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1.
Acta otorrinolaringol. esp ; 71(2): 93-98, mar.-abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192446

RESUMO

INTRODUCCIÓN: Las técnicas quirúrgicas para extirpación de tumores de la glándula parótida han evolucionado significativamente en los últimos años. Los datos publicados previamente sugieren que el uso del bisturí armónico disminuye el tiempo operatorio, la pérdida de sangre intraoperatoria, la producción del drenaje postoperatorio y la incidencia de lesión del nervio facial, en comparación con la disección con bisturí frío. MATERIAL Y MÉTODOS: Se realizó un análisis retrospectivo en 2grupos de pacientes operados con bisturí armónico y disección en frío más coagulación bipolar. El objetivo principal fue comparar el tiempo quirúrgico y la tasa de complicaciones posquirúrgicas: lesión del nervio facial, aparición de sialocele o formación de fístula salival después de la parotidectomía por tumores benigno de la glándula parótida. RESULTADOS: Se incluyó a 108 pacientes. Con respecto al tiempo quirúrgico, el tiempo medio para usar el bisturí armónico fue de 114 ± 39 minutos (mín.: 60/máx.: 240) y el tiempo medio de uso de la diatermia bipolar fue de 135 ± 38 minutos (mín.: 90/máx.: 285) y este fue el único parámetro en el que evidenciamos una diferencia significativa entre ambas técnicas (p = 0,049). CONCLUSIONES: El bisturí armónico es una herramienta segura y eficaz para realizar la cirugía de la parótida en tumores benignos. Sin embargo, la disminución del tiempo quirúrgico fue la única ventaja que encontramos en comparación con el método tradicional de disección en frío y coagulación bipolar


INTRODUCTION: Surgical techniques for extirpation of tumours of the parotid gland have evolved significantly in recent years. Previous data suggest the use of Harmonic Scalpel reduced operative time, intraoperative blood loss, postoperative drain production, and incidence of facial nerve injury, in comparison to cold scalpel dissection MATERIAL AND METHODS: retrospective analysis of 2group of patients operated using harmonic scalpel versus cold knife dissection and bipolar diathermy and compare operative time and post-surgical complication rate:, facial nerve injury, sialocele or salivary fístula formation, after parotidectomy for benign parotid tumours. RESULTS: 108 patients were included. Regarding surgical time, the mean time to using Harmonic Scalpel was 114 ± 39 (Min: 60/Max: 240), and the mean time using bipolar diathermy was 135 ± 38 (Min: 90/Max: 285) and this was the only significant difference between the 2 techniques (p = .049). CONCLUSIONS: Harmonic scalpel is a safe and effective tool to perform parotid surgery in benign tumours. However, a shorter surgical time was the only advantage found over the traditional cold dissection and bipolar dissection method


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Duração da Cirurgia , Perda Sanguínea Cirúrgica , Estudos Retrospectivos , Diatermia/instrumentação
2.
J Plast Reconstr Aesthet Surg ; 73(5): 921-926, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32165143

RESUMO

OBJECTIVE: The aim of this study is to evaluate the feasibility and aesthetic results when comparing two cosmetic approaches that were employed in parotidectomy according to the tumour location with the traditional Blair approach. DESIGN: Retrospective study. SETTING: Tertiary Referral Centre. PATIENTS: Seventy-six patients were included in the study. RESULTS: The degree of satisfaction with the cosmetic incision approach was significantly higher than that with the traditional Blair approach. The incidence of transient facial paralysis and salivary fistula were not statistically significant when compared with those in the traditional incision in 6-month follow-up post-operatively. DISCUSSION: Conventional parotidectomy using the traditional Blair incision (or its modification) usually leaves a visible scar in this region, which can have major adverse impacts on the social or psychological well-being of an individual. To achieve better aesthetic results, according to the location of the benign parotid tumour, two formal cosmetic approach incisions could be performed in parotidectomy, which was superior to the traditional Blair incision. The authors propose that these two cosmetic approaches for parotidectomy can be both technically feasible and safe.


Assuntos
Cicatriz/prevenção & controle , Estética , Neoplasias Parotídeas/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/cirurgia , Satisfação do Paciente , Estudos Retrospectivos
3.
Ann R Coll Surg Engl ; 102(5): 340-342, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32159383

RESUMO

INTRODUCTION: Fine-needle aspiration cytology (FNAC) is an important diagnostic tool used preoperatively for the diagnosis of parotid lump. Mucoepidermoid carcinoma comprises 5-10% of all salivary gland tumours. It poses a diagnostic challenge on FNAC with high false negative rate. The objective of this study was to evaluate the discordance between cytology/FNAC and histopathology in patients with mucoepidermoid carcinoma. MATERIAL AND METHODS: A cross-sectional study was conducted from 1 January 2010 to 31 December 2014. Patients aged 18 years and above with FNAC or histopathology suggestive of mucoepidermoid carcinoma were identified. FNAC when compared with histology (gold standard) was classified into true positive (presence of mucoepidermoid carcinoma correctly diagnosed on FNAC), true negative (absence of mucoepidermoid carcinoma correctly diagnosed on FNAC), false positive (FNAC incorrectly diagnosed mucoepidermoid carcinoma), false negative (FNAC failed to diagnose mucoepidermoid carcinoma). RESULTS: A total of 16 patients fulfilled our eligibility criteria. Seven cytological samples were true positive (ie correctly diagnosed mucoepidermoid carcinoma by FNAC), eight cytological specimens were false negative (ie could not pick up mucoepidermoid carcinoma on FNAC). One case was false positive on cytology (ie diagnosed mucoepidermoid carcinoma on FNAC but was reported to be Warthin's tumour on histopathology) and none were true negative. CONCLUSION: FNAC is not reliable for diagnosis of mucoepidermoid carcinoma. More than 50% of our patients had discordant results between cytology and histology. We recommend a high index of suspicion for mucoepidermoid carcinoma given the poor yield of cytology.


Assuntos
Biópsia por Agulha Fina/normas , Carcinoma Mucoepidermoide/diagnóstico , Glândula Parótida/patologia , Neoplasias Parotídeas/diagnóstico , Adolescente , Adulto , Idoso , Biópsia por Agulha Fina/estatística & dados numéricos , Carcinoma Mucoepidermoide/patologia , Carcinoma Mucoepidermoide/cirurgia , Estudos Transversais , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/cirurgia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Reprodutibilidade dos Testes , Adulto Jovem
4.
Niger J Clin Pract ; 23(2): 266-269, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32031104

RESUMO

Epithelial myoepithelial carcinoma (EMC), a very rarely seen, low-grade, malignant, salivary gland tumor is most commonly located in the parotid gland followed by the submandibular gland. It is more often observed in females and in the 6th decade of life. Although primary treatment of the tumor is surgical resection, adjuvant radiotherapy may be applied to the adjacent area or close follow-up can be done if the surgical margin is closed. Patients must be followed up closely for recurrence and metastasis. Physical and radiological examinations (USG and MRI) should be performed to see for any recurrence in the operated area during the first year for every 2-3 months. This study presents the clinical, radiological, and pathological characteristics of a 59-year-old female patient with low-grade, oncocytic variant of EMC located in the left parotid gland.


Assuntos
Carcinoma/patologia , Mioepitelioma/patologia , Glândula Parótida/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Neoplasias das Glândulas Salivares/patologia , Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Mioepitelioma/diagnóstico por imagem , Mioepitelioma/cirurgia , Paratireoidectomia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/cirurgia , Neoplasias das Glândulas Salivares/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(7): e18763, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049782

RESUMO

RATIONALE: Warthin's tumor is the second most common tumor arising from the parotid gland, but it rarely occurs concomitantly with tuberculous granulomatous inflammation with only 13 documented case reports in the English literature. PATIENT CONCERNS: An 82-year-old woman had a left infraauricular mass for approximately 3 years that had significantly increased in size over the previous 1 month. DIAGNOSES: A diagnosis of Warthin's tumor was made by ultrasonography (US)-guided core needle biopsy. Pathological examinations of the specimen obtained by total extirpation confirmed that the tumor was superimposed with tuberculous granuloma. INTERVENTIONS: The core biopsy wound did not heal and there was formation of a skin fistula tract with persistent discharge. During the operation with en bloc resection of the necrotic parotid tumor, adhesion between the branches of the facial nerve was too tight to allow preservation. OUTCOMES: A diagnosis of necrotic Warthin's tumor superimposed with tuberculous granuloma was made. Due to the high-clinical suspicion of tuberculosis (TB) due to Mycobacterium tuberculosis infection, anti-TB chemotherapy was given. LESSONS: Poor wound healing from a core biopsy and formation of a skin fistulous tract with persistent discharge should raise concern regarding potential extrapulmonary tuberculous infection. Although very rare, tuberculous granuloma concomitant with Warthin's tumor should be considered in the differential diagnosis of a parotid mass lesion. Adhesion of branches of the facial nerve should be expected, and sacrifice of the nerve may be planned. This consideration can be explained to the patient in preoperative counseling and planning. Anti-TB chemotherapy should be given in cases with a definite pathological report associated with speculative clinical presentation.


Assuntos
Adenolinfoma/etiologia , Biópsia com Agulha de Grande Calibre/efeitos adversos , Granuloma/diagnóstico , Neoplasias Parotídeas/cirurgia , Tuberculoma/diagnóstico , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Nervo Facial , Feminino , Granuloma/tratamento farmacológico , Granuloma/patologia , Humanos , Neoplasias Parotídeas/etiologia , Neoplasias Parotídeas/patologia , Aderências Teciduais , Resultado do Tratamento , Tuberculoma/tratamento farmacológico , Tuberculoma/patologia , Ultrassonografia
7.
World J Surg Oncol ; 18(1): 8, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918725

RESUMO

BACKGROUND: Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. METHODS: We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015-2019) in the 1st ENT University Department, University of Athens, Greece. RESULTS: We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey's syndrome. CONCLUSIONS: The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.


Assuntos
Neoplasias Parotídeas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ritidoplastia/métodos , Sistema Musculoaponeurótico Superficial/cirurgia , Retalhos Cirúrgicos/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Ritidoplastia/efeitos adversos
8.
Eur. j. anat ; 24(1): 37-48, ene. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-186063

RESUMO

Paralysis of the facial nerve is a common complication during the surgical removal of parotid gland tumors (parotidectomies). This may be due to the close relationship of the tumor and the facial nerve (along its extracranial course). This study aimed to explore the extracranial course of the facial nerve in terms of branching patterns, bony anatomical landmarks and variations. The sample comprised of 40 facial nerve specimens. The parameters identified and recorded were facial nerve trunk division, branching patterns and variations in terms of connections, course and branching. The parameters were classified and compared according to sex and laterality. Bifurcation of the facial nerve trunk occurred in 90% of cases, whilst trifurcation occurred in only 10%. The cases of trifurcation displayed variations. The frequency of each type of branching pattern was: Type I = 7.5%, Type II = 12.5%, Type III = 25%, Type IV = 15%, Type V = 27.5% and Type VI =12.5%. The six types were further categorized into three subtypes based on the origin of the buccal branch. The distance fromthe facial nerve trunk to bony anatomical landmarks was measured viz. mastoid process, angle of the mandible and external auditory canal. Only the distance to the angle of the mandible displayed significant differences according to sex (p-value < 0.001) and laterality (p- value = 0.002). All three landmarks displayed good-excellent reliability (ICC values ranged from 0.82 to 0.95) with regard to bony anatomical landmarks for the localization of the facial nerve trunk. The present study proposes the use of the three subtypes in conjunction with the classification system. Anatomical knowledge of the extracranial course of the facial nerve and its relation to bony anatomical landmarks are of im-portance to surgeons during procedures such as parotidectomies


No disponible


Assuntos
Humanos , Masculino , Feminino , Nervo Facial/anatomia & histologia , Glândula Parótida/anatomia & histologia , Glândula Parótida/cirurgia , Pontos de Referência Anatômicos/inervação , Cadáver , Processo Mastoide/anatomia & histologia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Dissecação/métodos , Mandíbula/anatomia & histologia
9.
Oncology ; 98(2): 102-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31645043

RESUMO

OBJECTIVE: Conservative parotidectomy is known to reduce morbidity, but has been rarely examined in patients with clinically node-negative (cN0) parotid cancers. We evaluated the clinicopathological variables influencing the outcomes of these patients and the efficacy of conservative parotidectomy. METHODS: We reviewed the clinical and pathological data of 256 patients with cN0 parotid carcinomas who underwent curative surgery at our institution. Of these, 110 and 146 underwent conservative and total parotidectomy, respectively, with 83 undergoing elective neck dissection and 135 receiving postoperative radiotherapy. Univariate and multivariate analyses of variables predicting recurrence-free survival (RFS) and overall survival (OS) were performed. Morbidity, survival, and recurrence rates were compared between the conservative and total parotidectomy groups. RESULTS: The 5-year RFS and OS rates in all patients were 85.7 and 91.4%, respectively. Multivariate analysis showed that advanced T classification, positive resection margin, and high-histologic grade were independent prognostic factors for both RFS and OS. Among the 201 patients with low- or intermediate-grade parotid cancers, those who underwent total parotidectomy had a greater chance of facial nerve paralysis than those who underwent conservative parotidectomy (p < 0.001). The 5-year RFS and OS after conservative parotidectomy (93.7 and 100%, respectively) were not worse than those after total parotidectomy (85.5 and 90.9%, respectively). CONCLUSION: Patients with cN0 parotid cancers may be stratified by histological grade and T classification. Conservative parotidectomy may be suitable for early T1-2 low- or intermediate-grade tumors if a resection margin is secured.


Assuntos
Linfonodos/patologia , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/mortalidade , Adolescente , Adulto , Criança , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Parotídeas/epidemiologia , Neoplasias Parotídeas/cirurgia , Prognóstico , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Braz J Otorhinolaryngol ; 86(1): 105-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31122885

RESUMO

INTRODUCTION: Recently it has been reported that a high preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio may be related to increased recurrence risk, tumor aggressiveness, and worsened prognosis in various malignancies. OBJECTIVE: The objective of this research is to explore whether neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in parotid tumors may or may not be used as a cancer marker. METHODS: This retrospective research has been conducted on a total of 228 patients consisting of 83 healthy persons and 145 patients with a mass in the parotid gland, who applied to a tertiary referral center and underwent surgery. Patients have been divided into two groups by their histopathological findings as malignant or benign parotid tumor. A third group consisting of healthy people has been defined as the control group. Also the malignant parotid tumor group has been divided into two subgroups as early stage and advanced stage. The groups have been compared in terms of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and other laboratory data. RESULTS: The average neutrophil-lymphocyte ratio values of malignant parotid tumor, benign parotid tumor, healthy control groups were 2.51, 2.01, 1.79 respectively and the difference was statistically significant (p<0.001). There was no significant difference between advanced stage and early stage parotid tumor groups in terms of average neutrophil-lymphocyte ratio value (p=0.782). In dual comparisons, the platelet-lymphocyte ratio value of patients in the malignant group was found out to be statistically significantly higher than that of benign and control groups (p<0.001 and p=0.001 respectively). CONCLUSION: To the best of our knowledge our research is the first in the medical literature comparing neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with parotid tumor. neutrophil-lymphocyte ratio and platelet-lymphocyte ratio can serve as cost-effective, repeatable, easily accessible, and helpful inflammatory markers in order to distinguish patients with malignant parotid tumor from healthy people.


Assuntos
Adenoma Pleomorfo/patologia , Carcinoma de Células Escamosas/patologia , Linfócitos/citologia , Neutrófilos/citologia , Neoplasias Parotídeas/patologia , Adenoma Pleomorfo/sangue , Adenoma Pleomorfo/cirurgia , Adulto , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/cirurgia , Biomarcadores Ambientais , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Parotídeas/sangue , Neoplasias Parotídeas/cirurgia , Contagem de Plaquetas , Cuidados Pré-Operatórios , Prognóstico , Estudos Retrospectivos
11.
Ann Otol Rhinol Laryngol ; 129(1): 78-81, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31510759

RESUMO

BACKGROUND: The ansa cervicalis is useful for cranial nerve repair, and may be harvested without apparent morbidity. Herein we report an unusual and surgically relevant anatomic variant of the ansa cervicalis. METHODS: An adult male with left parotid adenoid cystic carcinoma underwent parotidectomy with upper-division facial nerve resection and planned interposition repair using the ansa cervicalis. The ipsilateral hypoglossal nerve was identified, together with a descending branch producing strap muscle contraction when stimulated. This presumed descendens hypoglossi was unusually large in caliber; further dissection revealed continuity with the vagus nerve. RESULTS: Ansa cervicalis harvest was aborted when its separation from vagus nerve epineurium was not possible. The sural nerve was alternatively harvested. The patient awoke with left vocal fold palsy, which completely resolved within 3 months. CONCLUSION: Anatomic variants of the ansa cervicalis exist that may preclude graft harvest and place the vagus nerve at risk of inadvertent injury.


Assuntos
Variação Anatômica , Carcinoma Adenoide Cístico/cirurgia , Plexo Cervical/anormalidades , Nervo Facial/cirurgia , Neoplasias Parotídeas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Transferência de Nervo/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Nervo Sural/transplante
12.
BMJ Case Rep ; 12(12)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31796459

RESUMO

Chondrosarcomas of head and neck region are rare. Very few cases of chondrosarcomas arising in parotid gland have been reported and none with intracranial extension. We report a case of a female presenting with a parotid swelling and a mass in external auditory canal with extradural extension to posterior cranial fossa. With a preoperative fine needle aspiration diagnosis of pleomorphic adenoma, it was excised and the histopathology came out to be low-grade myxoid chondrosarcoma. She has not received any adjuvant chemoradiotherapy and there is no evidence of recurrence at months.


Assuntos
Condrossarcoma/patologia , Neoplasias Parotídeas/patologia , Neoplasias da Base do Crânio/patologia , Biópsia por Agulha Fina , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/cirurgia , Meato Acústico Externo/patologia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Imagem por Ressonância Magnética , Mastoidectomia , Invasividade Neoplásica , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Biomed Res Int ; 2019: 9869406, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886274

RESUMO

Myeloid sarcoma (MS) is a rarely encountered extramedullary localized tumor that is composed of immature myeloid cells. We reported an extremely rare case of MS with concurrent bone marrow (BM) involvement that invaded into a preexisting sebaceous lymphadenoma in the parotid gland and neck lymph nodes. Prompted by this case, we also present a literature review of MS invasion into salivary glands. A 62-year-old man was initially diagnosed with carcinoma that arose in a sebaceous lymphadenoma in the parotid gland, through a total parotidectomy with neck dissection. After an extensive histopathological review that included immunohistochemistry, a pathologic diagnosis of MS with infiltration into the sebaceous lymphadenoma with concurrent BM involvement was confirmed. MS is difficult to diagnose accurately; herein, we analyzed the clinical presentations and effectiveness of the various diagnostic methods with a review of the literature. There are 17 cases, including our case, reported in 13 studies. Of the cases in which the salivary glands were affected, 10 involved the parotid gland, six involved the submandibular gland, and one involved both. Isolated invasion of the salivary gland was found in one case of parotid gland invasion and three cases of submandibular gland invasion. In 13 cases, the salivary glands were affected by various other lesions. Although there were no incidences of isolated MS, six patients were diagnosed with secondary MS and eight patients with MS with BM involvement, including this case. The diagnosis of MS is difficult given its rarity, and a high index of suspicion and integrated radiologic and careful histopathologic evaluation are required. Most cases of MS infiltrating the salivary gland might be indicated by the possibility of BM involvement. MS with BM involvement predicts poor prognosis and the need for intensive systemic treatment.


Assuntos
Adenolinfoma , Neoplasias Parotídeas , Sarcoma Mieloide , Neoplasias das Glândulas Sebáceas , Adenolinfoma/diagnóstico , Adenolinfoma/patologia , Adenolinfoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/patologia , Glândula Parótida/cirurgia , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/secundário , Neoplasias Parotídeas/cirurgia , Sarcoma Mieloide/diagnóstico , Sarcoma Mieloide/patologia , Sarcoma Mieloide/cirurgia , Neoplasias das Glândulas Sebáceas/diagnóstico , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias das Glândulas Sebáceas/cirurgia , Glândulas Sebáceas/diagnóstico por imagem , Glândulas Sebáceas/patologia , Glândulas Sebáceas/cirurgia , Adulto Jovem
14.
BMC Surg ; 19(1): 199, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878919

RESUMO

BACKGROUND: The reported incidence of facial weakness immediately after parotid tumor surgery ranges from 14 to 65%. The purpose of this study was to evaluate the incidence of postoperative facial weakness related to parotidectomy with use of preoperative computed tomography (CT), intraoperative facial nerve monitoring, and surgical magnification. Also, we sought to elucidate additional information about risk factors for postoperative facial weakness in parotid tumor surgery, particularly focusing on the tumor subsites. METHODS: We retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009-2016). Patients with pretreatment facial palsy were excluded from the analyses. Tumor subsites were stratified based on their anatomical relations to the facial nerve as superficial, deep, or both. Multivariable logistic regression analyses were conducted to identify risk factors for postoperative facial weakness. RESULTS: The overall incidences of temporary and permanent (more than 6 months) facial weakness were 9.2 and 5.2% in our series utilizing preoperative CT, intraoperative facial nerve monitoring, and surgical magnification. Multivariable analysis revealed that old age, malignancy, and recurrent tumors (revision surgery) were common independent risk factors for both temporary and permanent postoperative facial weakness. In addition, tumor subsite (tumors involving superficial and deep lobe) was associated with postoperative facial weakness, but not tumor size. Extent of surgery was strongly correlated with tumor pathology (malignant tumors) and tumor subsite (tumors involving deep lobe). CONCLUSION: Aside from risk factors for facial weakness in parotid tumor surgery such as old age, malignant, or recurrent tumors, the location of tumors was found to be related to postoperative facial weakness. This study result may provide background data in a future prospective study and up-to-date information for patient counseling.


Assuntos
Paralisia Facial/epidemiologia , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 54(12): 847-850, 2019 Dec 09.
Artigo em Chinês | MEDLINE | ID: mdl-31874486

RESUMO

Objective: To summarize the preliminary experience of endoscope -assisted resection of superficial parotid gland benign tumors, and to discuss the indications, advantages and disadvantages of the operation. Methods: The clinical data of 18 patients who underwent extracapsular resection of superficial parotid gland benign tumor in Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University from March 2018 to March 2019 were retrospectively analyzed, and the surgical methods were introduced. The indications, long axis length of tumor, incision design, operation time, intraoperative blood loss, postoperative drainage and drainage time, aesthetic satisfaction, postoperative complications and follow-up time were counted. Results: All procedures were completed as expected. The length of the long axis of the tumor was (2.3±0.6) cm, the incision in the tragus around the earlobe was short and concealed, the incision length was (5.1±1.3) cm, the operation duration was (2.0±0.4) h, intraoperative blood loss was (168.9±18.8) ml, postoperative drainage was (29.5±11.7) ml, drainage time was (3.6±0.5) d, 2 cases of temporary facial paralysis or earlobe numbness, three months after the operation, the results of the visual analogue scale of the incision design and the aesthetic effect were (9.6±0.1). Conclusions: Endoscope-assisted resection of superficial parotid gland benign tumor by inner tragus around earlobe approach is applicable and reliable, can reduce complications, shorten surgical incision to obtain satisfactory aesthetic effect, which is worth further expansion and improvement.


Assuntos
Endoscopia , Neoplasias Parotídeas/cirurgia , Estética Dentária , Humanos , Glândula Parótida/patologia , Glândula Parótida/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos
16.
Cir. plást. ibero-latinoam ; 45(4): 387-394, oct.-dic. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186025

RESUMO

Introducción y objetivo: El melanoma y las tumoraciones cutáneas no melanomas (TCNM) situadas en cabeza y cuello pueden extenderse a la glándula parótida (GP), bien por continuidad o por diseminación a través del sistema linfático. Cuando esto ocurre, el tratamiento a seguir es preferentemente quirúrgico, siempre y cuando la evolución tumoral, el estado general del paciente y la no diseminación del tumor a otras zonas del organismo lo permitan. Nuestro objetivo es analizar el tratamiento seguido, el número de recidivas y la mortalidad en nuestra serie de las citadas tumoraciones, con invasión de la GP. Material y método: Presentamos una serie de 26 pacientes (24 varones y 2 mujeres) con afectación tumoral parotídea consecuencia de metástasis de melanoma o de TCNM. A todos se les realizó tratamiento quirúrgico, parotidectomía del lóbulo superficial en 5 casos y parotidectomía total en 21. La disección cervical radical modificada tipo III se efectuó en 19 pacientes. Posteriormente siguieron tratamiento radio y/o quimio o inmunoterápico. Resultados: Desarrollamos el estudio desde 2012 a 2018, con un seguimiento de los pacientes de 0 a 114 meses, encontrando un grado de recidiva del 15.38% y una mortalidad del 34.6%. La complicación más frecuente como consecuencia de la cirugía ablativa realizada fue la parálisis facial en los 3 casos en que no se preservó el nervio facial y la neuropraxia del nervio facial, principalmente de sus ramas bucal y marginal, que cedió con el tiempo. Conclusiones: El tratamiento de las tumoraciones metastásicas de la GP consecuencia de este tipo de tumoraciones cutáneas, es preferentemente quirúrgico con exéresis de la glándula y respetando el nervio facial siempre que la invasión tumoral no lo afecte. La radioterapia postoperatoria será también útil como complemento del tratamiento. Los resultados con el tratamiento combinado son actualmente poco esperanzadores, pero se espera una mejoría de las expectativas principalmente por los tratamientos inmunoterápicos en el caso de los melanomas y radioterápicos en las invasiones por carcinomas espinocelulares. Seguramente todo ello permitirá que el tratamiento quirúrgico sea menos radical y con secuelas escasas


Background and objective: When developed on head and neck, both melanoma and non-melanoma skin cancer (NMSC) can be spread to the parotid gland (PG) because of its permanence or due to the lymphatic spreading. In this case, the most appropriate option is the surgical procedure, provided that the progression of the tumor, the general condition of the patient and the non-dissemination of the tumor allow it. Our aim is to analyze the treatment followed and the number of recurrences, as well as mortality of our series in which the tumors cited invades the GP. Methods: The study includes a selection of 26 patients (22 male and 2 female) with a parotid gland tumor diagnosis as a consequence of a melanoma/ NMSC metastasis. All of them had undergone surgical procedure, 5 with a superficial lobe parotidectomy, and the remaining 19 with a total parotidectomy. Modified radical neck dissection Type III was applied to 19 patients. After that, they continued receiving radiotherapy and/or chemo o inmunotherapy. Results: This study was conducted between 2012 and 2018, with a patient’s follow-up from 0 to 114 months. Patients had a recurrence rate of 15.38% a mortality of 34.6%. The most frequent complications as a result of the surgical ablation were the facial paralysis in all 3 cases where the facial nerve was not preserved, and the neurapraxia in the facial nerve, specifically the marginal mandibular branches and the buccal branches, which decreased over time. Conclusions: The preferred treatment of metastasis of PG tumors as a consequence of this kind of skin cancer is the surgical procedure with gland exeresis and keeping the facial nerve, as long as the tumor invasion does not affect it. Postoperative radiotherapy will also be an essentially useful resource as a treatment complement. For the moment, the results of the combinated therapy are not encouraging. However, thanks to the immunotherapies applied in melanoma cases and to the radiotherapy applied in squamous cell carcinoma invasions, best prospects are expected. Probably, this will result in less radical surgical procedures with few sequelae


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso de 80 Anos ou mais , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/cirurgia , Metástase Neoplásica/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Parotídeas/patologia , Melanoma/patologia , Melanoma/cirurgia , Imunoterapia , Neoplasias Parotídeas/tratamento farmacológico , Neoplasias Parotídeas/radioterapia
17.
Rev. esp. patol ; 52(4): 260-264, oct.-dic. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-191948

RESUMO

Epithelioid hemangioendothelioma (EHE) is a malignant vascular tumor that usually affects the liver, lung, bone and deep soft tissues of the extremities or trunk. To our knowledge, only 3 cases in the parotid gland have been reported to date. We report a case of a 62-year-old woman who presented with a 1-year history of a slow-growing, painless mass over the left mandibular angle. Imaging studies showed a 2cm mass over the left parotid gland with peripheral calcifications. The patient underwent a superficial parotidectomy. Sections displayed neoplastic epithelioid cells with cytoplasmic vacuoles containing erythrocytes, surrounded by a myxohyaline stroma. Immunohistochemistry was positive for CD31, CD34, ERG, and factor VIII, but negative for cytokeratin AE1/AE3, CK7, EMA, SMA, and S100. The findings were those of an EHE involving the parotid gland. This case demonstrates an EHE in a rare location and emphasizes the need to consider this tumor when diagnosing uncommon soft tissue tumors of salivary glands


El hemangioendotelioma epitelioide (HEE) es un tumor vascular maligno, que generalmente afecta el hígado, los pulmones, los huesos y los tejidos blandos profundos de las extremidades o el tronco. Por lo que sabemos, solo 3 casos reportados en la literatura han descrito este tumor en la glándula parótida. Presentamos el caso de una mujer de 62 años que presentó una historia de un año, de una masa indolora, de crecimiento lento sobre el ángulo mandibular izquierdo. Los estudios de imagen mostraron una masa de 2cm sobre la glándula parótida izquierda con calcificaciones periféricas. La paciente se sometió a una parotidectomía superficial. Los cortes mostraron células epitelioides neoplásicas con vacuolas citoplasmáticas que contenían eritrocitos, rodeadas por un estroma mixohialino. Se demostró mediante técnicas de inmunohistoquímica positividad en la celularidad neoplásica para CD31, CD34, ERG y factor VIII, pero negatividad para la citoqueratina AE1/AE3, CK7, EMA, SMA y S100. Estos hallazgos fueron los de un HEE comprometiendo la glándula parótida. Este caso demuestra un HEE en una localización rara y enfatiza la necesidad de considerar este tumor al diagnosticar tumores raros de tejidos blandos de glándulas salivales


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Neoplasias das Glândulas Salivares/patologia , Hemangioendotelioma Epitelioide/patologia , Neoplasias Parotídeas/cirurgia , Neoplasias das Glândulas Salivares/cirurgia , Hemangioendotelioma Epitelioide/cirurgia , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Resultado do Tratamento
19.
J Otolaryngol Head Neck Surg ; 48(1): 64, 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31744535

RESUMO

BACKGROUND: Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy. METHODS: A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events. RESULTS: There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation. CONCLUSIONS: There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.


Assuntos
Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/complicações , Neoplasias Parotídeas/patologia , Readmissão do Paciente , Reoperação , Estudos Retrospectivos , Estados Unidos
20.
Plast Reconstr Surg ; 144(5): 853e-863e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688764

RESUMO

BACKGROUND: Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors' experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy. METHODS: A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes. RESULTS: A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05). CONCLUSION: The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Retalhos de Tecido Biológico/transplante , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Músculo Quadríceps/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Estudos Retrospectivos , Medição de Risco , Coxa da Perna/cirurgia , Quimeras de Transplante , Resultado do Tratamento , Cicatrização/fisiologia
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