Factors associated with facial weakness following surgery for benign parotid disease: a retrospective multicenter study.

BACKGROUND: Facial nerve weakness is the most common and most concerning complication after parotidectomy. Risk factors for this complication following surgery for benign diseases remain controversial. OBJECTIVE: Review the frequency and prognosis of facial nerve weakness after parotidectomy and analyze potential risk factors. DESIGN: Retrospective review of medical records. SETTINGS: Two tertiary care centers. PATIENTS AND METHODS: We included all parotidectomies performed for benign diseases from January 2006 to December 2018. Details about the development and recovery of postoperative facial weakness were recorded. Patient, disease and surgery-related variables were analyzed using bivariate and multivariate analyses to identify risk factors. MAIN OUTCOME MEASURES: Frequency, recovery rates and risk factors for facial nerve weakness SAMPLE SIZE: 191 parotidectomies, 183 patients, 61 patients with facial weakness. RESULTS: The frequency of postoperative facial weakness was 31.9% (61/191 parotidectomies). Among patients with temporary weakness, 90% regained normal facial movement within 6 months. Steroid therapy was not associated with a faster recovery. Postoperative weakness was not associated with age, diabetes, smoking, disease location, use of an intraoperative facial nerve monitor or direction of facial nerve dissection. Risk factors for temporary weakness were total parotidectomy and surgical specimens larger than 60 cubic centimeters. Revision surgery was the only identified risk factor for permanent weakness. CONCLUSION: Larger parotid resections increase the risk of temporary facial nerve weakness while permanent weakness is mainly influenced by previous surgeries. LIMITATIONS: Retrospective nature, underpowered sample size, selection bias associated with tertiary care cases. CONFLICT OF INTEREST: None.

The incidence and management of siaolocele after parotidectomy.

OBJECTIVES: (1) To determine if a postparotidectomy sialocele occurs at a higher incidence with a partial superficial parotidectomy compared with a near-complete parotidectomy and (2) to determine if needle aspiration versus observation yield more persistent sialoceles beyond 1 month. STUDY DESIGN: A single-surgeon, single-institution case series with a chart review. METHODS: Comparing 100 consecutive partial superficial parotidectomy procedures and 20 consecutive near-total parotidectomy procedures for formation of a postoperative sialocele. Patients were evaluated at 1 week and 1 month postoperatively. The first 18 sialoceles were treated with one or more needle aspirations. The last 21 sialoceles were treated with observation. RESULTS: There were 39 sialoceles in the partial superficial parotidectomy group (39/100, 39%) and none in the near-total parotidectomy group (0/20, 0%) (P < 0.05). All sialoceles resolved by the end of the first postoperative month whether aspirated or not aspirated. CONCLUSIONS: Sialoceles are common postpartial superficial parotidectomy, and they did not occur after near-total parotidectomy. Sialoceles can generally be treated by observation with an expectation of resolution within 1 month.

[An evaluation of parotid gland masses]. / Parotis kitlelerinin degerlendirilmesi.

OBJECTIVES: We retrospectively evaluated patients who underwent surgery for parotid gland masses. PATIENTS AND METHODS: A total of 50 patients (25 females, 25 males; mean age 48.5 years; range 18 to 76 years) who underwent surgery for parotid gland masses were evaluated with regard to age, sex, preoperative diagnostic methods, histopathologic diagnoses, and surgical techniques. RESULTS: Preoperative diagnostic studies included ultrasonography, fine-needle aspiration biopsy, computed tomography, and magnetic resonance imaging. Histopathological diagnoses were benign in 33 patients (66%), malignant in nine patients (18%), and tumor-like pathologies in eight patients (16%), the most common being pleomorphic adenoma (n=28, 56%), Warthin's tumor (n=4, 8%), and squamous cell carcinoma (n=4, 8%). Superficial and total parotidectomies were performed in 40 (80%) and 10 (20%) patients, respectively. Nine patients with malignant tumors also had neck dissection and postoperative radiotherapy. Mortality occurred in one patient with metastasis to the parotid gland. One patient with lipoma developed recurrence two years after surgery. Follow-up was five years in 28 patients (56%), three years in 12 patients (24%), and two years in five patients (10%). Complete and transient facial paralysis developed in 10 patients and five patients following total and superficial parotidectomy, respectively. CONCLUSION: Superficial parotidectomy is the minimal surgery for parotid gland masses. If the deep lobe of the gland is involved, total parotidectomy should be performed with preservation of the facial nerve. In malignant tumors, neck dissection and postoperative radiotherapy should be added.

Parotid masses: face the facts.

Parotid masses present both functional and aesthetic consequences due to the proximity of the facial nerve and the glands' alignment with the contours of the mandible. As the largest salivary glands, the parotids participate in providing moisture to the mouth through the production of saliva. This paper presents an overview of the anatomy and physiology of the parotid glands, signs and symptoms of parotid conditions, relevant diagnostic testing, medical and surgical treatment of parotid masses, postoperative recovery, and the role of the otorhinolaryngology (ORL) nurse in the continuum of care and patient education.

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.

[Calcifications of the parotid space. A review]. / Calcifications de la loge parotidienne. Mise au point.

INTRODUCTION: Parotid lithiasis is the main cause of calcifications in the parotid space. However, there are many other less known causes. The aim of our study was to point out the non-lithiasic causes of calcifications in the parotid space. MATERIAL AND METHODS: We conducted an exhaustive review of the literature by mean of PubMed, using the keywords "parotid" and "calcification" and limiting our analysis to the original articles in humans published in English and in French. Articles reporting about microscopic calcifications and who were not dealing with parotid calcifications were excluded. RESULTS: Twenty articles met the inclusion criterions. Tumoral and non-tumoral local causes and systemic causes of parotid calcification were found. The way they revealed was variable. The main tumoral local causes were pleomorphic adenomas, salivary duct carcinomas and adenocarcinomas. The main non-tumoral local causes included vascular malformations and calcified parotid lymph nodes. The main systemic causes were chronic kidney diseases, HIV infection, chronic alcoholism, elevated levels of alkaline phosphatase and auto-immune diseases. DISCUSSION: Eighteen different etiologies of parotid space calcifications could be identified. First line exploration of these lesions relies mainly on conventional radiography and ultrasound examination that are easily available. CT scan remains the reference examination.

Benign lymphoepithelial parotid lesions in vertically HIV-infected patients.

Benign lymphoepithelial parotid lesions (BLL) are frequently reported in HIV-infected patients, although their clinical and prognostic significance in HIV infection has not been clearly defined. Ultrasonography (USG) has been shown to be a reliable method in monitoring the progression of such lesions. The purpose of this study was to describe the spectrum of sonographic and Doppler findings and to monitor any clinically evident physical change of parotid glands in a cohort of congenitally HIV-infected patients taking antiretroviral therapy. USG findings-based on their severity-have been grouped in three different patterns (0, 1, 2). Our cohort consisted of 51 patients with HIV in various Centers for Disease Control (CDC) stages and being given different antiretroviral protocols. The median USG follow-up was 36 months. The most frequent USG pattern was aspecific parotid gland enlargement (type 0, 45,1%). Patients with either lower CD4+ % (p < 0.20) and higher absolute and percent CD8+ cell count (p < 0.001 and p < 0.003) presented more frequently a type 2 USG pattern. None of them had any symptoms ascribed to "sicca syndrome" and only one patient developed non-Hodgkin's lymphoma during the follow-up, although his USG pattern at baseline was type 0. In summary, the spectrum of USG findings of BLL in vertically HIV-infected patients is broad. Because of the reported, although rare, possible malignant transformation of BLL in HIV-infected children, it is advisable to perform-even in asymptomatic patients-USG at least once per year or in concomitance with any physical modification of the parotid lesions.

Longitudinal study of the prevalence and prognostic implications of oral manifestations in romanian children infected with human immunodeficiency virus type 1.

OBJECTIVE: We evaluated the prevalence and predictive value for human immunodeficiency virus (HIV) disease progression of oral manifestations in Romanian children. METHODS: A nonrandom sample of 238 HIV-infected children was followed prospectively between 1998 and 2001 at the Romanian-American Children's Center in Constanta, Romania. Study subjects underwent comprehensive annual oral examinations. Oral manifestations of interest, demographic data and other selected medical information were recorded at baseline and at each subsequent visit. Descriptive statistics and survival analysis methods were used in the study. A level of statistical significance of alpha = 0.05 was used. RESULTS: The study subjects' mean age was 9.9 +/- 1.2 (SD) years. The most common oral lesions were gingivitis (49%), parotid enlargement (13%) and oral candidiasis (11%). Oral candidiasis was associated with progression to acquired immunodeficiency syndrome or death (whichever occurred first) (log rank P = 0.03) and with death (log rank P < 0.001). Oral hairy leukoplakia also was associated with progression to death (log rank P = 0.001). The risk of dying was 3.43 (95% confidence interval, 1.86-6.34; P < 0.001) for children who had oral candidiasis at baseline and 4.62 (95% confidence interval, 1.67-12.77; P = 0.003) for those who had oral hairy leukoplakia. CONCLUSIONS: Oral manifestations occur commonly among HIV-infected Romanian children. Oral candidiasis and oral hairy leukoplakia were positive predictors of HIV disease progression.

Parotid abscess in Singapore.

INTRODUCTION: In most parts of the world, acute parotid abscess is a rare pathology. It occurs mainly in elderly debilitated patients and patients with oral sepsis. In Singapore, this lesion appears to be more common. METHODS: We retrospectively reviewed all patients admitted to our hospital over a three-year period with parotid abscess. RESULTS: Ten patients were treated for parotid abscess. Only two of these patients were elderly and debilitated. The remaining patients were atypical in that they were relatively young and fit with no history of oral sepsis. All the abscesses responded to simple drainage and antibiotic therapy without the need to resort to the radical drainage techniques reported historically. CONCLUSION: Parotid abscess is seen in an unusually young cohort of patients in Singapore. The cause for this is unclear but it may be a result of chronic oral dehydration as a consequence of our climate.

[Combined approach of parotid lithiasis. A technical note]. / Abord combiné des lithiases parotidiennes. Note technique.

INTRODUCTION: Sialendoscopy, extracorporeal lithotripsy and transoral removal are the usual treatments for parotid lithiasis. These techniques cannot treat all the patients. In fact, removal of lithiasis bigger than the ductal diameter and situated in the middle or posterior third of the duct may fail with such techniques. For this reason the combined approach has been developed. Our technical note describes this procedure. TECHNICAL NOTE: Preoperative check-up needs an ultrasound or a CT scan of the parotid region. The procedure is conducted under general anesthesia. It begins with the localization of the lithiasis with help of the sialendoscope light visible through the skin. A face lift approach is performed giving access to the SMAS that is opened over the lithiasis and the transilluminated area. A window is opened on the duct and the lithiasis is removed. Proximal duct permeability is assessed with the sialendoscope. The different layers are sutured and a suction drainage is left in place. DISCUSSION: Combined approach is indicated in case of failure of conservative techniques. It provides good results in removal of lithiasis located in the posterior or middle thirds of the duct. Its morbidity is low. It can avoid performing a parotidectomy and lowers the risk of facial palsy. In case of failure, botulinum toxin injection may be indicated.

Clinical associations of incidentally detected parotid gland calcification on CT.

OBJECTIVES/HYPOTHESIS: Parotid gland calcifications can be incidental findings on computed tomography (CT) and have been reported to be associated with chronic inflammatory conditions. Associations between parotid gland calcification and other common medical conditions have not been reported. METHODS: Following institutional review board approval, 1,571 patients who underwent noncontrast head CT with 1.25-mm slice thickness on a 64-detector row CT between January 2011 and July 2011 were retrospectively reviewed for parotid gland calcifications. Medical records were reviewed for chronic kidney disease, alcoholism, autoimmune conditions, endocrine disorders, elevated alkaline phosphatase, and HIV (human immunodeficiency virus) status. Statistical analyses were performed using Fisher's exact test and multiple logistic regression. RESULTS: Sixty-three of 1,571 (4%) patients had parotid gland calcifications. Significant associations were observed between parotid gland calcifications and HIV infection (P = 0.002), chronic kidney disease (P < 0.0001), alcoholism (P < 0.0001), elevated alkaline phosphatase (P = 0.003), and autoimmune disease (P = 0.02). CONCLUSION: Parotid gland calcifications were associated with HIV, alcoholism, chronic kidney disease, autoimmune disease, and elevated alkaline phosphatase. LEVEL OF EVIDENCE: 4.

Radiation therapy as a treatment for benign lymphoepithelial parotid cysts in patients infected with human immunodeficiency virus-1.

Patients who are infected with the human immunodeficiency virus (HIV) may develop benign lymphoepithelial cysts within the parotid gland that cause severe facial deformity. Standard treatment for this disorder has been superficial parotidectomy, repeated fine-needle aspirations or observation alone. These approaches are unsatisfactory because elective surgery in immunocompromised patients should be avoided, the cysts recur soon after aspiration, and observation alone for a treatable deforming facial process is unacceptable. Radiotherapy's proven effectiveness in treating other benign disorders of the parotid gland led us to evaluate its usefulness as a treatment for this disorder. Eight patients with parotid enlargement, who were seropositive for HIV, received 8-10 Gy to the parotids in 1 week. Five patients had complete response and three patients had partial response. All were very satisfied with the cosmetic result. Treatment-related toxicity was well tolerated and consisted of mild xerostomia and transient taste loss. In all cases, these side effects resolved within 1 month. Radiation therapy thus appears to be an effective and well-tolerated treatment for AIDS-related parotid enlargement.

Major salivary gland lymphoepithelial lesions and the acquired immunodeficiency syndrome.

Presently, there is no consensus regarding the most appropriate diagnostic and therapeutic approach to patients with human immunodeficiency virus (HIV)-associated lymphoepithelial lesions of the major salivary glands. A retrospective review of 60 consecutive patients with lymphoepithelial lesions is presented. Thirty-eight cases were associated with HIV infection. Lesions associated with HIV infection were usually bilateral, multiple, cystic, and associated with lymphadenopathy. In contrast, in those cases without HIV infection, the lesions tended to be solitary and solid. In the HIV-infected group, treatment included surgery, radiotherapy, zidovudine (AZT), and/or cyst aspiration. All therapeutic regimens, other than aspiration alone, were found to be effective. Eighteen of the patients with HIV infection developed the acquired immunodeficiency syndrome (AIDS) during the study period. Surgical treatment is probably not necessary in the majority of HIV-associated cases. Depending upon individual circumstances, treatment with AZT or low-dose radiotherapy is recommended. A diagnostic and therapeutic algorithm is presented as a guide to the management of future cases.

Parotid lipomatosis.

A case of parotid lipomatosis is reported, and the literature is reviewed. This rare condition presents as a slow growing parotid mass, which may be diagnosed preoperatively using computed tomography or magnetic resonance imaging. Long-term clinical follow-up is important because apparently complete surgical excision may be complicated by recurrence.

High prevalence of parotideal abnormalities among HCV infected patients.

Several salivary diseases, such as Sjogren syndrome (SS), chronic lymphocytic sialadenitis and parotid non-Hodgkin's lymphoma, may occur in the setting of HCV infection. Our aim was to evaluate the prevalence of parotid abnormalities in a cohort of 310 patients with chronic hepatitis C (CHC) attending the Unit of Infectious Diseases of the Garibaldi Nesima Hospital of Catania. Our control group consisted of 188 patients with chronic HBV infection. We found that the prevalence of parotideal diseases was significantly higher among HCV-infected patients in comparison with HBV-infected (17% vs. 1%). Indeed, 53 CHC subjects had parotideal abnormalities: 24 patients (45.3%) had lymphoepithelial cysts of the salivary gland, six patients (11.3%) had a benign tumour, six patients (11.3%) had granulomatous lesions, 12 patients (22.7%) had Sjogren's syndrome and four patients (7.5%) were diagnosed as having chronic lymphocytic sialadenitis. Finally, one patient (1.9%) had parotid non-Hodgkin's lymphoma. In conclusion, parotideal abnormalities are common among HCV-infected individuals and targeted diagnostic protocols may help identify parotid involvement in this population of subjects.

Facial nerve morbidity following surgery for benign parotid tumours.

OBJECTIVE: To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. METHODOLOGY: Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. RESULTS were described as frequency percentages. RESULTS: Out of 235 patients, 159 (67.65%) were female and 76 (32.35%) were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour (n=194, 82.6%), followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 (72%) patients and nerve dysfunction was observed in 66 (28%) patients. Complete paresis involving all the branches of facial nerve was seen in 25 (10.6%) patients and 41 (17.4%) patients were having incomplete dysfunction. Of these, 62 (26.3%) recovered and 04 (1.7%) had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 (86.3%) cases. CONCLUSION: The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours.

Mycobacterial tuberculosis superimposed on a Warthin tumor.

The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.

Lipid infiltration in the parotid glands: a clinical manifestation of metabolic syndrome.

BACKGROUND: The clinical features of lipid infiltration in the parotid glands (LIPG) have not been studied. Monitoring of atomic-bomb survivors for late effects of radiation exposure has provided the opportunity to review the clinical findings of LIPG. METHODS: A total of 992 atomic-bomb survivors in Nagasaki, Japan underwent lachrymal and salivary secretion tests and anthropometric, biochemical, and abdominal ultrasonographic examinations between 2002 and 2004. Among 465 subjects who had reduced tear and/or salivary excretion, 176 subjects took a salivary magnetic resonance imaging (MRI) examination. RESULTS: LIPG was detected in 53 of the 176 subjects who had salivary MRI. LIPG cases showed a preponderance of females and fatty liver compared with the subjects without LIPG. Age-and-sex-adjusted regression analysis revealed that body mass index (BMI), low-density lipoprotein cholesterol, triglycerides, hemoglobin A1c, and C-reactive protein were higher, whereas high-density lipoprotein cholesterol and adiponectin were lower, in the subjects with LIPG. Multivariate logistic regression analysis showed that BMI and fatty liver were mutually associated with LIPG independently from radiation dose. CONCLUSIONS: LIPG associated with BMI, fatty liver, and coronary risk factors was a clinical manifestation of metabolic syndrome.

Features of parotid gland diseases and surgical results in southern Taiwan.

Various parotid gland diseases are seen clinically, including inflammation, sialolithiasis, and benign and malignant tumors. It is important to differentiate between these to make a correct diagnosis and for proper management. Here, we investigated the relationship between tumor characteristics and pathology, and considered whether the former could be used to differentiate malignant from benign parotid gland diseases. We retrospectively reviewed the charts and data of 316 patients who underwent surgery in Kaohsiung Medical University Chung-Ho Memorial Hospital from January 1, 1998 to December 31, 2008. Two hundred and eighty-one patients (88.9%) had benign disease, and 35 (11.1%) had malignant disease. The most common benign disease was pleomorphic adenoma (115 cases, 36.4%), but the most common disease in male patients was Warthin's tumor, a finding which, as far as we aware, has not been previously been reported in the literature. The incidence of Warthin's tumor seems to be increasing. In malignant disease, the most common was acinic cell carcinoma (8 cases, 22.9%). Compared with benign disease, malignant parotid gland disease more often presents as a hard, painful, fixed and large mass (> 3 cm), and more often involves the deep lobe of the parotid gland. Partial parotidectomy was adequate for most tumors, including pleomorphic adenoma. The most common postoperative complication was temporary facial palsy, followed by permanent facial palsy. However, there was no difference in transient facial palsy rate between benign and malignant parotid gland disease, although parotid gland cancer had a higher incidence of permanent facial palsy postoperatively.