surgery for frontal sinus osteoma between January 2016 and December 2019. Demographic characteristics, site and size of osteoma, presenting symptoms, frontal sinus osteoma grading system, presence of frontal sinusitis, surgical methods, treatment outcome, operation time, and complications were reviewed. RESULTS: The endoscopic approach was performed in all patients except one. Among patients who underwent an endoscopic approach, endoscopic sinus surgery was performed in ten patients and endoscopic-modified Lothrop procedure was performed in seven patients. The mean size of the frontal sinus osteoma was 1.5 ± 0.7 cm. According to the frontal sinus osteoma grading system, grade III (n = 9, 50.0%) was the most common, followed by grade II (n = 4), grade I (n = 3), and grade IV (n = 2). The size of the osteoma and frontal osteoma grading system exhibited statistical significance with the operation time (p < 0.05). There were no major surgical complications or recurrence. CONCLUSION: The operation time was prolonged when the frontal sinus osteomas were more than 1.5 cm or in grade III and IV frontal osteomas.

Facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery.

BACKGROUND: Unexpected facial nerve damage can occur during parotid gland tumor surgery. We sought to determine the incidence and treatment outcomes of unexpected facial nerve injuries in patients with parotid gland tumor surgery. METHODS: We retrospectively enrolled in this study five patients, who underwent facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery January 2012-August 2019. RESULTS: There were five patients (0.008%) with unexpected facial nerve injuries during the parotid gland tumor surgery of 577 patients in our hospital for approximately 8 years. The most common injury site of facial nerve was the marginal mandibular branch (n = 3), followed by the buccal branch (n = 1), and the cervicofacial division (n = 1). In the case of unexpected facial nerve damage, our treatment is immediate primary neurorrhaphy and steroid treatment. Three patients of five recovered and two did not worsen immediately after surgery. CONCLUSION: Unexpected facial nerve injury during parotid gland tumor surgery is extremely unfortunate. In this case, immediate primary neurorrhaphy and systemic steroids are recommended to restore facial function and reduce cosmetic deficits.

Clinical difference between benign and malignant tumors of the hard palate.

OBJECTIVE: To determine the clinical characteristics and treatment results of benign and malignant tumors of the hard palate in our hospital. PATIENTS AND METHODS: A total of 25 patients who underwent surgical treatment for hard palate tumors between 2008 and 2018 were included in this study. Their demographic characteristics, smoking status, alcohol consumption, symptoms, duration of symptoms, size and localization of hard palate tumor, status of mucosal surface, radiologic examinations, surgery, reconstruction method, histopathologic results, treatment outcomes, oral intake start time, adjuvant treatment, postoperative complications, and recurrence were reviewed. RESULTS: Of the 25 patients with hard palate tumors, 15 (60.0%) had benign tumors and 10 (40.0%) had malignant tumors. Both benign and malignant tumors of the hard palate occurred more frequently in females than in the males. The most common symptom of hard palate tumor was palate mass. The most common benign tumor was pleomorphic adenoma (n = 13). The most common malignant tumors were squamous cell carcinoma and carcinoma ex pleomorphic adenoma (n = 3 for each). All patients were operated via transoral approach without external incision. We did not experience any recurrence in this study. The oral intake start time was late in malignant hard palate tumors (p < 0.05). CONCLUSION: The comparison of clinical features of benign and malignant hard palate tumors showed a statistical significance only for oral intake start time. Transoral surgical removal with clear margin is a safe and effective procedure for benign and malignant hard palate tumors.

Nasal Septum Actinomycosis Mimicking Mucocele.

Actinomycosis commonly occurs in the cervicofacial region, but rarely in the paranasal sinus. The authors report an unusual case of nasal septum actinomycosis that was mistaken for a mucocele. The patient was treated accordingly using antibiotic therapy after endoscopic sinus surgery was performed. It is noteworthy that actinomycosis of the nasal septum could appear as a mucocele without central calcification or bony destruction in imaging studies.

Gelatin Sponge Induced Maxillary Sinusitis After Transsphenoidal Pituitary Surgery.

Transsphenoidal pituitary surgery is a safe, well-established treatment method, but it is associated with several postoperative nasal complications. However, gelatin sponge induced maxillary sinusitis after transsphenoidal pituitary surgery has not been reported. In this study, we present an unusual case of gelatin sponge induced maxillary sinusitis after transsphenoidal pituitary surgery. Therefore, it should be recognized that gelatin sponge induced maxillary sinusitis may occur as a complication after transsphenoidal pituitary surgery.