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.

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.

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.

[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.

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.

On stages of postdenervational disturbances in functioning of the human salivary parotid gland (a concise report).

The author presents an original classification of the muscarinic cholinoreceptor subpopulations in the human salivary parotid gland in normal condition or following parasympathetic denervation. The criteria characterizing each stage of the postdenervational syndrome and the general scheme of their occurrence and restoration both reflect the stages of evolutionary transformations in cholinergic receptors. Assessment of salivation rate and volume, observed as the effect of vegetotropic agents, and of electrolyte contents in saliva provide the above scheme of 3 stages of the postdenervational syndrome.

Functional characteristics of atrophic parotid acinar cells from rats after liquid feeding.

Rat parotid atrophy, induced by liquid feeding over 10 days, was manifested as gland weight loss (40%) and histologically as acinar shrinkage. Acinar secretory function was investigated in the same glands using enzymatically dispersed cell preparations and superfused gland slices. Results were normalized for the acinar proportional volume, determined by stereological analysis. Although total amylase activity was significantly lower in liquid-fed (LD) rats, the percentage amylase releases elicited by isoproterenol (10 mumol/L) and carbachol (10 mumol/L) were unchanged from controls (CON). Superfused gland slices from LD and control (CON) rats exhibited increases in membrane permeability (86Rb+ efflux) and in the efflux and re-uptake of K+ in response to acetylcholine (10 mumol/L). However, the recorded maxima were significantly lower in LD than in CON (86Rb+, 27% lower; K+ efflux, 35% lower; K+ re-uptake, 35% lower). Similarly, after 60-minute equilibration, the 36Cl- content of cells from LD rats was 57% lower than that from CON. Carbachol (10 mumol/L), acting for 1 min with bumetanide (100 mumol/L), elicited an efflux of 36Cl- from cells from LD rats, but this was significantly lower (32.2%) in LD than in CON (49.9%). The reduced levels of ion movement are probably commensurate with the reduced acinar cell volume occurring in LD rats. These results show that mechanisms for the formation of primary saliva (exocytosis and transepithelial ion movements) are substantially preserved in the altered acinar cells of LD rats. Thus, in salivary disorders, severe morphological acinar atrophy may not inevitably signify exhausted secretory function.

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.

Facial nerve function after parotidectomy.

OBJECTIVES: To analyze the incidence of facial nerve dysfunction following parotidectomy and to correlate this with the extent of parotid gland resection, the pathological diagnosis, and the clinical setting. DESIGN: A review of prospectively collected data from a dedicated computerized head and neck database. SETTING: Tertiary care center. PATIENTS: Between 1987 and 1995, 248 patients underwent 259 parotidectomies performed by the same surgeon (C.J.O'B.). Indications were clinical tumor (n=213) or sialadenitis (n=46). There were 235 previously untreated patients and 13 who had undergone a prior operation on that side. Facial nerve function was normal in 242 patients and abnormal before surgery in 6. Cancers accounted for 88 parotidectomies and benign disease accounted for 171. Of 213 clinical tumors, 41 (19%) were situated deep to the plane of the facial nerve. RESULTS: The facial nerve was intentionally sacrificed in 28 of 259 operations (18 total and 10 partial sacrifice). In 230 parotidectomies in which facial nerve function was normal before surgery and the nerve was preserved, the incidence of initial postoperative facial weakness was 29%. Based on the diagnosis and extent of surgery, rates of facial weakness were 16.5% and 13%, respectively, for benign and malignant tumors located in the superficial lobe and treated with limited superficial parotidectomy; 30% and 34% for sialadenitis treated with complete superficial parotidectomy and near-total parotidectomy, respectively; 31% and 100%, respectively, for benign and malignant lobe tumors treated with near-total parotidectomy; 83% for parotidectomy associated with a neck dissection; and 33% for patients who had previous parotid surgery. Permanent weakness occurred in 13 (5.6%) of 230 patients, but 10 of these 13 had simultaneous neck dissection and facial nerve dysfunction involved only the marginal mandibular branch. Recovery of normal facial movements occurred within 6 months in 46 (68%) of 67 of those with initial weakness. CONCLUSIONS: The likelihood of temporary facial weakness correlated with the extent of surgery and was especially influenced by tumor location deep to the plane of the facial nerve, previous parotid surgery, a diagnosis of sialadenitis, and the addition of neck dissection to the parotidectomy. Permanent weakness mainly affected the marginal mandibular branch when neck dissection was included.

Investigation of the clinical value of total saliva flow rates.

The symptom of dry mouth was correlated with unstimulated (UWSFR) and stimulated (SWSFR) whole-saliva flow rate on chewing medical paraffin in 62 patients with dry-mouth complaints (30 with Sjögren's syndrome, 32 with sialosis) and 23 controls. The symptom of dry mouth was classified into grades 0,1,2,3,4 according to a Treatment Emergent Symptom Scale (TESS). UWSFR and SWSFR were determined after fasting in the morning. UWSFR was 0.070 +/- 0.089 ml/min in Sjögren's syndrome, 0.175 +/- 0.115 ml/min in sialosis, 0.330 +/- 0.188 ml/min in controls. SWSFR was 0.709 +/- 0.720 ml/min in Sjögren's syndrome, 1.561 +/- 0.867 ml/min in sialosis, 1.894 +/- 0.661 ml/min in controls. A highly significant correlation was found between TESS score and UWSFR and between TESS score and SWSFR. Only UWSFR was decreased in the patients with a TESS score of 1 or 2, while both UWSFR and SWSFR were significantly decreased in the patients with TESS scores of 3, 4. It is concluded that UWSFR is more sensitive in relation to dry-mouth complaints than SWSFR, and that a mild dry mouth is mainly related to decreased UWSFR.

Parotid salivary secretory pattern in bulimia nervosa.

Parotid gland enlargement occurs in about 25% of patients with the binge eating syndrome of bulimia nervosa. The parotid salivary secretory patterns in 28 bulimics were determined in order to investigate the functional abnormality in the glands. Bulimia patients had a reduced resting flow rate. Bulimics who developed sialadenosis (4 patients) had reduced resting and stimulated flow rates. The salivary amylase activity was increased in both the resting and stimulated states in bulimics and the sialadenosis group. The resting total protein levels were greater in the bulimics. The electrolyte and immunoglobulin levels were within normal limits. The possibility of protein and enzymatic secretory disturbances due to autonomic nerve disorders as an explanation for the development of sialadenosis in bulimia nervosa is discussed.

Tuberculosis of the parotid salivary gland.

An interesting and rare case of tuberculosis involving a parotid gland is discussed. Although pulmonary tuberculosis is not uncommon in Turkey, primary parotid gland involvement is rare. The patient was treated by parotidectomy and antituberculous chemotherapy.

Cat scratch disease: an unusual cause of acute parotid pain (a case report with a literature review).

CSD is a well recognised cause of cervical lymphadenopathy, and parotid involvement occurs in 3 per cent of cases. Parotid lymphadenopathy is usually asymptomatic or tender but acute parotid pain treated successfully by surgery is previously undescribed. In our case excision of the primary lesion with parotid biopsy provided an immediate diagnosis and decompression of the parotid capsule resulted in dramatic relief of the patient's pain. We would therefore recommend that, in all cases of obscure cervical lymphadenopathy, CSD should be considered and a documentation of domestic pets actively sought. We would also advise that in those cases of parotid CSD in which either the diagnosis is equivocal, CS antigen is unavailable or intense parotid pain is a predominant feature, excision of the primary lesion together with surgical decompression of the parotid capsule should be performed.

Unilateral parotid hypersialism in a dachshund.

Hypersialism as an apparently primary condition is recorded in a young miniature long-haired dachshund. The condition was unilateral and cure was effected by ligation of the parotid salivary duct.

The influence of pre-radiation salivary flow rates and radiation dose on parotid salivary gland dysfunction in patients receiving radiotherapy for head and neck cancers.

Radiotherapy (RT) used for head and neck cancers causes permanent salivary gland dysfunction (SGD). Previous short-term studies have demonstrated that pre-RT salivary flow rates and the amount of radiation exposure to parotid glands influence the amount of RT-induced SGD. The purpose of this study was to determine which variables are related to the development of long-term post-RT SGD. Parotid flow rates (PFR) were assessed prior to and 1 year after completion of RT in spared parotid glands from 34 patients from 2 parotid-sparing protocols. The results reveal that spared PFR were not significantly higher 1 year post-RT in patients who had high pre-RT PFR, when compared with patients with low pre-RT PFR. However, patients who received higher doses of RT to spared parotid glands had lower PFR 1 year post-RT, compared with patients who had received lower doses of RT. These one-year findings suggest that high pre-RT PFR do not provide protection against RT-induced SGD. Conversely, reduced RT dosages to contralateral parotid glands are protective of PFR after completion of RT.

Sialosis of unknown origin.

Sialosis (sialadenosis) is defined as an asymptomatic, non-inflammatory, non-neoplastic parenchymal salivary gland disease accompanied by a persistent painless bilateral swelling of the salivary glands, most commonly involving the parotid glands. There is no sex predilection, and the peak age incidence is between 30 and 70 years of age. Sialosis occurs in three different groups of patients: alcoholics, diabetics and the malnourished. An autonomic neuropathy, seen as a demyelinating polyneuropathy, seems to be the common underlying basis for this seemingly disparate group of patients with sialosis.

[Tuberculosis of the parotid gland]. / Tuberculosis parotídea.

We present a case of parotid tuberculosis diagnosed through F.N.A.C. (fine needle aspiration cytology). Due to this rare extrapulmonary location of the tuberculosis, the AA. make a review of the last 12 years concerning literature together with a monographic study of the process.

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.