Long-term quality of life and sensory impact of great auricular nerve preservation in parotid surgery as measured with the Parotidectomy Outcome Inventory-8.

OBJECTIVES: This study aimed to evaluate sensory dysfunction resulting from great auricular nerve (GAN) sacrifice versus preservation in parotid surgery for benign lesions and its imact on long-term health-related quality of life (QOL). DESIGN: Retrospective. SETTING/MAIN OUTCOME MEASURES: Participants were divided into two groups (GAN and non-GAN), and both short-term (two postoperative weeks) and long-term (at least 5 years) QOL were assessed. The second item of the Parotidectomy Outcome Inventory-8 (POI-8) was used to analyse postoperative sensory loss. All items of the POI-8 questionnaire were used to determine health-related QOL.We used t test for dependent samples and Mann-Whitney U-test to compare patient groups PARTICIPANTS: A total of 137 patients (65 male and 72 female) enrolled in this study. Average age at the time of surgery was 53 years (±12.8). RESULTS: The GAN preservation group had significantly better sensation than the GAN sacrifice in short term (2.8 vs 2.1; P = 0.017). Both groups experienced improved sensation in the long term, and there was a trend towards better QOL in the GAN-preservation group. However, the difference in sensation was not statistically significant (1.7 vs 1.3; P = 0.145). Health-related QOL also increased in the long term (compared to short term) for both groups (7.6 ± 6.2 to 12 ± 7.6; P < 0.0001) postoperatively. GAN preservation did not significantly improve sensation in long term, nor did it increase health-related QOL postoperatively. CONCLUSION: Although GAN preservation was easily feasible, it only improved sensation in short term. We report a negative result: GAN preservation did not significantly improve sensation in long-term, nor did it increase health-related QOL postoperatively when compared to GAN sacrifice.

First bite syndrome - An 11-year experience.

OBJECTIVE: First bite syndrome is the development of pain in the ipsilateral parotid region after the first few bites of food and can be seen after surgery of the upper cervical region. The aim of this study is to highlight the etiology of this potentially debilitating chronic pain syndrome. MATERIALS AND METHODS: Retrospective review of 53 patients undergoing surgery of the upper neck between 2002 and 2013. RESULTS: FBS developed in 16 patients (30%). Partial resolution of FBS symptoms occurred in 69% and complete resolution in 12%, whereas 15% had no change. FBS was most common in the patients who had tumor arising from deep lobe of parotid gland in comparison with other sites (50% vs 18%, p=0.017). FBS developed in 57% of patients undergoing external carotid artery (ECA) ligation and in 12.5% of patients in whom ECA was preserved (p=0.0008). Among the patients in whom ECA was preserved, FBS developed in 43% of the patients in whom sympathetic chain was sacrificed and in 4% of the patients in whom sympathetic chain was preserved. CONCLUSION: Present results further support the role of sympathetic chain in the development of FBS.

Case of Suspected Sialodochitis Fibrinosa (Kussmaul's Disease).

Here we report a case of Kussmaul's disease, or sialodochitis fibrinosa. This rare disease is characterized by recurrent swelling of the salivary glands, which then discharge clots of fibrin into the oral cavity. An 80-year-old man with a history of allergic rhinitis visited our department with the chief complaint of pain in the bilateral parotid gland area on eating. An initial examination revealed mild swelling and tenderness in this region, and indurations could be felt around the bilateral parotid papillae. Pressure on the parotid glands induced discharge of gelatinous plugs from the parotid papillae. No pus was discharged, and there were no palpable hard objects. Panoramic X-ray showed no obvious focus of dental infection, and there was no calcification in the parotid gland region. Magnetic resonance imaging revealed segmental dilatation of the main ducts of both parotid ducts, with no signs of displacement due to sialoliths or tumors, or of abnormal saliva leakage. Two courses of antibiotic therapy resulted in no improvement. During treatment, gelatinous plugs (fibrin clots) obstructing the left parotid duct were dislodged by massage, which prevented further blockage by encouraging salivary outflow. The obstruction persisted in the right parotid duct, however. Therefore, the distal portion of the right parotid duct was partially resected and the opening into the mouth enlarged, which, in combination with massage, prevented further obstruction. The pain and swelling of the parotid gland and discharge of gelatinous plugs improved, with no further recurrence at 12 months postoperatively. This case is presented along with a review of the relevant literature.

Computational fluid dynamics for investigation of saliva pressure in parotid obstruction.

UNLABELLED: OBJECTIVES/HYOTHESIS: Parotid obstruction is one of the most common problems affecting the parotid gland. We aimed to investigate the blockage ratio (BR) and the intraductal pressure change of Stensen's duct using computational fluid dynamics. STUDY DESIGN: Retrospective review of 16 patients who had undergone interventional sialendoscopy for parotid obstruction from 2009 to 2011. METHODS: The three-dimensional configurations of Stensen's duct were reconstructed from computed tomography (CT) sialographic images. Finite volume modeling in fluid dynamics of parotid obstruction was used to analyze the pressure distribution under conditions of rest and stimulation. RESULTS: Intraductal pressure increased with increasing distance from the orifice. The upstream pressure was higher than that of downstream pressure in the same BR (P < .05). The upstream pressure increased as the BR increased. Statistically, the pressure turning point was indicated when BR = 60%. Only when the BR was much greater than 90% did the pressure reach 811.64 Pa, at which point patients could feel the painful swelling under the rest condition. Under the stimulated condition, the upstream pressure increased from 1.3- to 2.9-fold of that of the no blocking state when the BR increased from 80% to 90%, which may aggravate the obstructive symptoms. There was no significant difference observed for downstream pressure under the same condition (P > .05). CONCLUSIONS: CT sialography was effectively used for analysis of the intraductal pressure distribution in patients with parotid obstruction. Analysis of salivary fluid dynamics in Stensen's duct may provide a further pathophysiological mechanism for obstructive diseases.

Assessment of patients with primary Sjögren's syndrome--outcome over 10 years using the Sjögren's Syndrome Damage Index.

OBJECTIVE: To evaluate the long-term outcome in a cohort of patients with primary SS (PSS) using the recently proposed Sjogren's Syndrome Damage Index. METHODS: We reviewed the clinical records of 60 patients attending our Sjögren's clinic at University College London Hospital, who strictly fulfilled the American-European Consensus Group criteria and on whom we had a minimum of 10 years of follow-up (or until death) during this decade. However, we could not retrospectively identify damage in the oral domain as this had not been recorded reliably. RESULTS: Fifty-five per cent of patients in this study had no damage after 10 years of disease--a lower figure than our comparative group of patients with SLE (32.4%). Damage accrual was mostly in the ocular domain, parotid swelling and malignancy categories. There was a 6-fold increase in the 'malignancy damage' compared with the 2-fold increase in the total damage score in PSS. CONCLUSIONS: Unlike patients with SLE, it is clear that fewer patients with SS develop permanent damage, even after 10 years of follow-up. These data are thus encouraging but clearly larger numbers of patients need to be assessed.

Neumoparotiditis o neumoparótida en el niño: Un diagnóstico diferencial a considerar / Pneumoparotitis or pneumoparotid: A differential diagnosis to consider

Childhood parotid swelling has a number of differential diagnosis mostly of inflammatory origin. Pneumoparotitis is an uncommon cause of parotid inflammation. It is caused by an excessive increase of intraoral pressure and secondary passage of air into the Stensen or Stenon duct and its glandular branches. Diagnostic clues can usually be obtained by a directed anamnesis. Ultrasonography (US) and computed tomography are essential diagnostic tools for this condition that has a benign course with spontaneous resolution in most cases. We present four cases of pneumoparotitis diagnosed by US in children 5 to 13 years of age. One of the cases occurred after the child chewed gum and made bubbles for a prolonged timeperiod and the other three after inflating baloons, making bubbles inside a pool and after playing the flute. All cases resolved spontaneously after two days. We suggest to consider pneumoparotitis in the differential diagnosis of parotid swellig in children.

Electromyographic facial nerve monitoring during parotidectomy for benign lesions does not improve the outcome of postoperative facial nerve function: a prospective two-center trial.

OBJECTIVES/HYPOTHESIS: To analyze the benefit of electromyographic (EMG) neuromonitoring during primary surgery on benign parotid lesions for postoperative facial function compared to visual observation only. STUDY DESIGN: Prospective controlled clinical two-center trial. METHODS: Using an operation microscope, 100 parotidectomies in 96 patients were performed: 50 procedures with a continuous EMG monitoring plus visual facial observation (EMG group), and 50 procedures with only visual facial control (control group). The rate of postoperative facial weakness was detected. Patients with postoperative facial paralysis were followed up until total recovery or defective healing by repeated EMG examinations. RESULTS: Seventy-nine superficial and 21 total parotidectomies were performed. Histological analysis found pleomorphic adenoma in 38 patients, cystadenolymphoma in 39, and chronic parotitis in 18. Immediate postoperative facial paralysis was evident in 41 patients. Six patients had permanent paralysis; in this group definitive defective healing was detected by EMG in five cases. EMG was not classifiable in one case. Intraoperative EMG monitoring had no significant effect on immediate postoperative or definitive facial outcome (P =.23 and P = .45, respectively). The duration of superficial, but not of a total parotidectomy, was diminished in the EMG group (P = .02 and P = .61, respectively). This result was independent of the specimen's histology. CONCLUSIONS: EMG monitoring in parotid surgery in addition to visual facial observation did not diminish either the incidence of postoperative facial paralysis or the final facial outcome. Nevertheless, the duration of surgery for superficial parotidectomy could be reduced by using EMG monitoring.

[Pneumoparotitis or pneumoparotid: a differential diagnosis to consider]. / Neumoparotiditis o neumoparótida en el niño: un diagnóstico diferencial a considerar.

Childhood parotid swelling has a number of differential diagnosis mostly of inflammatory origin. Pneumoparotitis is an uncommon cause of parotid inflammation. It is caused by an excessive increase of intraoral pressure and secondary passage of air into the Stensen or Stenon duct and its glandular branches. Diagnostic clues can usually be obtained by a directed anamnesis. Ultrasonography (US) and computed tomography are essential diagnostic tools for this condition that has a benign course with spontaneous resolution in most cases. We present four cases of pneumoparotitis diagnosed by US in children 5 to 13 years of age. One of the cases occurred after the child chewed gum and made bubbles for a prolonged time-period and the other three after inflating baloons, making bubbles inside a pool and after playing the flute. All cases resolved spontaneously after two days. We suggest to consider pneumoparotitis in the differential diagnosis of parotid swelling in children.

Case report: parotid abscess due to Salmonella enterica serovar Enteritidis in an immunocompetent adult.

There are reports of increasing incidence of focal extra-intestinal infections from non-typhoidal salmonellae during the past two decades. We present the first case of a parotid abscess caused by Salmonella enterica serovar Enteritidis (S. Enteritidis) in an apparently immunocompetent adult without other abnormality of the parotid glands. A 58-year-old man was admitted to our hospital because of a 3-day history of fever and painful swelling of the right parotid gland. His medical history was unremarkable. A CT scan revealed an abscess of the right parotid. S. Enteritidis was isolated from a sample of fluid aspirated from the parotid abscess under ultrasound guidance. The stool, urine, and blood cultures were negative. The patient was treated with ciprofloxacin 500 mg per os every 12 h for 10 days, with complete remission of symptoms. The infection did not recur during 3 years of follow up. Our case report adds to the literature regarding the extra-intestinal infections with S. Enteritidis, a common non-typhoidal salmonellosis.

Dynamic magnetic resonance sialography as a new diagnostic technique for patients with Sjögren's syndrome.

OBJECTIVE: To evaluate the clinical utility of dynamic magnetic resonance (MR) sialographic images as a diagnostic tool for patients with Sjögren's syndrome. METHODS: The morphological findings and various kinds of functional parameters in volunteers on dynamic MR sialographic images were compared with those in five patients with definite Sjögren's syndrome. RESULTS: On the MR sialographs of all five patients with Sjögren's syndrome, the so-called 'apple-tree appearance' was seen. The difference in two functional parameters using the dynamic MR sialographic data was elucidated between the two groups. The maximum area of the detectable ducts in the group of patients was significantly smaller (P < 0.001) than that in the group of volunteers. The ratio of change in the detectable ducts in the group of patients was significantly lower (P = 0.011) than that in the group of volunteers. CONCLUSIONS: Our study suggests that dynamic MR sialographic data in addition to MR sialographic images might be useful for the diagnosis of Sjögren's syndrome.

Pilocarpine for the treatment of salivary glands' impairment caused by radioiodine therapy for thyroid cancer.

OBJECTIVES: To study the effect of single-dose pilocarpine hydrochloride 5 mg on the whole unstimulated and stimulated salivary flow in patients suffering from thyroid cancer treated with radioiodine therapy, and to investigate the changes in vital signs during the treatment. SUBJECTS AND METHODS: Five such patients were referred with complaints of dry mouth, rampant caries, and pain in the parotid gland region or history of chronic recurrent suppurative sialodenitis. A single dose of 5 mg pilocarpine hydrochloride was administered to each patient and blood pressure, heart rate, body temperature and salivary secretion rate were monitored at 1, 2 and 3 h. RESULTS: A significant elevation of unstimulated and stimulated saliva flow rate was observed in four patients without significant alteration of the monitored vital signs. CONCLUSIONS: Treatment with pilocarpine hydrochloride may be beneficial in the case of impaired salivary function in patients treated with radioiodine.

The impact of malignant disease on facial nerve function after parotidectomy.

OBJECTIVES/HYPOTHESIS: Studies of immediate postoperative facial nerve function following parotidectomy focus on benign disease. The purpose of the study was to compare facial nerve function with regard to benign or malignant disease in patients undergoing superficial parotidectomy. STUDY DESIGN: Retrospective cohort study of consecutive patients undergoing parotidectomy between 1995 to 2002. METHODS: House-Brackmann (HB) grade was recorded or assigned at the first postoperative visit. For patients with HB grade of III or greater, final resolution of facial nerve function was recorded. A chi2 analysis for independence was conducted between patients with HB grade of II or less and those with HB grade of III or greater and final pathological finding (benign vs. malignant disease). Mean and median times to resolution were determined for patients with HB grade of III or greater. Times to resolution for benign and malignant disease for those with HB grade of III or greater were compared (Kaplan-Meier method). RESULTS: Sixty-seven patients with benign disease and 52 with malignant disease were included. Ninety-four percent of patients with benign disease had HB grade of II or less at first postoperative visit (mean period, 11.6 d) compared with 76.9% of patients with malignant disease (mean period, 12.4 d). A chi2 analysis found this difference significant (chi2 = 7.36, P =.0067). Time to resolution for HB grade of III or greater was 253.8 days (+/-168.2 d) with median time of 229.5 days for benign disease and 182.4 days (+/-134.6 d) with median time of 138 days for malignant disease. Kaplan-Meier comparison found no significant differences in time to final resolution (P =.83). Three patients in the group with malignant disease had unresolved dysfunction (one patient for >2 y). CONCLUSIONS: Patients with benign disease have a greater chance of having HB grade of II or less immediately following surgery; however, whether the disease is benign or malignant, long-term final facial nerve function is the same.

Tuberculose de parótida / Tuberculosis of parotid

A tuberculose primária em glândulas salivares é uma patologia incomum, com poucos relatos descritos na literatura mundial. Um diagnóstico pós-operatório de tuberculose, acometendo a glândula parótida, nos levou a uma revisão da literatura e ao relato do caso, na intenção de alertar e ilustrar este diagnóstico diferencial raro na avaliação de nódulos da região parotídea

Tumores benignos das glândulas parótidas: análise retrospectiva de uma série de 222 casos / Benign tumors of the parotid glands: retrospective analysis of a series of 222 cases

A experiência do Hospital do Câncer com tumores benignos da glândula parótida tratados cirurgicamente num período de 25 anos, totalizando 222 pacientes, foi submetida a estudo retrospectivo, avaliando-se dados demográficos, clínicos e histológicos, além dos resultados do tratamento empregado. Houve predominância do sexo feminino, com 126 casos (56,7%), sendo o maior número observado entre os 31 e 50 anos de idade, na faixa etária de 1 a 80 anos. O adenoma pleomórfico predominou, com 165 casos (74,3%), seguido pelo tumor de Warthin, com 38 casos (17,1%). A principal modalidade cirúrgica utilizada foi a parotidectomia parcial com conservação do nervo facial, realizada em 182 casos. A taxa de recidiva local foi de 4,8%, sendo todos esses casos de adenoma pleomórfico. A disfunção do nervo facial no pós-operatório, a síndrome de Frey, a presença de seroma, de necrose e infecção foram observadas em 25,2%, 7,2%, 2,2% e 1,3%, respectivamente. A radioterapia foi empregada como tratamento complementar em 12 casos. Doze pacientes apresentaram segundas neoplasias durante o período de seguimento, que variou de 16 dias a 234 meses. Na instituição, consideramos atualmente que a cirurgia mínima para o tratamento dos tumores benignos da parótida é a parotidectomia parcial com conservação do nervo facial; e, sempre que o nervo é sacrificado, procedimentos de reanimação facial são realizados. O uso da radioterapia deve ser reservado ao pós-operatório de cirurgias de resgate, em casos de recidiva local.

A 25-year experience of the Hospital do Cancer with benign parotid tumours surgically treated in a consecutive series of 222 patients has been reviewed, evaluating demographic, clinic and histopathological data as well as results of treatment. The female gender predominated with 126 cases (56,7%). Age ranged from 1 to 80 years old with the highest incidence from 31 to 50 years old (42 patients). Pleomorphic adenoma was the predominant histopathological type observed in 165 (74,3N) cases, followed by Warthin's tumor with 38 (17,1%) cases. Partial parotidectomy with facial nerve preservation was the main and minimal procedure performed. Local recurrences ocurred in 4,8% of the pleomorfic adenomas. Postoperative facial disfunction, Frey's syndrome, seroma, necrosis and infection were observed irk 25,2%, 7,2%, 2,2% and 1,3%, respectively. Radiotherapy was used as postoperative adjuvant treatment in 12 cases. Twelve patients presented other neoplasms during the follow-up period which ranged from 16 days to 234 months. We consider that partial parotidectomy with facial nerve preservation is the minimal surgical procedure to treat benign parotid tumors and facial reanimation must be tried whenever the facial nerve is sacrificed. Radiotherapy must be reserved to- postoperative period after salvage surgery for local recurrences.