Elective parotidectomy and neck dissection are not beneficial in cutaneous squamous cell carcinoma of the head.

OBJECTIVE: Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. METHODS: We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. RESULTS: We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. CONCLUCION: Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. LEVEL OF EVIDENCE: How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series).

Elective parotidectomy and neck dissection are not beneficial in cutaneous squamous cell carcinoma of the head

Abstract Objective Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. Methods We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. Results We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. Conclucion Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. Level of evidence How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series)

Programa de entrenamiento de parotidectomía en modelo cadavérico perfundido

Introducción: La parotidectomía es una cirugía infrecuente y técnicamente compleja determinada por la dificultad de disección del nervio facial, cuya lesión produce alto grado de morbilidad en los pacientes. Los modelos de simulación animales no logran reproducir las características de la anatomía regional, por lo que se hace necesario explorar otras alternativas para el entrenamiento de estas habilidades. Nuestro objetivo es evaluar un programa de entrenamiento de técnicas de parotidectomía en un modelo cadavé-rico perfundido. Métodos: Se diseñó un programa educacional de Kern de entrenamiento de residentes de Cirugía de Cabeza y Cuello para la realización de parotidectomía total en un modelo cadavérico perfundido. La evaluación se realizó mediante el modelo de Kirkpatrick, en los niveles 1 (reacción), 2A (cambio de actitudes) y 2B (adquisición de conocimientos y habilidades). Resultados: Se elaboró un programa teórico-práctico basado en cátedras y simulación de alta fidelidad. En su mayoría los participantes: recomendarían el curso (Nivel 1); tuvieron mayor motivación para el aprendizaje (Nivel 2) y presentaron mejores indicadores sobre conocimientos, habilidades y percepción de mejoría de sus competencias (Nivel 2B). Conclusión: La utilización de un programa de parotidectomía simulado en un modelo de alta fidelidad basado en modelos cadavéricos humanos perfundidos es una alternativa que mejora la calidad de entrenamiento y es útil y factible para el aprendizaje de técnicas de parotidectomía en residentes de Cirugía de Cabeza y Cuello.

Introduction: The parotidectomy is an infrequent and technically complex surgery due to a difficult dissection that may affect the facial nerve, generating high degree of morbidity in patients. Animal simulation models may not reproduce the human characteristics of cervical anatomy. Therefore, it is necessary to explore other alternatives for training dissection skills. Our objective is to evaluate a parotidectomy's techniques training program in a perfused cadaveric model. Methods: A Kern educational program was designed to train Head and Neck Surgery residents to perform total parotidectomy in a perfused cadaveric model. The evaluation was performed using Kirkpatrick model, at levels 1 (reaction), 2A (change of attitudes) and 2B (acquisition of knowledge and skills). Results: A theoretical-practical program based on lectures and high-fidelity simulation was developed. Most of the participants would recommend the course (Level 1); had greater motivation for learning (Level 2) and showed better indicators of knowledge, skills and perception of improvement in their competencies (Level 2B). Conclusion: The use of a simulated parotidectomy program in a high-fidelity model based on perfused human cadaveric models is an alternative that improves the quality of training and is useful and feasible for learning parotidectomy techniques in residents of Head and Head Surgery.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases

Abstract Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases.

Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy / A punção aspirativa com agulha fina é confiável no diagnóstico de tumoresde parótida? Comparação dos resultados pré e pós-operatórios e fatores que afetam sua precisão

Abstract Introduction: Fine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. Objective: We aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. Methods: Patients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. Results: 217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5 ± 15.88 (7-82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ = 0.52). The sensitivity was 54.54% in tumors less than 2 cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. Conclusion: Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2 cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.

Resumo Introdução: A punção aspirativa com agulha fina é uma ferramenta valiosa na avaliação pré-operatória de tumores de cabeça e pescoço. No entanto, sua precisão no tratamento de tumores de glândulas salivares é discutível. Objetivo: Nosso objetivo foi investigar a eficácia e precisão da punção aspirativa com agulha fina nos tumores da glândula parótida. Método: Pacientes submetidos à parotidectomia entre janeiro de 2008 e junho de 2017 por tumor de glândula parótida foram examinados retrospectivamente. Foram incluídos pacientes com punção aspirativa com agulha fina pré-operatória e histopatologia cirúrgica pós-operatória. A punção aspirativa com agulha fina pré-operatória foi categorizada como benigna, maligna ou com suspeita de malignidade. O histopatológico cirúrgico foi agrupado como benigno ou maligno. Os exames histopatológicos foram comparados com a punção aspirativa com agulha fina e a sensibilidade, especificidade, acurácia e concordância entre os dois testes foram investigadas. Resultados: Foram avaliados 217 casos e excluídos 23 porque o diagnóstico da punção aspirativa com agulha fina não foi conclusivo ou estava indisponível. Portanto, foram incluídos 194 casos. A média de idade dos pacientes foi de 47,5 ± 15,88 (7-82). Havia 157 casos benignos, 37 malignos na punção aspirativa com agulha fina e 165 benignos e 29 malignos na histopatologia. O tumor benigno mais comum foi o adenoma pleomórfico (43,3%) e o tumor maligno mais comum foi o carcinoma mucoepidermoide (4,13%). A acurácia diagnóstica da punção aspirativa com agulha fina na detecção de malignidade foi de 86,52%. A sensibilidade e especificidade foram de 68,96% e 89,63%, respectivamente. O valor preditivo positivo foi de 54,05% e o valor preditivo negativo foi de 94,23%. Houve concordância moderada entre a punção aspirativa com agulha fina e histopatológico (κ = 0,52). A sensibilidade foi 54,54% em tumores menores do que 2 cm e 77,77% em tumores maiores. Nos tumores que se estendiam até o lobo profundo, a sensibilidade foi de 80%. Conclusão: A punção aspirativa com agulha fina é uma importante ferramenta diagnóstica na avaliação dos tumores da glândula parótida. É mais precisa na detecção de tumores benignos. Em tumores maiores do que 2 cm que se estendem até o lobo profundo, a sensibilidade da punção aspirativa com agulha fina é alta. O uso dessa ferramenta em conjunto com a avaliação clínica e radiológica pode ajudar a reduzir os resultados falso-positivos e falso-negativos.

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy.

INTRODUCTION: Fine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. OBJECTIVE: We aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. METHODS: Patients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. RESULTS: 217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5±15.88 (7-82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ=0.52). The sensitivity was 54.54% in tumors less than 2cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. CONCLUSION: Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.

Tumores de glándula parótida: experiencia quirúrgica Hospital Guillermo Grant Benavente / Parotid gland tumors: surgical experience Hospital Guillermo Grant Benavente

RESUMEN Introducción: La glándula parótida es el sitio más común de tumores de glándulas salivales, correspondiendo al 75%-85% de éstos y al 3% de todos los tumores de cabeza y cuello. Ochenta por ciento de ellos corresponden a tumores benignos. Objetivos: Analizar la experiencia quirúrgica en tumores parotídeos operados en el Hospital Guillermo Grant Benavente. Material y método: Revisión de todos los pacientes con tumores parotídeos operados en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, del Hospital Guillermo Grant Benavente entre enero del año 2011 y abril del año 2016. Las cirugías fueron realizadas por el mismo equipo quirúrgico. Se registraron datos demográficos, clínicos, quirúrgicos, histológicos y resultados posoperatorios. Resultados: En el periodo descrito se operó un total de 94 pacientes. 84,3% correspondieron a tumores benignos y 15,7% a tumores malignos. El 62,9% corresponde a pacientes de sexo femenino y 37,1% de sexo masculino, representando una relación de 1,69:1. La incidencia de parálisis facial transitoria fue de 16,1%, y de ellos solo un paciente mantuvo una parálisis permanente. Conclusión: Los tumores malignos representaron el 15,7%, siendo menor a lo reportado en la literatura. Se presenta una gran serie de tumores parotídeos tratados quirúrgicamente a nivel nacional, con una baja tasa de complicaciones.

Abstract Introduction: Parotid gland is the most common site of salivary gland tumors, corresponding to 75-85% of these and 3% of all head and neck tumors. 80% of them correspond to benign tumors. Aim: To analyze the surgical experience in parotid tumors operated in the Guillermo Grant Benavente Hospital. Material and Method: Review of all patients with parotid tumors operated in the Otorhinolaryngology and Head and Neck Surgery Unit of Hospital Guillermo Grant Benavente between January 2011 and April 2016. All surgeries were performed by the same surgical team. Demographic, clinical, surgical, histological and postoperative results were recorded. Results: In the period described, a total of 94 patients were operated on. 84.3% corresponded to benign tumors and 15.7% to malignant tumors. 62.9% corresponds to female patients and 37.1% male, representing a ratio of 1.69:1. The incidence of transient facial paralysis was 16.1%, and of these, only one patient maintained permanent paralysis. Conclusions: Malignant tumors represented 15.7% of cases, being less than reported in the literature. This article presents a large series of parotid tumors treated surgically in our country, with a low associated complication rate.

Parotidectomy under sedation and locoregional anesthesia with monitoring of brain activity.

BACKGROUND: Parotidectomy is usually performed while the patient is under general anesthesia, however, sedation with locoregional anesthesia could be an alternative. METHODS: Fifteen adult patients with parotid tumors of the superficial lobe were included in this study. Anesthetic procedure consisted of sedation associated with cervical plexus and auriculotemporal nerve block. Sedation was managed based on the bispectral index. RESULTS: Superficial parotidectomies were performed in 13 patients, and combined partial resections were performed in 2 patients. The mean operative time was 118.2 ± 16.4 minutes. Conversion to general anesthesia was necessary in only 1 patient. Ten surgeries were performed on an outpatient basis. Definitive facial paralysis occurred in 1 patient. All patients reported total satisfaction with the procedure. CONCLUSION: In selected cases, parotidectomy under sedation plus locoregional anesthesia is feasible and safe. The careful selection of patients and the close collaboration with an anesthesiologist is the key to a successful procedure. © 2016 Wiley Periodicals, Inc. Head Neck 39: 744-747, 2017.

Adenoma pleomorfo parotídeo gigante: a propósito de un caso clínico / Giant parotid pleomorphic adenoma: a case report

El adenoma pleomorfo es el tumor benigno más frecuente de las glándulas salivales, con mayor predilección por la glándula parótida. Se presenta un caso clínico de paciente femenino de 53 años de edad, con aumento de volumen en región parotídea y geniana derecha de15 × 12 centímetros, de ocho años de evolución, la tomografía simple de la región presenta tumoración parotídea bien delimitada, la cual afecta lóbulo superficial y profundo de la glándula parótida derecha, la biopsia incisional confi rmó el diagnóstico histopatológico de adenoma pleomorfo por lo cual se realiza parotidectomía total sin preservación del nervio facial.

Pleomorphic adenoma is the most common benign tumor of the salivaryglands, with greater predilection for the parotid gland. We presentthe case of a 53-year-old female patient with a 15 x 12 cm increasein volume in the parotid and right genial region with eight years ofevolution. A simple CT scan of the region revealed a well-defi ned parotidtumor aff ecting the superfi cial and deep lobe of the right parotidgland. An incisional biopsy confi rmed the histopathological diagnosisof pleomorphic adenoma, for which reason a total parotidectomy wasperformed without preservation of the facial nerve.

Facial paralysis after superficial parotidectomy: analysis of possible predictors of this complication / Paralisia facial após parotidectomia superficial: análise de possíveis preditivos dessa complicação

ABSTRACT INTRODUCTION: Salivary gland tumors represent 3-10% of all head and neck neoplasms. These tumors occur predominantly in major salivary glands. The parotid gland is affected most often, ranging from 36.6% to 83%. The pleomorphic adenoma comprises 45-60% of all salivary gland tumors. Several surgical approaches have been described to treat this tumor. Lesion of the facial nerve is one of the most serious complications that can occur after parotid gland surgery. OBJECTIVES: To determine possible predictive factors related to the occurrence of peripheral facial paralysis (PFP) after superficial parotidectomy in the surgical treatment of the pleomorphic adenomas of the parotid gland. METHODS: This was a primary, observational, case-control study performed through the revision of patients' charts and histopathological reports. Data was obtained from 1995 to 2014. The analyzed events were: tumor's length and depth; duration of the disease referred by the patient (more than 1, 5 or 10 years); primary or secondary surgical approach. RESULTS: The analysis showed that tumor lengths equal or superior to 3.0 cm were a risk factor of PFP with an odds ratio of 3.98 (p = 0.0310). Tumor depths equal or superior to 2.0 cm were also a risk factor with an odds ratio of 9.5556 (p = 0.0049). When the tested event was secondary surgery to recurrent tumors we have found an odds ratio of 6.7778 (p = 0.0029). CONCLUSION: Tumors with 3.0 cm or more in length and/or 2.0 cm or more in depth have a significant higher risk of facial nerve injury. Secondary surgery to recurrent tumors also has a much higher risk of evolving with facial palsy after superficial parotidectomy.

Resumo Introdução: Os tumores de glândulas salivares representam de 3 a 10% de todas as neoplasias de cabeça e pescoço. Esses tumores ocorrem predominantemente nas glândulas salivares maiores. A glândula parótida é afetada na maioria das vezes, variando de 36,6 a 83%. O adenoma pleomórfico abrange 45-60% de todos os tumores de glândulas salivares. Diversas abordagens cirúrgicas foram descritas para o tratamento desse tumor. A lesão do nervo facial é uma das complicações mais graves que podem ocorrer após cirurgia de glândula parótida. Objetivos: Determinar possíveis fatores preditivos relacionados à ocorrência de paralisia facial periférica (PFP) após parotidectomia superficial no tratamento cirúrgico de adenomas pleomórficos de glândula parótida. Método: Estudo preliminar, observacional, de caso-controle, realizado por meio de revisão dos prontuários de pacientes e laudos histopatológicos. Os dados foram obtidos no período de 1995-2014. Os eventos analisados foram o tamanho do tumor no maior diâmetro e a profundidade, o tempo de doença referido pelo paciente (mais de 1, 5 ou 10 anos) e a abordagem cirúrgica primária ou secundária. Resultados: A análise mostrou que o tamanho do tumor igual ou superior a 3,0 cm foi um fator de risco para PFP, com uma razão de chance de 3,98 (p = 0,0310). A profundidade do tumor igual ou superior a 2,0 cm também foi um fator de risco, com uma razão de chance de 9,5556 (p = 0,0049). Quando o evento testado foi cirurgia secundária para tumores recorrentes, encontramos uma razão de chance de 6,7778 (p = 0,0029). Conclusão: Os tumores de 3,0 cm ou mais de comprimento e/ou 2,0 cm ou mais de profundidade apresentam um risco significativamente maior de lesão do nervo facial. A cirurgia secundária para tumores recorrentes também apresenta um risco maior de evoluir com paralisia facial após parotidectomia superficial.

Facial paralysis after superficial parotidectomy: analysis of possible predictors of this complication.

INTRODUCTION: Salivary gland tumors represent 3-10% of all head and neck neoplasms. These tumors occur predominantly in major salivary glands. The parotid gland is affected most often, ranging from 36.6% to 83%. The pleomorphic adenoma comprises 45-60% of all salivary gland tumors. Several surgical approaches have been described to treat this tumor. Lesion of the facial nerve is one of the most serious complications that can occur after parotid gland surgery. OBJECTIVES: To determine possible predictive factors related to the occurrence of peripheral facial paralysis (PFP) after superficial parotidectomy in the surgical treatment of the pleomorphic adenomas of the parotid gland. METHODS: This was a primary, observational, case-control study performed through the revision of patients' charts and histopathological reports. Data was obtained from 1995 to 2014. The analyzed events were: tumor's length and depth; duration of the disease referred by the patient (more than 1, 5 or 10 years); primary or secondary surgical approach. RESULTS: The analysis showed that tumor lengths equal or superior to 3.0cm were a risk factor of PFP with an odds ratio of 3.98 (p=0.0310). Tumor depths equal or superior to 2.0cm were also a risk factor with an odds ratio of 9.5556 (p=0.0049). When the tested event was secondary surgery to recurrent tumors we have found an odds ratio of 6.7778 (p=0.0029). CONCLUSION: Tumors with 3.0cm or more in length and/or 2.0cm or more in depth have a significant higher risk of facial nerve injury. Secondary surgery to recurrent tumors also has a much higher risk of evolving with facial palsy after superficial parotidectomy.

Frey's syndrome: diagnosis in geriatric dentistry.

Frey's syndrome, is characterized by warmth, flushing and sweating of the face, most of time in the preauricular region, initiated by any gustatory stimulus. It is frequently related to parotid surgery. A case of Frey's syndrome in a 81-year-old female whose long-delayed clinical onset post-parotidectomy is presented.

Consideraciones anatómicas en la parotidectomía: revisión de la literatura a propósito de un caso / Anatomical considerations in parotidectomy: review of the literature and case report

La parotidectomía es un procedimiento quirúrgico habitualmente realizado por Cirujanos Maxilofaciales y Cirujanos de Cabeza y Cuello, en el cual se remueve parcialmente o en su totalidad a la glándula parótida. Las indicaciones más comunes para éste procedimiento son las neoplasias de la glándula. Aproximadamente el 80% del total de los tumores de glándulas salivales ocurren en la parótida. De estos, el 75-80% son de naturaleza benigna. Sin embargo, la parotidectomía es un procedimiento sumamente complejo debido a la anatomía regional y por la íntima relación de la glándula parótida con el nervio facial. Siendo la clave de este procedimiento la preservación funcional de éste nervio y de sus ramos. Por lo tanto el conocimiento acabado de la anatomía de la glándula parótida y de sus estructuras anexas es necesario para el éxito quirúrgico. Esta revisión y reporte de caso discutirá las consideraciones anatómicas que deben tenerse durante la parotidectomía para disminuir la posibilidad de alguna complicación.

Parotidectomy is a surgical procedure usually performed by Oral and Maxillofacial Surgeons and Head and Neck Surgeons, in which the parotid gland may be removed partially or totally. The most common indications for this procedure are the neoplasms of the gland. Approximately 80% of total salivary gland tumors occur in the parotid gland. Of these, 75-80% are benign. However, the parotidectomy is a highly complex procedure because of the regional anatomy and the close relationship of the parotid gland with the facial nerve. The most important aspect of this procedure is the functional preservation of the facial nerve and its branches. Therefore, the thorough knowledge of the anatomy of the parotid gland and related structures is necessary for surgical success. This review and case report will discuss the anatomical considerations that must be taken during parotidectomy to reduce the possibility of complications.

Parotidectomy by periauricular incision.

OBJECTIVE: According to the literature, periauricular combined with submandibular or cervical incision is used in nearly every parotidectomy. The aim of this study was to present the results of the use of only periauricular incision in parotid surgical procedures. DESIGN: A case series with planned data collection. SETTING: Patients of the author were operated on at the Hospital Santa Casa de Misericórdia de Belo Horizonte, Brazil. SUBJECTS AND METHODS: Forty-one consecutive partial or total parotidectomies (27 cases of pleomorphic adenoma, 9 of other benign tumors, 3 of parotid cysts, and 2 of chronic parotiditis) were performed using only periauricular incision. RESULTS: The parotid tumors were removed in all cases with no need for any further skin procedures, as the incisions produced a good aesthetic result. All patients presented temporary hypoesthesia in the area that had been operated on for no more than 6 months. Ear discomfort was reported by 18 patients for a short period of time. Local infection occurred in 1 case successfully treated with systemic antibiotics. CONCLUSION: The results of the present study indicate that periauricular incision is a high-quality and highly aesthetic option for surgical procedures concerning benign conditions of the parotid gland.

Abordaje periauricular en las lesiones de la glándula parótida / Parothid glan lesions incision aroud ear

Evaluar la posibilidad de resección de las lesiones de la glándula parótida por incisiones periauriculares (grupo I) y valorar las complicacionesin mediatas derivadas de esta técnica, resultados cosméticos y dolor posoperatorio, comparándolas con el abordaje preauricular-transcervical (grupo II). Los 61 pacientes, de ambos sexos, entre julio de 2006 a julio de 2009, fueron sometidos a este estudio prospectivo, aleatorizado doble ciego, evaluando dos grupos, categorizados grupo I yII, haciendo comparaciones en cuanto a dolor posoperatorio según la escala analógica de niveles de dolor, complicaciones relacionadas al nervio facial, posibilidad de resección indistintamente del tipo histológico, del lóbulo afectado, y por último, la satisfacción cosmética. Los 59 pacientes completaron este estudio, no obteniendo diferencias estadísticamente significativas en cuanto al dolor posoperatorio, ni en cuanto a las complicaciones, pero si en lo referido a la visualización de la cicatriz operatoria; 96% de los pacientes (grupo I), refirió satisfacción con el resultado cosmético en comparación con 65% del grupo II; siendo estadísticamente significante. No hubo diferencias en cuanto a la presentación de dolor ni complicaciones posoperatorias en cuanto al abordaje periauricular en comparación a los que se les realizó el abordaje preauricular-transcervical. Fue mayor la manifestación de satisfacción cosmética en el abordaje periauricular, la cual recomendamos, porque no produce dificultades técnicas, indistintamente del sexo, edad, tipo histológico o ubicación de la lesión dentro de la glándula parótida.

To evaluate the possibility of resection of the lesions of the parotid gland by the incisions around the ear (Group I) and assess immediate complications arising fromthis technique, the cosmetics results and the post operative pain, comparing them with the ahead ear - transcervical approach (Group II). In 61 patients of both sex, from July 2006 to July 2009, were subjected to this prospective study, and randomized double blind, evaluating the two groups, categorized group I and II, making comparisons on post operative by the analog levels of the pain, complications related to the facial nerve, possibility of resection regardless of the histological type, the affected lobe, and finally, the cosmetic satisfaction. The 59 patients that completed this study, no statistically significant differences we found in the post operative pain getting. There were no differences also on complications, but if in connection with the post operative scar, the 96%patients (Group I), spoke to us, their satisfaction with the cosmetic outcome compared with 65% of Group II; that being statistically significant. There was no differences as regards the presentation of the painor the post operating complications in the around ear compared to the ahead ear - transcervical approach. The manifestation of cosmetic satisfaction in around ear were approach, we recommend it because it does not produce technical difficulties, without any distinction of sex, age, histological type, or location into the parotid gland.