Postoperative pain after parotid surgery-comparison between superficial/total parotidectomy and extracapsular dissection: a prospective observational study.

PURPOSE: To evaluate postoperative pain and discomfort after parotid surgery with regard to different surgical approaches. METHODS: This clinical study was carried out at a single tertiary referral center (2021-2022) and included 2 groups of adult patients (mean age 56.6 ± 12.7 vs. 53.4 ± 14.1 years) following elective parotid surgery due to a parotid tumor of any entity. The first group (SP/TP group) consisted of 31 patients after superficial parotidectomy (SP) or total parotidectomy (TP) (n = 31). The second group (ECD group) included all patients who had undergone extracapsular dissection (ECD) (n = 51). Primary endpoints comprised pain on ambulation as well as maximum and minimum pain (NRS 0-10) on the first three postoperative days (PODs). A neuropathic pain component (evaluated on POD 1 and 3), the analgesic score (collected from the patient file on POD 1-3), treatment-related side-effects/pain-associated impairments, and patient satisfaction (all measured on the 1st POD) were defined as secondary endpoints. Patients were surveyed using the standardized and validated "Quality Improvement in Postoperative Pain Treatment" (QUIPS) questionnaire and the painDETECT® questionnaire. Comparisons were performed using independent t tests, Wilcoxon tests, and χ2 tests, and the respective effect sizes were calculated. RESULTS: Looking at the first postoperative day, patients of both groups (SP/TP vs. ECD) reported comparable pain on ambulation (2.8 ± 2.0 vs. 2.6 ± 1.8; p = 0.628, r = 0.063), maximum (3.5 ± 2.2 vs. 3.5 ± 2.3; p = 0.992, r = 0.002) and minimum pain (1.1 ± 1.04 vs. 1.0 ± 1.2; p = 0.206, r = 0.157). Furthermore, there were no significant differences in pain-related restrictions or pain medication requirement. The patients in both groups were equally satisfied with their pain therapy (p = 0.282, R = 0.135). The sum score of the painDETECT® questionnaire delivered clearly negative (< 12) results on average (POD1: 6.81; POD3: 6.59); no significant difference between the groups was found (p = 0.991, R2 < .001). CONCLUSION: Neither surgical technique on the parotid gland was significantly superior to the other in terms of postoperative pain perception. Overall, postoperative pain can be classified as mild to moderate following parotid surgery. A neuropathic pain component could be excluded for the acute postoperative phase. TRIAL REGISTRATION: The study was registered in the German Registry for Clinical Studies (DRKS) (application No.: DRKS00016520).

Unusual Presentation of a Parotid Gland Malignancy: A Case Report.

The most commonly occurring malignant salivary gland tumor is mucoepidermoid carcinoma (MEC). It consists of intermediate cells, squamous cells, and mucous-secreting cells. It is usually not capsulated and is identified by mucocarmine staining. Mucoepidermoid carcinoma exists in the thyroid gland and lungs as well. This report presents a case of a very rare sclerosing variant of MEC of the parotid gland in a 48-year-old patient. The patient presented with a small swelling below the left earlobe. Ultrasound-guided fine-needle aspiration cytology (FNAC) was carried out. A diagnosis of pleomorphic adenoma was given. The patient underwent a partial parotidectomy under general anesthesia. The final diagnosis was made through histopathological examination after the surgical removal of the tumor. The patient is now under close follow-up to look out for a recurrence. This case highlights the importance of recognizing and managing rare variants of MEC to optimize patient outcomes.

Anatomical study and clinical outcomes of endoscopic transoral surgery for benign salivary gland tumors in the parapharyngeal space.

The existing literature provides little insight into the efficacy of transoral endoscopy in exposing benign tumors originating from salivary glands in the parapharyngeal space at the parotid gland base and resecting part of the deep lobe with a safe margin. This study aims to investigate the efficacy of the endoscopic transoral approach for the visualization and resection of such tumors. Through transoral endoscopic cadaveric dissections and surgical procedures, we examined the anatomical structures of the parapharyngeal space and the deep lobe of the parotid gland, identifying key anatomical landmarks. We conducted a retrospective analysis of 19 patients with benign salivary gland-derived tumors in the parapharyngeal space who underwent transoral endoscopic resection. Intraoperative visualization of the tumor pedicle and the deep lobe of the parotid gland was successfully achieved in all cases, allowing for resection with safe margins. During a median follow-up period of 54.0 months, imaging revealed no signs of recurrence. Endoscopic transoral approach provides effective visualization of the deep lobe of the parotid gland and the medial portion of the parotid bed from the parapharyngeal space. Benign tumors of salivary gland-derived in this area can be well exposed and safely resected with adequate margins.

Parotid Gland Suspension Combined with Rhytidectomy to Recontour the Lower Face and Neck Enlargement Caused by Benign Parotid Hypertrophy.

BACKGROUND: Lower face and neck aging and facial shape changes are usually caused by soft tissue descent. During lower face and neck enlargement, parotid hypertrophy is an important influence factor of morphologic changes in the periauricular regions. Most plastic surgery techniques greatly improve the shape of the lower face and neck, but ignore the manipulation of the parotid gland. We aimed to resolve the lower face and neck enlargement caused by parotid hypertrophy. Thus, we performed parotid gland suspension combined with rhytidectomy to improve the lower face and neck contour. METHODS: This retrospective study recruited 22 patients who underwent parotid gland suspension combined with rhytidectomy from 2012 to 2020. The evaluation of patient outcomes was performed by selecting items from the FACE-Q scale. Surgical procedures involved parotid gland exposure and parotid fascia suspension. RESULTS: Patient-perceived age appraisal indicated a younger appearance with follow-ups for approximately 3-10 year after the surgery (mean ± standard deviation - 5.53 ± 3.67). Patients had a high satisfaction level for facial appearance (67.15 ± 16.84), lower face (74.69 ± 21.22), and contour of the parotid gland areas of the neck (65.76 ± 23.62). The lower face and neck contours were narrowed and tightened. The parotid gland area showed a remarkable improvement after surgery. CONCLUSIONS: Parotid gland suspension combined with rhytidectomy obtained an outstanding improvement. This method can achieve a better lower face and neck contour, especially in patients with benign parotid hypertrophy or lower face and neck enlargement in periauricular regions. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Feasibility and safety of preauricular incision for extracapsular dissection in benign parotid tumors.

PURPOSE: Parotidectomy techniques continuously evolve to improve outcomes while minimizing morbidity. This study investigates the rationale behind developing and evaluating the feasibility and safety of extracapsular dissection (ECD) via preauricular incision for benign parotid tumors in the anterior or superior part of the parotid gland. METHODS: The preauricular approach is developed to address the increasing demand for minimally invasive techniques that prioritize both functional and aesthetic outcomes. Minimizing visible scarring and preserving facial nerve function offers a compelling solution for patients seeking optimal cosmetic results without compromising surgical efficacy. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. RESULTS: Eight patients underwent ECD via the preauricular approach, demonstrating favorable outcomes with preserved facial nerve function and minimal complications. CONCLUSION: This study highlights the potential of the preauricular approach as a preferred option for managing benign parotid tumors in the anterior or superior parotid region, emphasizing aesthetic outcomes and preserving gland function. LEVEL OF EVIDENCE: IV.

A presentation of basal cell adenoma: a case report.

BACKGROUND: While statistically rare in comparison to other head and neck tumours, parotid gland swellings are often encountered in clinical practice where one of the primary goals of examination becomes distinction between benign and malignant lesions. Hallmarks of malignancy are characterized by a female preponderance, history of radiation exposure, a positive family history, and clinical features like heterogenous consistency, fixity to skin/underlying tissues and involvement of facial nerve. CASE PRESENTATION: Here we present a case of parotid swelling in a 72-year old gentleman from south India that had a curious amalgamation of both benign and malignant features. CONCLUSIONS: While benign, the risk of malignant transformation and rare multicentric occurrence indicates a need to keep basal cell adenoma in mind in case of parotid swellings and their surgical management.

Using Machine Learning on MRI Radiomics to Diagnose Parotid Tumours Before Comparing Performance with Radiologists: A Pilot Study.

The parotid glands are the largest of the major salivary glands. They can harbour both benign and malignant tumours. Preoperative work-up relies on MR images and fine needle aspiration biopsy, but these diagnostic tools have low sensitivity and specificity, often leading to surgery for diagnostic purposes. The aim of this paper is (1) to develop a machine learning algorithm based on MR images characteristics to automatically classify parotid gland tumours and (2) compare its results with the diagnoses of junior and senior radiologists in order to evaluate its utility in routine practice. While automatic algorithms applied to parotid tumours classification have been developed in the past, we believe that our study is one of the first to leverage four different MRI sequences and propose a comparison with clinicians. In this study, we leverage data coming from a cohort of 134 patients treated for benign or malignant parotid tumours. Using radiomics extracted from the MR images of the gland, we train a random forest and a logistic regression to predict the corresponding histopathological subtypes. On the test set, the best results are given by the random forest: we obtain a 0.720 accuracy, a 0.860 specificity, and a 0.720 sensitivity over all histopathological subtypes, with an average AUC of 0.838. When considering the discrimination between benign and malignant tumours, the algorithm results in a 0.760 accuracy and a 0.769 AUC, both on test set. Moreover, the clinical experiment shows that our model helps to improve diagnostic abilities of junior radiologists as their sensitivity and accuracy raised by 6 % when using our proposed method. This algorithm may be useful for training of physicians. Radiomics with a machine learning algorithm may help improve discrimination between benign and malignant parotid tumours, decreasing the need for diagnostic surgery. Further studies are warranted to validate our algorithm for routine use.

New 3-D Technologies in Salivary Gland Surgery: The Exoscope-Assisted Surgery for Treatment of Benign Tumors of Parotid Gland.

New technologies are increasingly widespread in medical practice. Particularly, the 3D view is considered among the most useful innovations for surgery. It allows the operator to reconstruct the patient's anatomy in his own mind, going beyond his personal imagination. In the last few years, a new facility has been experienced, it's the Exoscopy. Exoscopy is a magnified vision system, similar to Microscopy, but which also allows a tridimensional vision of the surgical anatomy. Despite Exoscopy having been used for years in Neurosurgery, it has been just rarely described in parotid surgery. We intend to report our experience with Exoscope Aesculap AEOS used to remove benign tumors of the parotid gland. We treated 14 patients with benign tumors of the parotid gland, since September 2023 to November 2023. Each surgery was conducted by the same expert surgeon which also reported his experience about intra-operative complications (as bleeding) in comparison to the traditional procedure without Exoscope. We evaluated the learning curve of Exoscope-Assisted Parotid Surgery comparing, among them, the operative times of the same procedures performed in chronological order. Each patient underwent the same follow-up which included three checks at one month, three months and six months. The follow-up was especially about the evaluation of palsy of the VII C.N. which was assessed through House-Brackmann score (H-B score). The results of our experience reports that the Exoscope is a useful tool for parotid gland surgery. It allows an excellent visualization of the facial nerve main trunk and its branches. Although the first procedures presented longer times in comparison to traditional surgery, the progressive reduction of the operative times demonstrates that the learning curve of Exoscopy is very fast. Certainly, more experience is required for the full introduction of Exoscopy in surgery practice of parotid gland but, now, its potentialities are highly exciting.

Revealing Enigma in Parotid Gland: Venolymphoma-A Rare Case Report.

Venolymphoma (VL) is a benign condition of oral cavity, but it is misdiagnosed as pleomorphic adenoma. Exact diagnosis can be made only after histopathological examination. In this report the author has presented a case of a 45-year-old male patient with VL of right parotid which was operated. The treatment indicated was complete excision of the lesion, which showed an excellent prognosis with low recurrence rate.

Parotid gland MALT lymphoma with amyloid deposition, challenges in preoperative diagnosis: A case report.

Mucosa-associated lymphoid tissue (MALT) lymphoma commonly arises from chronic inflammation or autoimmune diseases, such as Sjögren syndrome (SjS). Although rare, amyloid deposition in MALT lymphoma has been reported. We present a rare case of parotid gland MALT lymphoma in a 49-year-old woman, in whom preoperative diagnosis was challenging due to atypical imaging findings resulting from amyloid deposits. MRI showed T2-hypointense and T1-iso- to slightly hyperintense masses in the left parotid gland and right sublingual gland, with predominant marginal contrast enhancement and no significant diffusion restriction. Additionally, atrophy and fatty replacement of the parenchyma were noted in bilateral parotid glands, suggesting SjS. Left superficial parotidectomy was performed and pathological findings confirmed MALT lymphoma with extensive amyloid deposition. Histopathological findings of the resected parotid gland parenchyma also suggested SjS. MALT lymphoma should be considered in the differential diagnosis of multiple salivary gland masses in patients with suspected SjS. If MRI reveals atypical imaging findings for malignant lymphoma, particularly T2-hypointensity with no significant diffusion restriction, the possibility of amyloid deposition in MALT lymphoma should be considered.

Follicular dendritic cell sarcoma involving the parotid gland with expression of the melanocytic marker PRAME.

Follicular dendritic cell sarcoma is a rare mesenchymal neoplasm arising from follicular dendritic cells (FDC) of lymphoid follicles. While the majority of FDC sarcoma cases arise within lymph nodes, approximately 30% manifest in extranodal sites. Only 4 prior occurrences of intra-parotid FDC sarcomas have been documented. We are reporting a rare case of FDC of the parotid gland in a 65-year-old male with a questionable history of B-cell lymphoma. The patient underwent a right total parotidectomy and bilateral neck dissection. A diagnosis of follicular dendritic cell (FDC) sarcoma was made, with one positive intra-parotid node. The malignant cells expressed the characteristic markers for FDC sarcoma but with positivity of the melanocytic marker PRAME. This is a case of FDC sarcoma with an unusual extranodal localization in the parotid gland. Immunohistochemistry was useful in making a diagnosis although the positivity for the melanocytic marker PRAME was unusual and unreported before.

Outcomes of a modified technique of partial parotidectomy and novel parotid tumour position classification from a single surgeon prospective database.

BACKGROUND: Conservative parotidectomy for benign tumours reduces facial nerve palsy, without increasing local recurrence. We report a modified technique of partial parotidectomy and using a novel description of tumour position, explore relationships between tumour position and histological margins, facial nerve palsy and local recurrence. METHODS: A prospectively collected single surgeon parotidectomy database was analysed, including tumour location (superficial/deep lobe; central/peripheral) and outcomes. A partial parotidectomy identified the facial nerve and the proximal portion of its branches with a macroscopically clear resection margin. Mean follow up was 5.9 years for pleomorphic adenomas. RESULTS: Three hundred and three patients underwent parotidectomy; 257 (84.8%) were superficial and 46 (15.2%) deep lobe. Tumour position was recorded in 291: 236 (81.1%) were peripheral tumours and 55 (18.9%) central. Histological margin involvement was similar in central and peripheral tumours, both overall and for superficial and deep lobe tumours, but was commoner in central deep lobe tumours, (P = 0.003). Temporary partial facial nerve palsy occurred in 21 (6.9%), with one permanent partial nerve palsy (0.3%). Deep lobe tumours and total parotidectomy were associated with facial nerve palsy (P = 0.01). Facial nerve monitoring reduced the risk of palsy (P < 0.01). Local recurrence of pleomorphic adenomas was uncommon, occurring in 3 (2.0%) of 151 patients. CONCLUSION: This series confirms the safety and adequacy of more conservative partial parotidectomy for benign tumours, highlighting most tumours are peripheral, but not more prone to histological margin involvement or local recurrence, and with routine intraoperative facial nerve monitoring, is achieved with low facial nerve palsy rates.

Percutaneous injection of minocycline in postoperative sialocele following condylar fracture.

Sialocele is a common complication of parotid tumour surgery. Aspiration and pressure dressing are the most common conservative treatments for sialoceles. However, they occasionally exhibit a refractory nature. In this case report, a minocycline injection was administered for refractory sialocele following a condylar fracture treated using the retromandibular anterior transparotid approach. Aspiration of the sialocele and the same amount of minocycline injection using three-way stopcocks were performed four weeks after surgery. After the injection, the buccal swelling completely disappeared without complications, including facial palsy. Percutaneous injection of minocycline might be the first choice for postoperative refractory sialocele following condylar fracture.

Ultrasonographic study and anatomical guidelines for botulinum neurotoxin injection into the parotid gland.

Benign enlargement of the parotid gland hypertrophy results in a bulky lateral facial contour and esthetic appearance. This study aimed to determine the depth from the skin surface to the parotid fascia, which encompasses the parotid gland. The anatomical properties of the parotid glands were evaluated in 40 patients using ultrasonography. An up-to-date understanding of the localization of botulinum neurotoxin (BoNT) injection based on anatomy could lead to better localization of the injection into the parotid gland through morphological measurements using data previously published from cadaveric studies. Measurement using the otobasion inferius as a landmark revealed parotideomasseteric fascia thickness averaging 4-6 mm from the skin surface, with the parotid gland extending approximately 15 mm anteriorly. Analysis showed a 3-7 mm thickness range, indicating an optimal injection depth for safety and efficacy in BoNT procedures. Utilizing the otobasion inferius as an anatomical landmark offers a practical approach for measuring parotideomasseteric fascia thickness, addressing cadaveric study limitations. These guidelines aim to maximize the effects of BoNT therapy, which can be useful in clinical settings, by minimizing its deleterious effects.

The comparative morphology of the oral cavity glands in captive South African painted dogs (Lycaon pictus pictus) and captive fennec foxes (Vulpes zerda) (Carnivora: Canidae).

BACKGROUND: The African painted dog is classified as a relic canid lineage, inhabiting areas south of the Sahara. The fennec fox is the smallest member of the Canidae family, found in the Arabian Peninsula and northern Sahara. METHODS: The gross anatomy and light microscopic examination of the oral cavity glands were studied in five adult captive South African painted dogs and five adult captive fennec foxes from the Wroclaw Zoological Garden, Poland. In this research, the zygomatic gland, monostomatic sublingual gland, polystomatic sublingual gland, mandibular gland, and parotid gland were examined for their topography, morphometry, histology, and histochemistry using hematoxylin and eosin, azan trichrome, mucicarmine, PAS, AB pH 1.0, AB pH 2.5, AB pH 2.5 PAS, and HID. RESULTS: We found that the parotid glands were consistently the largest, followed by the mandibular and sublingual glands (both monostomatic and polystomatic). The zygomatic gland was the smallest in both South African painted dogs and fennec foxes. Interestingly, there were noticeable differences in the size, shape, and even composition of the secretory products between the two species. The zygomatic and polystomatic sublingual glands in the South African painted dog and the fennec fox were complex branched tubular. In the South African painted dog, the monostomatic gland was a branched tubular compound gland, while in the fennec fox, it was a branched tubuloalveolar compound gland. The mandibular gland in hunting dogs was a branched tubular compound gland, while in the fennec fox a branched tubuloalveolar compound gland. The parotid gland in the fennec fox was a branched acinar compound gland, whereas in the painted dog was a branched tubuloacinar. CONCLUSIONS: The basic structure of their glands is similar to that of other terrestrial carnivores, indicating a shared evolutionary origin and function. However, differences in the composition of their secretory products can reflect adaptations to their specific diets. This research provides valuable insights for veterinary medicine and underscores the importance of further studies. By analyzing wild canid populations and including a broader range of species with diverse diets, we could gain a deeper understanding of how diet influences salivary gland morphology within the Canidae.

Ultrasound-Guided Sialendoscopy Surgery for Parotid Sialolithiasis Using Yttrium Aluminum Garnet (YAG)-Holmium Laser: A Prospective Case Series.

BACKGROUND: Parotid sialolithiasis is a common condition in middle-aged individuals, with most cases occurring in the submandibular and sublingual glands, followed by the parotid glands and minor salivary glands. The treatment of salivary gland stones, particularly those of the parotid glands, remains challenging. Endoscopic surgery using a yttrium aluminum garnet (YAG)-holmium laser for parotid sialolithiasis is a minimally invasive approach that provides effective treatment for patients. This study aimed to evaluate the outcomes of the endoscopic laser treatment of parotid sialolithiasis a YAG-holmium laser. MATERIALS AND METHODS: A prospective case series study was conducted on 21 patients diagnosed with salivary gland stones in the parotid gland based on clinical features and imaging findings (including ultrasound and computed tomography scans), from March 2022 to March 2024. These patients underwent sialendoscopy surgery using a YAG-holmium laser and were evaluated for surgical results at 2, 4, and 12 weeks. RESULTS: Cases with completely reduced symptoms accounted for 90.5%, whereas cases with partially reduced symptoms accounted for 9.5%. The ultrasound image of the salivary gland after surgery was significantly improved compared to that before surgery. After three months of surgery, most patients (90.5%) were satisfied. The postoperative complication rate was 14.3%, which included scarring at the opening of the salivary gland and in the salivary duct. CONCLUSION: Sialendoscopic surgery using a YAG-holmium laser for parotid sialolithiasis is a minimally invasive surgical intervention that leaves no scarring, reduces the risk of complications as seen in open surgery, and shortens the postoperative care time for patients.

Spontaneous cutaneous-parotid fistula of the cheek caused by sialolithiasis in a child: a case report.

INTRODUCTION: Cheek fistulas of salivary origin in children are very rare, predominantly of congenital or traumatic origin but rarely caused by parotid sialolithiasis given its low prevalence in paediatric populations. CASE PRESENTATION: A 3-year-old child with no history other than substantial left-cheek swelling for 2 months was referred. We identified a cutaneous fistula with seropurulent discharge. At this time, we only observed mild inflammation of the left parotid duct papilla with no visible calculi. A first ultrasound scan only detected acute inflammation of the parotid duct that was treated with antibiotics. The discharge subsided but the fistula persisted. Two more episodes of infection occurred at 6-month intervals that were both treated by antibiotics. After this second treatment, a second ultrasound scan showed dilatation of the left parotid duct upstream of the cheek fistula with the presence of a calcification. We performed sialoendoscopy under general anaesthesia 10 days later. Before introduction of the sialoendoscope, we noticed a whitish calculus within the papilla that was removed by intraoral incision and digital pressure alone. Sialoendoscopy went on to detect a dilated parotid duct that was highly inflamed and bled upon contact at the site of the cheek fistula. No other sialoliths were detected. The fistula had healed four months later without any recurrence of parotitis or discharge. CONCLUSION: Sialolithiasis should be considered for spontaneous cheek fistulas in children. Sialoendoscopic-assisted diagnosis and treatment can result in complete resolution of cutaneous-parotid fistulas without the need for more aggressive surgery.

Metastatic malignancies in the parotid gland: A retrospective study.

The aim of this study was to compare treatment modalities, pathological and clinical characteristics, and outcomes in patients with metastasis in a parotid gland. The medical records of 34 patients who received treatment for metastasis in the parotid gland over a twenty-year period were evaluated. Patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) metastasis were retrospectively reclassified using the P/N and N1S3 staging system. Patients with neck metastasis showed a significantly poorer prognosis (P = 0.025). Univariate analysis also revealed that extent of parotidectomy and type of neck dissection did not influence recurrence free survival (RFS) and overall survival (OS). When comparing the usefulness of the P/N and S1N3 staging systems, a positive correlation was observed between the P stage and the N1S3 stage in both RFS and OS. The extent of parotidectomy and concomitant neck dissection is still under discussion. Total parotidectomy and modified radical neck dissection did not improve RFS and OS. N1S3 is a less complex classification and possesses a higher predictive value when compared to the P/N staging system.

Diagnostic performance of MRI-based radiomics models using machine learning approaches for the triple classification of parotid tumors.

Rationale and objectives: Preoperative differentiation of malignant tumors (MT), pleomorphic adenomas (PA), and other benign tumors of the parotid gland is critical to clinical strategy, this study aimed to develop and validate a T2-weighted image (T2WI) based radiomics model through machine learning approaches for the triple classification of parotid gland tumors. Materials and methods: We retrospectively enrolled 147 patients from January 2010 to July 2022. T2WIs were used to extract radiomics features. Max-Relevance and Min-Redundancy (mRMR) and Extreme Gradient Boosting (XGBoost) algorithms were used to select features. Using a 5-fold cross-validation strategy, radiomics models were constructed using a Support Vector Machine (SVM), Logistic Regression (LR), and k-Nearest Neighbor (KNN) for the triple classification of parotid tumors. The three models were evaluated and compared using the receiver operator characteristic (ROC) curve, sensitivity, specificity, and accuracy. Results: A total of 1057 radiomics features were extracted, and 8 features were selected to developed the radiomics model, including First-order Median, First-order Skewness, First-order Minimum, Original_shape_Flatness, Glcm Inverse Variance, Glcm Inverse Variance, Glszm Low Gray Level Zone Emphasis, and Glszm Small Area Low Gray Level Emphasis. The mean area under the curves (AUCs) for the radiomics models in training and validation sets through LR, SVM and KNN were 0.85 and 0.80, 0.85 and 0.80 and 0.83 and 0.79, respectively. Conclusion: The T2WI-based radiomics models through LR, SVM and KNN demonstrated good performance in the triple classification of parotid tumors.

Comprehensive management and classification of first branchial cleft anomalies: An International Pediatric Otolaryngology Group (IPOG) consensus statement.

OBJECTIVE: First branchial cleft anomalies are rare congenital head and neck lesions. Literature pertaining to classification, work up and surgical treatment of these lesions is limited and, in some instances, contradictory. The goal of this work is to provide refinement of the classification system of these lesions and to provide guidance for clinicians to aid in the comprehensive management of children with first branchial cleft anomalies. MATERIALS AND METHODS: Delphi method survey of expert opinion under the direction of the International Pediatric Otolaryngology Group (IPOG) was conducted to generate recommendations for the definition and management of first branchial cleft anomalies. The recommendations are the result of expert consensus and critical review of the literature. RESULTS: Consensus recommendations include evaluation and diagnostic considerations for children with first branchial cleft anomalies as well as recommendations for surgical management. The current Work classification system was reviewed, and modifications were made to it to provide a more cogent categorization of these lesions. CONCLUSION: The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations based on review of the literature for the management of pediatric otolaryngologic disorders. These consensus recommendations are aimed at improving care of children presenting with first branchial cleft anomalies. Here we present a revised classification system based on parotid gland involvement, with a focus on avoiding stratification based on germ layer, in addition to guidelines for management.