Surgical technique and post-tonsillectomy hemorrhage: a single institution's retrospective study.

Post-tonsillectomy hemorrhage is one of the most common complications of tonsillectomy. The rate varies with different methods. We retrospectively analyzed patients who underwent tonsillectomy in a period of two years. Two surgical methods, cold dissection and microscopically assisted bipolar tonsillectomy, were compared. 1007 patients were included in the study. Postoperative hemorrhage occurred in 116 patients (11.5 %). By the cold dissection method, postoperative bleeding was noted in 86 patients (10.9 %), while by the microscopic bipolar method in 30 patients (13.9 %). A surgical hemostasis was required in 47 patients (5.9 %) and 17 patients (7.9 %), respectively. Concerning the time of occurrence of the first postoperative bleeding episode, we found that it occurred mainly on day 6 by the cold dissection technique (median = 6, mean = 5.84, SD = 3.30), whereas by the bipolar technique the first episode occurred on day 5 (median = 5, mean = 5.27, SD = 2.85). However, a statistical analysis did not show a significant difference. In conclusion, our study did not show a significant difference concerning the prevalence or the postoperative day of occurrence of the first bleeding episode after tonsillectomy when comparing the two methods, but recommendations concerning the duration of the in-hospital stay could be made. Each institution should perform its own individualized statistics concerning the occurrence of postoperative bleeding and should use a standardized documentation protocol. Level of evidence 3b.

Primary unclassified sarcoma of the parotid gland: a case of diagnostic and therapeutic challenge.

Malignant salivary gland sarcomas represent a clinically and histologically diagnostic challenge. Primary unclassified sarcomas of the parotid gland consist a rare salivary gland tumor. We report an unusual case of such a tumor, which occurred in the right parotid gland of a 54-year-old male and presented as an asymptomatic painless mass. The pathologoanatomical examination revealed a rhabdoid large-cell unclassified sarcoma. The patient was treated with superficial parotidectomy and adjuvant radiotherapy. No recurrence was noted in a 10-year follow-up period. Due to the rare occurrence of primary unclassified sarcomas, there is no evidence-based treatment of choice. An optimal approach is best planned in a multidisciplinary setting, taking into consideration the resectability of the tumor, individual patient characteristics, presence of local or distant metastatic activity, local infiltrative behavior and tumor stage. A close follow-up of the patient is strongly recommended.

Parotid Gland Tumors: A Multicenter Analysis of 1020 Cases. Increasing Incidence of Warthin's Tumor.

We assessed the frequency of the parotid gland tumor entities and correlated sex and age in different tumor types. Retrospective data were obtained from three major otorhinolaryngology clinics in Karlsruhe and Pforzheim, Germany within a 10-year period. In total, 1020 cases of parotidectomy for benign and malignant lesions were identified. We found 864 (84.7%) and 156 (15.3%) patients with benign and malignant tumors of the parotid gland, respectively. The most common benign parotid tumor was Warthin's tumor, followed by pleomorphic adenoma. The most common primary malignant tumor types were acinic cell carcinoma and mucoepidermoid carcinoma. Secondary malignant tumors of the parotid gland included lymphoma and metastatic, cutaneous squamous cell carcinoma. The frequency of Warthin's tumors was higher than that of pleomorphic adenomas. A large proportion of the malignant parotid tumors represent metastases from squamous cell carcinoma of the skin of the head and neck.

Sialoblastoma of the parotid gland in a 13-year-old girl with multiple recurrences and long-term follow-up.

BACKGROUND: Sialoblastoma is an extremely rare congenital salivary gland tumor of epithelial origin. It is usually localized in the parotid or submandibular gland and presents primarily at birth or in early childhood. METHODS: We report a case of a 13-year-old girl with a sialoblastoma of the parotid gland presenting as an asymptomatic painless mass. RESULTS: The patient showed multiple recurrences and, based on the histopathological finding of facial nerve infiltration, was treated surgically with total parotidectomy and facial nerve reconstruction. CONCLUSION: Because of the rare occurrence of sialoblastoma, there is no evidence-based treatment of choice. The treatment should be individualized, taking into consideration the patient's age, the high locoregional recurrence rate, the local aggressive characteristics, and the potential metastatic activity of this rare tumor. A close follow-up of the patient is strongly recommended.