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Hu LH, Yu Y, Tang ZN, Sun ZP, Yang C, Yu GY, Zhang WB, Peng X. Direct visualization of intraparotid facial nerve assisting in parotid tumor resection. J Craniomaxillofac Surg 2024; 52:659-665. [PMID: 38580555 DOI: 10.1016/j.jcms.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
Precise recognition of the intraparotid facial nerve (IFN) is crucial during parotid tumor resection. We aimed to explore the application effect of direct visualization of the IFN in parotid tumor resection. Fifteen patients with parotid tumors were enrolled in this study and underwent specific radiological scanning in which the IFNs were displayed as high-intensity images. After image segmentation, IFN could be preoperatively directly visualized. Mixed reality combined with surgical navigation were applied to intraoperatively directly visualize the segmentation results as real-time three-dimensional holograms, guiding the surgeons in IFN dissection and tumor resection. Radiological visibility of the IFN, accuracy of image segmentation and postoperative facial nerve function were analyzed. The trunks of IFN were directly visible in radiological images for all patients. Of 37 landmark points on the IFN, 36 were accurately segmented. Four patients were classified as House-Brackmann Grade I postoperatively. Two patients with malignancies had postoperative long-standing facial paralysis. Direct visualization of IFN was a feasible novel method with high accuracy that could assist in recognition of IFN and therefore potentially improve the treatment outcome of parotid tumor resection.
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Affiliation(s)
- Lei-Hao Hu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, 100081, China.
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, 100081, China.
| | - Zu-Nan Tang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, 100081, China.
| | - Zhi-Peng Sun
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, 100081, China.
| | - Cong Yang
- Tsinghua Laboratory of Brain and Intelligence, Tsinghua University, Haidian District, Beijing, 100084, China.
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, 100081, China.
| | - Wen-Bo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, 100081, China.
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Haidian District, Beijing, 100081, China.
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Sievert M, Koch M, Iro H, Thimsen V. [Sonography of the neck-aspects of differential diagnosis]. HNO 2023; 71:750-762. [PMID: 37801101 DOI: 10.1007/s00106-023-01375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
Sonography is the preferred method for primary diagnosis and acute treatment of pathologies involving the neck's soft tissues. Technological advances, particularly high image resolution and multiparametric ultrasound, have improved diagnostic performance. Clinical interest focuses on examining the cervical lymph nodes, salivary glands, and the thyroid gland, as well as space-occupying and inflammatory processes of the neck. In addition, sonography enables targeted minimally invasive histology acquisition using ultrasound-guided biopsies. In this context, the examiner's comprehensive anatomical knowledge and clinical experience are of utmost importance for the quality of findings. This article provides an overview of the most important findings related to sonography of the neck and highlights the relevance of this imaging modality in the hands of the otorhinolaryngologist.
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Affiliation(s)
- Matti Sievert
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland.
| | - Michael Koch
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Heinrich Iro
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Vivian Thimsen
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
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Meliante PG, Colizza A, Ralli M, Minni A, Angeletti D, Cambria F, de Vincentiis M. Treatment of relapses of benign latero-cervical pathology: a narrative literature review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S76-S83. [PMID: 37698104 PMCID: PMC10159646 DOI: 10.14639/0392-100x-suppl.1-43-2023-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 09/13/2023]
Abstract
Benign laterocervical pathologies are not without pitfalls. Many may relapse after many years and, sometimes, they cannot be predicted. The purpose of this review is to describe the surgical measures necessary for the treatment of relapses of the most common benign laterocervical masses. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials databases for articles describing the treatment of the most common benign cervical disease recurrences, and summarised available evidence in this narrative review. We overviewed observations about recurrent benign mixed tumour (pleomorphic adenoma), parapharyngeal space tumours and carotid body paragangliomas, thyroglossal duct anomalies and branchial cleft anomalies. Proper surgical technique is crucial for safely and effectively managing the relapses of benign latero-cervical diseases. Radiotherapy is indicated in several cases of recurrence such as pleomorphic adenoma and unresectable paraganglioma. Long-term follow-up is of utmost importance to promptly recognise and treat recurrencies.
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Affiliation(s)
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Assessment of Parotid Gland Tumors by Means of Quantitative Multiparametric Ultrasound (mpUS). Diagnostics (Basel) 2022; 13:diagnostics13010012. [PMID: 36611304 PMCID: PMC9818404 DOI: 10.3390/diagnostics13010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The preoperative diagnostical differentiation of parotid gland tumor (PGT) is not always simple due to several different entities. B-mode-ultrasound (US) remains the imaging modality of choice, while histopathology serves as the gold standard for finalizing the diagnosis. We aimed to evaluate the use of multiparametric US (mpUS) in the assessment of PGT. METHODS We included 97 PGTs from 96 patients. A standardized mpUS protocol using B-mode-US, shear-wave elastography (SWE), and standardized contrast-enhanced ultrasound (CEUS) was performed prior to surgical intervention. SWE was assessed by real-time measurement conducting a minimum of five measurements, while quantitative CEUS parameters were assessed with a post-processing perfusion software. RESULTS SWE allowed differentiation between benign PGT (Warthin's Tumor (WT) paired with lymph nodes (LN) and pleomorphic adenoma (PA)), and WT and LN were softer compared to PA. WT showed lower velocities than squamous cell carcinoma (SCC): the most common malignant PGT. CEUS parameters showed significant group differences between WT and PA, WT and malignant lesions, WT and SCC, WT paired with LN versus PA, and WT paired with LN versus SCC. CONCLUSION MpUS seems to be beneficial in the assessment of PGT characterization, with benign PGT appearing to be softer in SWE than tumors with malignant tendencies. The quantitative CEUS parameter shows higher perfusion in WT than in PA, and malignant PGTs are less vascularized than WTs.
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Diagnostic value of various criteria for deep lobe involvement in radiologic studies with parotid mass: a systematic review and meta-analysis. Radiol Med 2022; 127:1124-1133. [DOI: 10.1007/s11547-022-01540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/07/2022] [Indexed: 10/15/2022]
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Thielker J, Kouka M, Guntinas-Lichius O. [Preservation, reconstruction, and rehabilitation of the facial nerve]. HNO 2022; 71:232-242. [PMID: 35288765 PMCID: PMC8920054 DOI: 10.1007/s00106-022-01148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
Der Umgang mit dem N. facialis ist bei der Operation eines Parotiskarzinoms wichtig für die Langzeitlebensqualität des Patienten. In etwa 2 Drittel der Fälle ist der N. facialis nicht vom Tumor befallen. In diesen Fällen sind neben vollständiger Tumorentfernung die Identifizierung und der Erhalt des Nervs für eine erfolgreiche Operation wesentlich. Ist der Nerv vom Tumor infiltriert, muss der betroffene Teil des Nervs im Rahmen einer radikalen Parotidektomie reseziert werden. Die primäre Nervenrekonstruktion, sofern möglich, führt zu den besten funktionellen und kosmetischen Langzeitergebnissen. Das individuell optimale Therapiekonzept basiert zum einen auf der klinischen Prüfung der Gesichtsbeweglichkeit, zum anderen auf der präoperativen Bildgebung, um die Lagebeziehung zwischen Tumor und Nerv zu verstehen, und schließlich auf einer elektrophysiologischen Untersuchung zur Funktion des Nervs. Intraoperativ hilft ein standardisiertes Vorgehen, um den Nerv zu identifizieren und zu erhalten. Wenn eine radikale Parotidektomie indiziert ist, kann bereits die präoperative Diagnostik helfen, neben der einzeitigen Rekonstruktion auch die adjuvante postoperative Therapie zu planen. Das Ziel der Rehabilitation ist die Wiederherstellung von Tonus, Symmetrie und Bewegung des gelähmten Gesichts. Die Wiederherstellung des Augenschlusses hat hohe Priorität. Bei der chirurgischen Therapie von Gesichtslähmungen gab es in den letzten Jahren viele Verbesserungen. Die vorliegende Arbeit gibt einen Überblick über die jüngsten Fortschritte in der Diagnostik, den Operationstechniken und weiteren Möglichkeiten zur Protektion des gesunden N. facialis. Anderseits wird die Rehabilitation des tumorinfiltrierten N. facialis im Kontext der Behandlung von Speicheldrüsenmalignomen beschrieben.
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Affiliation(s)
- Jovanna Thielker
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland
| | - Mussab Kouka
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland
| | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland. .,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland.
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Jering M, Mayer M, Thölken R, Schiele S, Maccagno A, Zenk J. Diagnostic Accuracy and Post-Procedural Complications Associated with Ultrasound-Guided Core Needle Biopsy in the Preoperative Evaluation of Parotid Tumors. Head Neck Pathol 2021; 16:651-656. [PMID: 34919166 PMCID: PMC9424419 DOI: 10.1007/s12105-021-01401-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 11/08/2022]
Abstract
Correct diagnosis of a parotid neoplasm based on histology preoperatively is of utmost importance in order to guide patient management. The aim of this study was to evaluate the diagnostic accuracy of an ultrasound-guided core needle biopsy of a parotid lesion and to describe associated post-procedural complications. A retrospective study was conducted between January 2015 and March 2021 of all patients who were referred to a tertiary care center for evaluation of a parotid lesion and who underwent core needle biopsy due to high-risk features or when malignancy was suspected on clinical examination or ultrasonography. Patient characteristics, histological findings, and post-procedural complications were recorded and evaluated. Among 890 patients referred for evaluation of a parotid lesion, in 138 patients a core needle biopsy was undertaken. On the basis of core needle biopsy findings, 11 lymphomas and 82 non-lymphoma malignancies were diagnosed in the parotid gland. The sensitivity of the core needle biopsy predicting the accurate tumor type was 97.56% (95% CI 91.47-99.70%) and the specificity 94.64% (95% CI 85.13-98.88%). The accuracy for the correct histopathological diagnosis was 93.48% (95% CI 87.98-96.97%). Post-procedural minor complications occurred in 19 patients (13.8%). In conclusion, a core needle biopsy can identify malignancy in the parotid gland with high sensitivity and specificity in a safe manner and therefore guide surgical treatment.
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Affiliation(s)
- Monika Jering
- grid.7307.30000 0001 2108 9006Department of Otolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Augsburg, University of Augsburg, Sauerbruchstaße 6, 86156 Augsburg, Germany
| | - Marcel Mayer
- grid.6190.e0000 0000 8580 3777Department of Otolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Straße 62, 50931 Cologne, Germany
| | - Rubens Thölken
- grid.7307.30000 0001 2108 9006Department of Otolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Augsburg, University of Augsburg, Sauerbruchstaße 6, 86156 Augsburg, Germany
| | - Stefan Schiele
- grid.7307.30000 0001 2108 9006Institute of Mathematics, University of Augsburg, Universitätsstraße 2, 86159 Augsburg, Germany
| | - Andrea Maccagno
- grid.7307.30000 0001 2108 9006Institute of General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - Johannes Zenk
- grid.7307.30000 0001 2108 9006Department of Otolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Augsburg, University of Augsburg, Sauerbruchstaße 6, 86156 Augsburg, Germany
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8
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Thölken R, Jering M, Mayer M, Schiele S, Müller G, Zenk J. Prospective study on complications using different techniques for parotidectomy for benign tumors. Laryngoscope Investig Otolaryngol 2021; 6:1367-1375. [PMID: 34938876 PMCID: PMC8665421 DOI: 10.1002/lio2.694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Long-term prospective studies on procedure-related complications after parotid surgery for benign neoplasms (BNs) are scarce. This is the first prospective study on the use of extracapsular dissection (ECD) for BNs, and it aimed to examine the incidence of postoperative complications after parotid surgery for BN. METHODS We collected data obtained in a prospective study of parotidectomy for BN at a university hospital and analyzed the transient and long-term complications. RESULTS The incidence rates of transient facial palsy immediately and 18 months after surgery were 15.0% and 3.7%, respectively. The rates of immediate postoperative facial palsy in patients who underwent ECD, partial superficial, superficial, and total parotidectomy were 5.8%, 29.3%, 20.0%, and 44.1%, respectively. Significant risk factors for facial palsy included multiple and larger lesions as well as surgery duration and extension. CONCLUSIONS Postoperative facial palsy remains a common complication after parotidectomy for BN and is associated with the extent of parotidectomy, presence of multiple neoplasms, and operative duration. The results of this study showed that ECD could be a safe technique for avoiding facial palsy. Level of Evidence: 2.
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Affiliation(s)
- Rubens Thölken
- Department of Otorhinolaryngology and Head and Neck SurgeryUniversity Hospital AugsburgAugsburgGermany
| | - Monika Jering
- Department of Otorhinolaryngology and Head and Neck SurgeryUniversity Hospital AugsburgAugsburgGermany
| | - Marcel Mayer
- Department of Otorhinolaryngology and Head and Neck SurgeryUniversity Hospital AugsburgAugsburgGermany
| | - Stefan Schiele
- Institute of Mathematics, Augsburg UniversityAugsburgGermany
| | - Gernot Müller
- Institute of Mathematics, Augsburg UniversityAugsburgGermany
| | - Johannes Zenk
- Department of Otorhinolaryngology and Head and Neck SurgeryUniversity Hospital AugsburgAugsburgGermany
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9
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Jering M, Zenk J, Thölken R, Rüger H, Psychogios G. Can Ultrasound in Combination with Virtual Touch Imaging Quantification Predict the Dignity of a Parotid Tumor? ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1192-1203. [PMID: 33541749 DOI: 10.1016/j.ultrasmedbio.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/20/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
Pre-operative evaluation of a parotid gland tumor is crucial in guiding treatment. This study evaluates the diagnostic performance of B-mode ultrasound in combination with Virtual Touch imaging quantification (VTIQ) in the assessment of parotid lesions. A prospective study of 268 patients with parotid lesions was conducted. Pre-operative ultrasound findings and VTIQ data were compared against histologic results. Ill-defined margins on ultrasound were associated with a significantly higher risk of malignancy (odds ratio [OR] = 1224.0, 95 % confidence interval [CI]: 151.8-9872.7). Faster mean shear waves on VTIQ (OR = 1.81, 95% CI: 1.47-2.23, per 1 m/s increase) and an area with shear wave velocity >6.0 m/s involving >70 % of the lesion (OR = 19.80, 95 % CI: 6.22-63.07) were associated with higher risk of malignancy. Addition of VTIQ to routine pre-operative B-mode ultrasound can provide supplemental information on the dignity of a parotid tumor, allowing for peri-operative procedural optimization.
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Affiliation(s)
- Monika Jering
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany.
| | - Johannes Zenk
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Rubens Thölken
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Holger Rüger
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Georgios Psychogios
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany; Department of Otolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, Greece
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10
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Mantsopoulos K, Iro AK, Sievert M, Müller SK, Agaimy A, Koch M, Iro H. Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas. Acta Otolaryngol 2021; 141:414-418. [PMID: 33470131 DOI: 10.1080/00016489.2021.1871947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Traditional surgical philosophy condemns extracapsular dissection for pleomorphic adenoma as a euphemism for the enucleation of this lesion. OBJECTIVES The aims of the study were to trace the development of surgical treatment by pleomorphic adenomas of the parotid gland over the last 15 years and explore its effects on the histopathology specimen. MATERIALS AND METHODS The medical records of all cases with pleomorphic adenomas of the parotid gland between 2006 and 2020 were examined for information on age, gender, and type of surgery. An experienced head and neck pathologist re-evaluated the histology slides from all the cases. RESULTS The study included 844 patients. Our analysis showed an increase in the performance of extracapsular dissection from 52.8% (2006) to 63.3% (2020), and an increase in histopathology specimens with tumours completely covered by healthy tissue from 27.7% (2006) to 50% (2020). CONCLUSIONS Our decision-making process reached its peak in the last study years, in terms of reduced surgical invasiveness and quality of the pathology specimen. SIGNIFICANCE Extracapsular dissection has gained a firm hold as an indispensable tool for the experienced parotid surgeon. Proper indication is based on careful selection of cases and the correct interpretation of preoperative features on palpation and imaging.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Ann-Kristin Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Sarina Katrin Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
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11
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Mantsopoulos K, Iro AK, Sievert M, Müller SK, Agaimy A, Schapher M, Koch M, Iro H. Is extracapsular dissection for pleomorphic adenoma rather a euphemism for enucleation that jeopardises the intactness of the capsule? Br J Oral Maxillofac Surg 2021; 59:1204-1208. [PMID: 34274171 DOI: 10.1016/j.bjoms.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023]
Abstract
The aim of this study was to compare several surgical modalities with respect to the incidence of positive margins and focal capsular exposure of pleomorphic adenoma of the parotid gland. The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2006 and 2020 were retrospectively evaluated (n = 845). The lesion was removed by extracapsular dissection in 577 cases (68%) and facial nerve dissection in 268 (32%). Our analysis did not reveal a statistically significant difference between the examined modalities regarding positive margins (p=0.648) or capsular exposure (p=0.112). Recurrences were detected in 7/845 cases (0.82%) with a mean (range) follow-up time of 82.3 (6-183) months. The choice of surgical method does not seem to have a significant effect on the incidence of positive margins, or on the capsular exposure of a pleomorphic adenoma.
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Affiliation(s)
- K Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - A-K Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Sievert
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S K Müller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - M Schapher
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Koch
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Berner F, Koch M, Müller SK, Schapher M, Grundtner P, Iro H, Mantsopoulos K. Investigation of Sonographic Criteria for Reliable Identification of T1-T2 Low-Grade Malignant Tumors of the Parotid Gland. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:471-477. [PMID: 33309444 DOI: 10.1016/j.ultrasmedbio.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/01/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
The aim of this study was to investigate sonographic findings of low-grade malignant tumors of the parotid gland. The sonographic findings of all patients treated for T1-T2 low-grade carcinomas of the parotid gland between 2003 and 2018 were retrospectively examined and compared with those of patients with pleomorphic adenomas for the following parameters: definition of tumor margins, echotexture, echogenicity, shape and vascularization. Statistical analysis was performed using the χ2 test. A p value of <0.05 was considered statistically significant. A total of 310 patients (62 with T1-T2 low-grade malignant tumors, 248 with pleomorphic adenomas) were evaluated. Our analysis detected a statistically significant difference in the definition of margins, echotexture, echogenicity and shape. Furthermore, we could detect a specific pattern (anechoic islets in a small hypoechoic lesion with distal enhancement) appearing far more frequently in low-grade malignant lesions. It seems that there is still potential to reduce the incidence of the false working hypothesis "benign lesion" on imaging of low-grade malignant tumors.
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Affiliation(s)
- Ferdinand Berner
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Koch
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Mirco Schapher
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Philipp Grundtner
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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[Quality in the appraisal of head and neck sonography results in university hospitals-a random sample]. HNO 2021; 69:907-912. [PMID: 33439274 PMCID: PMC8545731 DOI: 10.1007/s00106-020-00989-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
Hintergrund Die Ultraschalldiagnostik gilt für den Radiologen, Hals-Nasen-Ohren-Arzt (HNO) oder Mund-Kiefer-Gesichts-Chirurgen als Standard in der Abklärung zahlreicher Pathologien. Es besteht ein Konsens, dass die digitale Dokumentation heute dringend notwendig ist, um die Qualität der sonographischen Dokumentationen zu verbessern und zu standardisieren. Es häufen sich Publikationen zur Implementierung standardisierter Befunddokumentation einschließlich der Kopf- und Halssonographie. Ziel der Arbeit Die vorliegende Arbeit zielt darauf ab, die Qualität von routinemäßig angefertigten Kopf- und Halssonographiebefunden nach Kriterien der Kassenärztlichen Vereinigung (KV) Bayern an einer Auswahl deutscher HNO-Universitätskliniken stichprobenartig zu ermitteln. Material und Methoden Insgesamt wurden retrospektiv 70 zufällig ausgewählte, anonymisierte schriftliche Befunde einschließlich Bildmaterial von insgesamt 7 HNO-Universitätskliniken stichprobenartig nach KV-Kriterien durch einen erfahrenen Prüfer der KV Bayern ausgewertet und deskriptiv analysiert. Ergebnisse Von 70 Befunden konnten 69 ausgewertet werden. Die Dokumentationsvollständigkeit lag im Mittel bei 80,6 %. Neun Befunde waren vollständig korrekt dokumentiert (13 %). Die Dokumentationsvollständigkeit der einzelnen Kliniken lag zwischen 68,1 % und 93 %. Mit 88,5 % vs. 75 % erbrachte eine strukturierte Befundung eine höhere Befundvollständigkeit. In 75 % der Fälle verfügten die Kliniken mit strukturiertem Befund auch über digitale Dokumentationslösungen. Schlussfolgerung Die Vollständigkeit und Qualität von routinemäßig angefertigten Kopf- und Halssonographiebefunden an einer Auswahl von HNO-Universitätskliniken ist insgesamt optimierbar. Die Implementierung strukturierter Befundmasken und die Umstellung der analogen Dokumentation auf digitale Lösungen sowie Vernetzung mit dem Klinikinformationssystem (KIS) und Bildarchivierungs- und Kommunikationssystem (PACS) sollte weiter vorangetrieben werden. Darüber hinaus sind leitende Ärzte dazu angehalten, die Befundqualität unerfahrener Kollegen regelmäßig zu prüfen und im Rahmen der Facharztausbildung auf die Erfüllung entsprechender Standards wie der KV-Ultraschallvereinbarung hinzuarbeiten.
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Rüger H, Psychogios G, Jering M, Zenk J. Multimodal Ultrasound Including Virtual Touch Imaging Quantification for Differentiating Cervical Lymph Nodes. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2677-2682. [PMID: 32651021 DOI: 10.1016/j.ultrasmedbio.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/13/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
Defining the entity of cervical lymph nodes (LNs) is essential for the diagnosis and staging of head and neck malignancies. Virtual Touch imaging quantification (VTIQ) is a relatively new method of elastography that measures tissue stiffness quantitatively. A prospective study was conducted that included 108 patients (57 benign and 51 metastatic lymph nodes [MLNs]). Shear wave velocities (SWVs) were analyzed using VTIQ and were compared with the histopathological results. Both maximum and minimum SWVs within the LNs significantly differed between benign masses and MLNs (p < 0.001). Percentage areas of the node with SWVs >6 m/s and <3.5 m/s differed significantly (p < 0.001). Intralesional areas with SWVs ≤3.5 m/s of 0-29% (odds ratio: 93.7) and 30%-69% (odds ratio: 46.3) were predictive of malignant LNs as well as ill-defined tumor (odds ratio: 5.2). VTIQ can provide more information on the entity of cervical LNs.
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Affiliation(s)
- Holger Rüger
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany.
| | - Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University of Ioannina, Ioannina, Greece
| | - Monika Jering
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany
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15
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Psychogios G, Bohr C, Constantinidis J, Canis M, Vander Poorten V, Plzak J, Knopf A, Betz C, Guntinas-Lichius O, Zenk J. Author's response to the letter of the editor regarding the "Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors". Eur Arch Otorhinolaryngol 2020; 277:3539-3540. [PMID: 32980892 DOI: 10.1007/s00405-020-06359-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ioannina, Leof. Stavrou Niarchou, 455 00, Ioannina, Greece. .,Multidisciplinary Salivary Gland Society, Geneva, Switzerland.
| | - Christopher Bohr
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany
| | - Jannis Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - Martin Canis
- Department of Otorhinolaryngology and Head and Neck Surgery, LMU Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Multidisciplinary Salivary Gland Society, Geneva, Switzerland
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic
| | - Andreas Knopf
- Department of Otorhinolarygology/Head and Neck Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Betz
- Department of Otorhinolaryngology, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology-Head and Neck, Surgery, Jena University Hospital, Jena, Germany.,Multidisciplinary Salivary Gland Society, Geneva, Switzerland
| | - Johannes Zenk
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Augsburg, Sauerbruchstraße 6, 86179, Augsburg, Germany.,Multidisciplinary Salivary Gland Society, Geneva, Switzerland
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Psychogios G, Bohr C, Constantinidis J, Canis M, Vander Poorten V, Plzak J, Knopf A, Betz C, Guntinas-Lichius O, Zenk J. Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors. Eur Arch Otorhinolaryngol 2020; 278:15-29. [DOI: 10.1007/s00405-020-06250-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
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17
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Moore MG, Yueh B, Lin DT, Bradford CR, Smith RV, Khariwala SS. Controversies in the Workup and Surgical Management of Parotid Neoplasms. Otolaryngol Head Neck Surg 2020; 164:27-36. [PMID: 32571148 DOI: 10.1177/0194599820932512] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Parotid neoplasms are a rare heterogeneous group of tumors with varied clinical presentation and behavior. Here we provide an evidence-based review of the contemporary approach to evaluation and surgical management of parotid tumors. DATA SOURCE PubMed and Web of Science Databases. REVIEW METHODS Searches of the PubMed and Web of Science databases were performed on subjects related to the diagnosis and surgical management of parotid neoplasms. Particular emphasis was placed on the following areas: evaluation of parotid tumors, including imaging workup and the utility of fine-needle aspiration; extent of surgery of the primary lesion, including the extent of parotidectomy as well as oncologic management of the facial nerve; the extent of surgery of involved and at-risk cervical lymphatics; and parotid bed reconstruction. Articles published from 2014 to the present were prioritized, supplementing with information from prior studies in areas where data are lacking. CONCLUSION A summary of the literature in these areas is outlined to provide an evidence-based approach to evaluation and management of parotid neoplasms. IMPLICATIONS FOR PRACTICE While data are available to help guide many aspects of workup and management of parotid neoplasms, further research is needed to refine protocols for this heterogeneous group of diseases.
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Affiliation(s)
- Michael G Moore
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bevan Yueh
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Derrick T Lin
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | | | | | - Samir S Khariwala
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Schapher M, Koch M, Goncalves M, Mantsopoulos K, Iro H. Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow-up. Laryngoscope 2020; 131:E445-E451. [PMID: 32396221 DOI: 10.1002/lary.28696] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/17/2020] [Accepted: 04/01/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess long-term results after the treatment of parotid pleomorphic adenomas (PPAs) using different surgical techniques and focusing on recurrence rates and the risk of adverse effects. STUDY DESIGN Retrospective analysis. METHODS Retrospective analysis of 182 patients treated exclusively for PPAs at a tertiary referral center between 2000 and 2004. Thorough follow-up examinations over a mean period of 13 years were possible in 53.8% (n = 98/182). Tumors were categorized according to the European Salivary Gland Society (ESGS) system to improve the comparison of outcomes. After different surgical resection strategies, recurrence rates, postoperative facial nerve paresis (FNP), and incidence of Frey's syndrome were assessed. The follow-up period included clinical examinations and imaging of every patient in the treating department. RESULTS Of 182 patients, extracapsular dissection (ED) was performed in 29.7%, and other surgical modalities (OSMs), including facial nerve dissection, in 70.3%. After the long-term follow-up, 98% of all the patients (n = 96/98) were recurrence free. When recurrence rates were compared, no significant differences were noted (P < .331). ED resulted in significantly lower FNP rates compared to OSMs (P < .001). FNP rates significantly increased with size and location of the tumors according to ESGS categories (temporary and permanent FNP, P = .04). Surgical invasiveness corresponded to a significant increase in the incidence of Frey's syndrome (P < .001). CONCLUSIONS ED was associated with the lowest complication rates, but not with a higher risk of recurrence, when compared with OSM in the long-term course. As ED can be performed in the majority of PPAs, it can be regarded as the treatment of choice whenever possible. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E445-E451, 2021.
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Affiliation(s)
- Mirco Schapher
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
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Psychogios G, Vlastos I, Thölken R, Zenk J. Warthin’s tumour seems to be the most common benign neoplasm of the parotid gland in Germany. Eur Arch Otorhinolaryngol 2020; 277:2081-2084. [DOI: 10.1007/s00405-020-05894-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/28/2020] [Indexed: 01/09/2023]
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