Protective effects of hesperidin in cyclophosphamide-induced parotid toxicity in rats.

Cyclophosphamide (CYP) is an alkylating agent that is used on a wide range as a treatment of malignancies and autoimmune diseases. Previous studies have shown the promising role of hesperidin (HSP) as an antioxidant agent against various models of toxic agents. The protective effect of the HSP against CYP-induced parotid damage was evaluated in this study. Forty rats (180-200 g) were divided into four equal groups: Group I (received normal saline), Group II (HSP-treated at a dose of 100 mg/kg/day for 7 consecutive days), Group III (CYP-treated at a dose of 200 mg/kg single intraperitoneal injection on the 7th day of the experiment), Group IV (CYP + HSP); HSP-treated at a dose of 100 mg/kg/day for 7 consecutive days and CYP (200 mg/kg) single intraperitoneal injection on the 7th day of the experiment. Afterwards, the oxidative stress and inflammatory markers, the histopathological and immunohistochemical alterations of the parotid tissues in the studied groups were evaluated. CYP intoxication induced a significant parotid tissue injury represented by the elevation in the values of malondialdehyde (MDA), tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) and decrease in the catalase activity and glutathione peroxidase (GPx). Histologically, extensive histopathological alterations e.g., widely spaced serous acini with irregular shapes and congested blood vessels as well as downregulated ki-67 and alpha-smooth muscle actin (α-SMA) immunoexpression were induced by CYP. HSP administration markedly improved the biochemical and the histopathological studies. We can conclude that HSP elicited protective effects against the CYP-induced parotid toxicity.

Delayed Management of Parotid Sialocele: Role for Two-week Intraoral Drainage.

Iatrogenic injury or trauma to the salivary gland duct is one of the most common causes of parotid sialoceles, which are usually superficial, soft, and filled with saliva. The enrolled 7 patients with parotid sialocele were divided into two groups: trauma group (4 cases) and iatrogenic group (3 cases). No evidence of recurrence or cranial nerve injuries were observed. With persisted parotid sialocele, intraoral drainage for two weeks as a safe and inexpensive method is recommended.

The paralyzing legal costs of facial nerve injury in head and neck tumors.

PURPOSE: Facial nerve paralysis from head and neck tumors can result from disease progression or iatrogenic causes, leading to litigation. The aim of this study was to investigate lawsuits regarding facial paralysis as a consequence of these tumors to understand and better educate physicians behind the reasons for litigation. METHODS: Jury verdict reviews were obtained from the Westlaw database from 1985 to 2018. Gathered data, including verdicts, litigation reasons, defendant specialties, and amounts awarded, were analyzed via Statistical Package for the Social Sciences. RESULTS: Of the 26 lawsuits analyzed, the leading reason for litigation was failure to diagnose (53.8%), followed by iatrogenic injury (34.6%). The average award was $2,704,470. Otolaryngologists were the most common defendants. Defendants that included an otolaryngologist had shorter delays of diagnosis compared to those that did not (p < 0.05). CONCLUSION: Failure to diagnose parotid injury was the leading cause of litigation. In instances where the jury found for the plaintiff, the amount was material. There were equivalent incidences of cases in favor of plaintiffs and defendants.

Complication After PDO Threads Lift.

Thread-lifting is as a minimally invasive procedure with limited scarring, rapid recovery, and fewer complications compared with the standard incisional surgery for facial rejuvenation. Using absorbable thread-like polydioxanone is a relatively simple procedure that is also performed by nonmedical professionals in Korea. Although several acute or delayed complications after using nonabsorbable thread types were also reported, it is uncommon to find cellulitis caused by a delayed complication after thread-lifting. A 41-year-old woman presented to our clinic with inflamed multiple palpable masses. She underwent 3 courses of acupoint embedding therapy at a Korean oriental medical clinic. She was treated with combination antibiotic therapy; however, the inflammation did not subside. Consequently, excisional biopsy was performed under local anesthesia. During the procedure, threads were detected and removed. Dimpling, thread exposure, alopecia, under-correction, asymmetry, and parotid gland injury also can occur as early complications of the procedure. Fortunately, these reactions are predominantly mild to moderate in intensity, and can be corrected by a relatively simple procedure. Chronic inflammatory reactions in the thread-lifting area, as identified in the authors' case, are an infrequent complication. It is recommended to consult with experts in the field for the implementation of this procedure. In addition, experts also need to notify the above side effects and solutions in advance to ensure safe and satisfactory procedures for their patients.

Application of Delayed Surgical Managements in Patients with Stensen's Duct Injury.

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries. Nine patients subjected to parotid gland and duct injuries with 1- to 3-month treatment delay were retrospectively evaluated with special reference of etiology, past medical history, and injury location. Conservative treatment, microsurgical anastomosis, and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury, time of repair and procedures. Assistant treatment as pressure dressing was adopted thereafter. All patients experienced an uneventful recovery at the time of finalizing the study. Two patients received Stensen's duct ligation, 5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas, and no re-occurrence was found. Facial paralysis occurred after surgery in 4 patients, and 3 of them recovered after the nerve nutrition treatment. Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

Bone marrow-derived mesenchymal stem cells ameliorate parotid injury in ovariectomized rats.

BACKGROUND AIMS: Parotid hypofunction causes life-disrupting effects, and there are no effective medications for xerostomia. We hypothesized that mesenchymal stem cells (MSCs) have repairing effects on parotid glands of ovariectomized (OVX) rats. METHODS: Forty-five adult female rats were divided into three equal groups: group I (Control group), group II (OVX-group) and group III (OVX rats that received MSCs at 4 and 8 weeks post-ovariectomy). At 12 weeks post-ovariectomy, histological (Masson's trichrome and periodic acid-Schiff with alcian blue stains), immunohistochemical (caspase-3 and CD44) and morphometric studies and salivary flow rate and saliva pH determination were carried out. RESULTS: Histologically, the OVX group displayed numerous irregular vacuolated acini, thickened septa with marked cellular infiltration and vascular congestion. Degenerated organelles and few or irregular secretory granules with a different density were observed. Caspase-3-positive cells were highly expressed. MSC-treated glands exhibited a considerable degree of preservation of glandular architecture with numerous CD44-expressing and few caspase-3-expressing cells. Significant decrease of the salivary flow rate in the OVX group was detected, which reverted to normal levels in group III. CONCLUSIONS: MSCs ameliorated the damaging effects of ovariectomy on the parotid glands.

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection

Abstract: Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

A Potential of sFasL in Preventing Gland Injury in Sjogren's Syndrome.

Fas and its ligand FasL, members of tumor necrosis factor receptor superfamily, have been implicated in the process of cell apoptosis. FasL consists of two forms, membrane FasL (mFasL) and soluble FasL (sFasL). sFasL can be produced by mFasL cleaved by matrix metalloproteinases (MMP) and also reveals a role for binding to Fas which is expressed on cell surface. Although Fas/FasL axis has been implicated in a variety of diseases, its role in Sjogren's syndrome still remains ill defined. In this study, we investigated the potential of sFasL in the pathogenesis of Sjogren's syndrome (SS). We found that the serum levels of sFasL in SS patients were significantly lower than healthy subjects. Moreover, serum levels of sFasL in patients with mild disease activity were higher than patients with severe disease activity. There is a positive correlation of the serum level of sFasL with uptake index of parotid gland in our expectation. In addition, liver injury involvement in SS patients showed decreased level of sFasL. Furthermore, we here also observed that the protective cytokine IL-10 expression was positively correlated with sFasL expression. Thus, our results here suggest a potential of sFasL in maintaining gland organ homeostasis.

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection.

Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

Colgajo temporal como alternativa reconstructiva en un carcinoma epidermoide cutáneo de la región parotídea / Temporal flap as a reconstructive alternative for cutaneous squamous cell carcinoma of the parotid region

El carcinoma epidermoide de piel posee una elevada incidencia en países pertenecientes al cinturón ecuatorial o con climas muy secos y soleados. Se relaciona con la exposición prolongada a las radiaciones ultravioletas, enfermedades como el Xeroderma Pigmentoso, dermatosis de larga evolución, infecciones e inmunosupresiones. Aparece con mucha frecuencia en la piel del territorio de cabeza y cuello, lo cual complejiza las posibilidades reconstructivas en muchos pacientes. Se presenta el caso de un paciente masculino de 66 años con diagnóstico de carcinoma epidermoide cutáneo en la región parotidea. Se efectuó una parotidectomía subtotal extendida a piel y se utilizó un colgajo miofascial temporal ipsilateral para la reconstrucción del defecto creado. El paciente se ha mantenido en seguimiento clínico por tres años y medio, no ha presentado recaídas, se encuentra controlado de su enfermedad y mantiene una buena apariencia estética. Esto refuerza la gran versatilidad de este colgajo dentro del arsenal reconstructivo(AU)

Epidermoid carcinoma of the skin has a high incidence in very dry and sunny countries or those belonging to the equatorial belt. It is related to lengthened exposure to ultraviolet radiation, diseases such as pigmentuous xeroderma, long evolution dermatosis, infections and immunosuppression. It appears frequently to the skin of the head and neck areas, which complicates reconstructive possibilities in many patients. The case of a 66-year-old male patient is presented, with a diagnosis of cutaneous squamous cell carcinoma in the parotid region. An extended subtotal parotidectomy was performed to the skin and ipsilateral temporal myofascial flap was used for reconstruction of the occurring defect. The patient has remained in clinical follow-up for three years and a half, he has not presented relapses, his disease is under control and he maintain good aesthetic appearance. This reinforces the versatility of this flap within the reconstructive spectrum(AU)

Treatment of Parotid Sialocele after Sustaining a Facial Injury. Case Report and Literature Review.

We are presenting the case of a patient who developed a parotid sialocele after sustaining a facial injury. The patient was treated by creating a controlled intraoral fistula that drained saliva into the oral cavity and led to resolution of the sialocele. Articles were reviewed for discussion of current treatment methods in managing parotid sialocele and fistula. The articles reported successful management of parotid sialocele and fistula using both nonsurgical and surgical methods. Treatment depends upon the location of the injury (ductal injury vs. parenchymal injury) and the time of treatment (delayed vs. immediate).

Sialocele post-trauma sin lesión penetrante / Sialocele post-trauma without penetrating injury

El sialocele es una colección de saliva en los tejidos que rodean al conducto de la glándula o del parénquima sin un drenaje adecuado. Su causa más común es la extravasación de saliva producto a una disrupción del parénquima o conducto parotídeo secundario a un trauma cortante. Si el tratamiento del sialocele no se realiza en forma oportuna se puede generar una fístula externa, cicatrices faciales e infecciones secundarias. Un hombre de 24 años ingresado al Hospital con múltiples fracturas faciales sin trauma cortante. Luego de la disminución del edema, continuó el aumento de volumen en la región geniana en forma localizada, fluctuante, ovalada. La piel se encontraba distendida, asintomática, sin secreciones, con alteración de la función motora y sensorial en la región geniana derecha. Se realizó la aspiración del contenido del aumento de volumen. Después de 2 días recidivó. Se solicitó una Tomografía computarizada y se volvió a realizar aspiración del contenido para enviarlo a cultivo citológico. Se hizo el diagnóstico de sialocele post-trauma de la parótida y se realizó un vaciamiento del contenido y drenaje tipo penrose intraoral. Se controló al siguiente día sin recidivas y se retiró el drenaje a los 2 meses. Es importante tener en cuenta que se puede generar un sialocele post-trauma sin necesariamente ser cortante.

Sialocele is a collection of saliva in the tissues surrounding the duct of the gland or parenchyma without proper drainage. The most common cause is the extravasation of saliva product to a disruption of the parenchyma or parotid duct secondary to a cutting trauma. If sialocele treatment is not performed in a timely manner it can generate an external fistula, facial scars and secondary infections. Male admitted to hospital with multiple facial fractures. After the reduction of edema, continued increased volume in the preauricular region localized, fluctuating, oval. The skin was asymptomatic, without secretions, with impairment of motor and sensory function in the right genial region. The aspiration of the increase in volume under a hypothesized hematoma was performed. After 2 days recurred. A tomography scan was requested and returned to realize the aspiration of which was sent to cytological exam. The diagnosis was post-trauma sialocele parotid and was performed emptying the contents and drainage type penrose intraoral. Was control the next day without relapses and the drain was removed after 2 months. It ́s important to know that can generate a post-trauma sialocele without necessarily cutting trauma.

Adipose Mesenchymal Stem Cell Secretome Modulated in Hypoxia for Remodeling of Radiation-Induced Salivary Gland Damage.

BACKGROUND AND PURPOSE: This study was conducted to determine whether a secretome from mesenchymal stem cells (MSC) modulated by hypoxic conditions to contain therapeutic factors contributes to salivary gland (SG) tissue remodeling and has the potential to improve irradiation (IR)-induced salivary hypofunction in a mouse model. MATERIALS AND METHODS: Human adipose mesenchymal stem cells (hAdMSC) were isolated, expanded, and exposed to hypoxic conditions (O2 < 5%). The hypoxia-conditioned medium was then filtered to a high molecular weight fraction and prepared as a hAdMSC secretome. The hAdMSC secretome was subsequently infused into the tail vein of C3H mice immediately after local IR once a day for seven consecutive days. The control group received equal volume (500 µL) of vehicle (PBS) only. SG function and structural tissue remodeling by the hAdMSC secretome were investigated. Human parotid epithelial cells (HPEC) were obtained, expanded in vitro, and then irradiated and treated with either the hypoxia-conditioned medium or a normoxic control medium. Cell proliferation and IR-induced cell death were examined to determine the mechanism by which the hAdMSC secretome exerted its effects. RESULTS: The conditioned hAdMSC secretome contained high levels of GM-CSF, VEGF, IL-6, and IGF-1. Repeated systemic infusion with the hAdMSC secretome resulted in improved salivation capacity and increased levels of salivary proteins, including amylase and EGF, relative to the PBS group. The microscopic structural integrity of SG was maintained and salivary epithelial (AQP-5), endothelial (CD31), myoepithelial (α-SMA) and SG progenitor cells (c-Kit) were successfully protected from radiation damage and remodeled. The hAdMSC secretome strongly induced proliferation of HPEC and led to a significant decrease in cell death in vivo and in vitro. Moreover, the anti-apoptotic effects of the hAdMSC secretome were found to be promoted after hypoxia-preconditioning relative to normoxia-cultured hAdMSC secretome. CONCLUSION: These results show that the hAdMSC secretome from hypoxic-conditioned medium may provide radioprotection and tissue remodeling via release of paracrine mediators.

The use of botulinum toxin B in the treatment of a post-traumatic sialocele in a 4-year-old child: A case report.

Parotid sialoceles are bothersome complications of parotidectomy and penetrating injury to the parotid gland. Though typically self-limited and responsive to conservative management, they can be particularly difficult to manage in the pediatric population where even conservative interventions are less well tolerated. We present the case of a 4-year-old child with a post-traumatic parotid sialocele that was successfully managed with a single injection of botulinum toxin B. To our knowledge, this is the first reported case of the use of botulinum toxin for this purpose in the pediatric population.

Penetrating Trauma to the Parotid Gland.

Penetrating trauma to the parotid gland may present unique challenges especially when Stensen duct, neurovascular structures, and/or collateral organs are involved. Especially ballistic injuries caused by high-velocity projectiles or fragments of grenades and improvised explosive devices are often associated with massive tissue damage and a high risk of infections and other posttraumatic complications. Because penetrating parotid trauma is not very common, only limited information on the primary treatment of such injuries is available. This article gives a short overview about actual aspects on diagnosis and treatment strategies especially focusing on ballistic parotid injuries.

Experience with the transparotid approach via a mini-preauricular incision for surgical management of condylar neck fractures.

INTRODUCTION: The aim of this study was to describe our experiences of a mini-preauricular transparotid approach for direct reduction and plating of condylar neck fractures. MATERIALS AND METHODS: A retrospective study was conducted on 58 patients from 2009 to 2011 with 69 condylar neck fractures in Chang Gung Memorial Hospital. The fractures were treated surgically either with a 2-cm mini-preauricular and transparotid approach in 29 patients with 36 fractures, or via endoscope-assisted intraoral, or facelift or retromandibular approaches in a control group of 29 patients with 32 fractures. The postoperative hospital stay, occlusion status, mouth opening and facial nerve and parotid gland related complications were compared between the two groups. RESULTS: In both groups around 90% of patients had good restoration of preinjury occlusion. Postoperative mouth opening was 39.8 mm and 39.9 mm in the mini-preauricular approach and the other approaches group, respectively. Facial symmetry was achieved in all of the patients. There was no incidence of facial nerve palsy, infection or hemorrhage in the mini-preauricular group. One patient in the control group had a persistent weakness due to frontal nerve palsy. CONCLUSION: Based on the results, the mini-preauricular approach can be an alternative, safe and effective method in the management of condylar neck and high subcondylar fractures.

Improvement in the repair of defects in maxillofacial soft tissue in irradiated minipigs by a mixture of adipose-derived stem cells and platelet-rich fibrin.

To find out if adipose-derived stem cells (ASC) and platelet-rich fibrin (PRF), alone or combined, had any effect on the repair of maxillofacial soft tissue defects in irradiated minipigs, ASC were isolated, characterised, and expanded. Twenty female minipigs, the right parotid glands of which had been irradiated, were randomly divided into 4 groups of 5 each: those in the first group were injected with both ASC and PRF (combined group), the second group was injected with ASC alone (ASC group), the third group with PRF alone (PRF group), and the fourth group with phosphate buffer saline (PBS) (control group). Six months after the last injection, the size and depth of each defect were assessed, and subcutaneous tissues were harvested, stained with haematoxylin and eosin, and examined immunohistologically and for apoptosis. Expanded cells were successfully isolated and identified. Six months after injection the defects in the 3 treated groups were significantly smaller (p<0.001) and shallower (p<0.001) than those in the control group. Those in the combined group were the smallest and shallowest. Haematoxylin and eosin showed that the 3 treated groups contained more subcutaneous adipose tissue than the control group, and also had significantly greater vascular density (p<0.001) and fewer apoptotic cells (p<0.001). Both ASC and PRF facilitate the repair of defects in maxillofacial soft tissue in irradiated minipigs, and their combined use is more effective than their use as single agents.