1
|
Badger CD, Michel MC, Goodman JF, Thakkar P, Joshi AS. Minimum fascia tumor distance for selection of extracapsular dissection for benign parotid tumors: A preliminary study. Am J Otolaryngol 2021; 42:102776. [PMID: 33125903 DOI: 10.1016/j.amjoto.2020.102776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is increasing literature supporting the use of extracapsular dissection (ECD) for the treatment of select superficial lobe parotid tumors, though no objective criteria for selection has been proposed. Prior studies have suggested the minimum distance between the parotideomasseteric fascia and the tumor edge or minimum fascia-tumor distance (MFTD) as a useful measurement for the identification of superficial parotid tumors. The objective of this study is to demonstrate the utility of the minimum fascia-tumor distance in selecting candidates for extracapsular dissection of benign parotid tumors. METHODS This is a retrospective case-control study at a tertiary academic otolaryngology clinic. Twenty-three patients with prior surgical excision of benign parotid tumors that underwent surgeon-performed ultrasonography prior to excision of tumor were identified. Ultrasound images were reviewed and the minimum fascia-tumor distance was recorded and categorized by less than 3 mm or as 3 mm or greater. The primary outcome was successful completion of extracapsular dissection versus more extensive resection. RESULTS Thirteen patients had a minimum fascia-tumor distance less than 3 mm; eleven of thirteen (84.6%) successfully underwent extracapsular dissection. Ten patients had a minimum fascia-tumor distance of 3 mm or greater; one of ten (10%) successfully underwent extracapsular dissection. A minimum fascia-tumor distance less than 3 mm was sensitive, specific, and accurate in predicting successful ECD at 91.7%, 81.8%, and 87.0% respectively (OR 49.5, 95% CI 3.4-573.2). CONCLUSION Minimum fascia-tumor distance may be a useful measurement in identifying candidates for removal of benign parotid tumors with extracapsular dissection.
Collapse
|
2
|
Koch M, Iro H. Salivary duct stenosis: diagnosis and treatment. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:132-141. [PMID: 28516976 PMCID: PMC5463521 DOI: 10.14639/0392-100x-1603] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
The management of stenoses of the major salivary glands had undergone a significant change during the last 15-20 years. Accurate diagnosis forms the basis of adapted minimal invasive therapy. Conventional sialography and MR-sialography are useful examination tools, and ultrasound seems to be a first-line investigational tool if salivary duct stenosis is suspected as cause of gland obstruction. Sialendoscopy is the best choice to establish final diagnosis and characterise the stenosis in order to plan accurate treatment. In all major salivary glands, inflammatory stenosis can be distinguished from fibrotic stenosis. In the parotid duct system, an additional stenosis associated with various abnormalities of the duct system has been reported. Conservative therapy is not sufficient in the majority of cases. The development of a minimally invasive treatment regime, in which sialendoscopy plays a major role, has made the preservation of the gland and its function possible in over 90% of cases. Ductal incision procedures are the most important measure in submandibular duct stenoses, but sialendoscopy becomes more important in the more centrally located stenoses. Sialendoscopic controlled opening and dilation is the dominating method in parotid duct stenoses. In 10-15% of cases, success can be achieved after a combined treatment regime had been applied. This review article aims to give an overview on the epidemiology, diagnostics and current state of the art of the treatment of salivary duct stenoses.
Collapse
Affiliation(s)
- M Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen, Nuremberg, Germany
| | - H Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen, Nuremberg, Germany
| |
Collapse
|
3
|
Konstantinidis I, Chatziavramidis A, Constantinidis J. Conservative management of bilateral pneumoparotitis with sialendoscopy and steroid irrigation. BMJ Case Rep 2014; 2014:bcr-2013-201429. [PMID: 25355739 DOI: 10.1136/bcr-2013-201429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pneumoparotitis is a rare condition related to retrograde airflow into the ductal system of the gland and secondary infections. Although counselling is enough in the majority of cases, persistent problems require surgery. Sialendoscopy and ductal irrigation with steroids have never been described as a treatment option. We present the case of a 61-year-old man with recurrent bilateral parotid swellings who had three episodes of sialadenitis on the right side within 2 years. Massage of the glands revealed air bubbles coming out from both papillae. A previous CT scan confirmed the presence of air in both parotid glands. The patient underwent sialendoscopy and irrigation of the ductal system with prednisolone. Ductal irrigation with steroids in three additional sessions led to a significant improvement of symptoms 6 months later. Sialendoscopy and irrigation with steroids could be another treatment modality in cases of recurrent pneumoparotitis avoiding major surgery.
Collapse
Affiliation(s)
- Iordanis Konstantinidis
- 2nd Academic ENT Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Angelos Chatziavramidis
- 2nd Academic ENT Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Jannis Constantinidis
- 2nd Academic ENT Department, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| |
Collapse
|
4
|
The Treatment of Large Sialoliths by Sialendoscopic Combined Approach. J Oral Maxillofac Surg 2014; 72:737-43. [DOI: 10.1016/j.joms.2013.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/29/2013] [Accepted: 09/02/2013] [Indexed: 11/22/2022]
|
5
|
Carroll WW, Walvekar RR, Gillespie MB. Transfacial ultrasound-guided gland-preserving resection of parotid sialoliths. Otolaryngol Head Neck Surg 2012; 148:229-34. [PMID: 23239807 DOI: 10.1177/0194599812471514] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Review surgical techniques and outcomes of ultrasound-guided, transfacial, gland-preserving removal of difficult parotid stones. STUDY DESIGN Case series with chart review. SETTING Two academic tertiary care centers. METHODS Patients who underwent ultrasound-guided, combined transfacial-endoscopic operation for symptomatic parotid sialolithiasis from June 2010 through June 2012 at 2 tertiary care university hospitals were evaluated. Outcome measurements included stone size, stone location, complications, symptom relief, and gland preservation rate. RESULTS A total of 14 patients underwent ultrasound-guided, transfacial operation for symptomatic parotid sialolithiasis. Ten of 14 patients (71%) had completely successful therapy defined by no symptoms postoperatively with a preserved, functional gland. Three of the 4 patients without complete symptom resolution did endorse symptom improvement, whereas the fourth patient eventually underwent parotidectomy. Needle localization was used to aid in transfacial stone retrieval in 57% of cases. CONCLUSION Ultrasound-guided, combined transfacial-endoscopic removal of certain parotid stones is an alternative to parotidectomy for patients in whom endoscopy or shock wave therapy for stone retrieval is ineffective, unavailable, or contraindicated. Needle localization is a useful adjunct in stone retrieval.
Collapse
Affiliation(s)
- William W Carroll
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425-5500, USA.
| | | | | |
Collapse
|
6
|
Wang SJ, Eisele DW. Parotidectomy-Anatomical considerations. Clin Anat 2011; 25:12-8. [DOI: 10.1002/ca.21209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 04/08/2011] [Accepted: 05/01/2011] [Indexed: 11/07/2022]
|
7
|
Koch M, Zenk J, Iro H. Algorithms for Treatment of Salivary Gland Obstructions. Otolaryngol Clin North Am 2009; 42:1173-92, Table of Contents. [DOI: 10.1016/j.otc.2009.08.002] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
8
|
Koch M, Iro H, Zenk J. Role of sialoscopy in the treatment of Stensen's duct strictures. Ann Otol Rhinol Laryngol 2008; 117:271-8. [PMID: 18478836 DOI: 10.1177/000348940811700406] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The origin of strictures of Stensen's duct often remains unclear, but chronic recurrent parotitis may be one associated disease. Failure of conservative therapy leads to a recommendation of parotidectomy in a high percentage of cases. Nowadays, development of new, minimally invasive methods may lead to a fundamental change in the treatment regimen. METHODS We retrospectively evaluated 39 patients who presented with symptomatic strictures of Stensen's duct from 2002 to 2005. Sialoscopy was performed with semirigid endoscopes. Therapy consisted of irrigation and intraductal infusion of cortisone. If possible, interventional sialoscopy was carried out as the first-line procedure. If indicated, operative procedures of the duct were performed. RESULTS After irrigation and intraductal medication, 17.9% of the patients were free of symptoms. Interventional sialoscopy was carried out in 74.4%, with a success rate of 75.9%. Operative duct procedures (extended papillotomy or resection of papilla stricture with duct reinsertion) were carried out in 23% of cases. In 5.1% of the total cases, parotidectomy was unavoidable. CONCLUSIONS Sialoscopy-based methods play a central role in gland-preserving treatment of strictures of Stensen's duct. Sialoscopy has proven to be a fast, useful, and relatively safe therapeutic tool with a high success rate. Parotidectomy is the last choice in symptomatic cases.
Collapse
Affiliation(s)
- Michael Koch
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | |
Collapse
|
9
|
Patel RS, Low THH, Gao K, O'Brien CJ. Clinical Outcome After Surgery for 75 Patients With Parotid Sialadenitis. Laryngoscope 2007; 117:644-7. [PMID: 17415134 DOI: 10.1097/mlg.0b013e318030acc0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the clinical outcome of patients treated surgically for chronic parotid sialadenitis. STUDY DESIGN A retrospective cohort study of patients whose clinicopathologic information had been collected prospectively onto a dedicated head and neck database. METHODS Between 1987 and 2006, a total of 75 patients had 78 parotidectomies, 17 superficial and 61 near-total, to treat chronic parotid sialadenitis. The clinicopathologic data including treatment morbidity and outcome were analyzed. RESULTS Temporary postoperative facial weakness occurred in 26 (33%) patients, and this was permanent, although partial, in one (1%) patient. There was no significant difference (P > .05) in the incidence of temporary facial nerve neuropraxia in the superficial (35%) and near-total parotidectomy (33%) groups. Recurrence of symptoms was noted in two patients who had undergone near-total parotidectomy and none of the patients who had undergone superficial parotidectomy. Chronic parotid sialadenitis was effectively treated in 97% of patients undergoing parotidectomy. CONCLUSION Near-total parotidectomy is a safe and efficacious surgical treatment in the management of patients with debilitating severe chronic parotid sialadenitis.
Collapse
Affiliation(s)
- Rajan S Patel
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, New South Wales, Australia.
| | | | | | | |
Collapse
|
10
|
Guntinas-Lichius O, Klussmann JP, Wittekindt C, Stennert E. Parotidectomy for benign parotid disease at a university teaching hospital: outcome of 963 operations. Laryngoscope 2006; 116:534-40. [PMID: 16585855 DOI: 10.1097/01.mlg.0000200741.37460.ea] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE/HYPOTHESIS The objective of this study was to analyze the perioperative and long-term complications after standardized lateral and total parotidectomy for benign parotid tumors and chronic parotitis with special regard on the training skill of the surgeons at a university teaching center. All teaching operations were performed under strict microscopic control and supervision of experienced surgeons. STUDY DESIGN The authors conducted a retrospective unicentric study in a tertiary university center. METHODS Medical records of 963 lateral and total parotidectomies treated from 1986 to 2004 were analyzed with regard to perioperative and long-term complications. The surgeons' expertise to perform a parotidectomy was classified as beginner (0-20 parotidectomies performed), advanced (21-50), experienced (51-100), or highly experienced (>100). RESULTS Eighty-five percent of the cases were primary operations (85%) and 15% revision operations. A lateral parotidectomy was necessary in 61% and total parotidectomy in 39%. The mean operation time was 192 minutes. The incidence of transient facial nerve dysfunction was 25%, and 6% for permanent weakness, respectively. Treatment for Frey's syndrome was performed in 5%. First recurrence for pleomorphic adenoma was observed in 2% and for Warthin's tumor in 3%. Significantly more complications were seen after total parotidectomy and in revision cases. Beginners and advanced surgeons (operated 41% of the cases) needed a longer operation time than experienced and highly experienced surgeon (59% of the cases). The surgeon's expertise had no influence on the incidence of complications. CONCLUSIONS Standardized education in lateral and total parotidectomy for treatment of benign parotid disease under precise microscopic control is safe, demonstrates good results, and has low perioperative and long-term morbidity.
Collapse
Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Koeln, Germany.
| | | | | | | |
Collapse
|
11
|
Baurmash HD. Chronic recurrent parotitis: a closer look at its origin, diagnosis, and management. J Oral Maxillofac Surg 2004; 62:1010-8. [PMID: 15278868 DOI: 10.1016/j.joms.2003.08.041] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
12
|
Nahlieli O, Bar T, Shacham R, Eliav E, Hecht-Nakar L. Management of chronic recurrent parotitis: Current therapy. J Oral Maxillofac Surg 2004; 62:1150-5. [PMID: 15346370 DOI: 10.1016/j.joms.2004.05.116] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Oded Nahlieli
- Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel.
| | | | | | | | | |
Collapse
|
13
|
Fattahi TT, Lyu PE, Van Sickels JE. In Reply:. J Oral Maxillofac Surg 2002. [DOI: 10.1053/joms.2002.35022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
14
|
Affiliation(s)
- Tirbod T Fattahi
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, KY 40536-0297, USA
| | | | | |
Collapse
|
15
|
Abstract
BACKGROUND Chronic parotitis, or CP, is a nonspecific sialadenitis that often is seen first in the dental office. The cause, although not definitively determined, is most likely multifactorial and includes decreased salivation, stasis and an ascending retrograde duct infection. The authors present a case report to illustrate the symptomatology of CP to facilitate its differentiation from other entities that mimic CP. CASE DESCRIPTION A 60-year-old woman with a 30-year history of recurrent swellings of her left parotid gland was diagnosed with CP. The diagnosis was based on history, clinical examination, salivary volume and chemistry, computerized tomographic scan and sialography. Treatment was palliative in nature. CLINICAL IMPLICATION As a member of the health care team, the dentist must be familiar with the various causes of recurrent parotid infections. Early clinical recognition of CP leads to appropriate and successful care.
Collapse
Affiliation(s)
- L Mandel
- Salivary Gland Center, and Division of Oral and Maxillofacial Surgery, Columbia University School of Dental and Oral Surgery, New York, NY 10032, USA
| | | |
Collapse
|
16
|
Amin MA, Bailey BM, Patel SR. Clinical and radiological evidence to support superficial parotidectomy as the treatment of choice for chronic parotid sialadenitis: a retrospective study. Br J Oral Maxillofac Surg 2001; 39:348-52. [PMID: 11601814 DOI: 10.1054/bjom.2001.0671] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a retrospective series of 23 consecutive parotidectomies, over a 10-year period (1989-1999) for 22 patients with chronic sialadenitis unresponsive to conservative measures. There were 10 male and 12 female patients. Mean age was 52 years (range 12-72), and mean duration of symptoms 4.5 years (range 8 months-30 years). All patients had preoperative sialography and 2 had computed tomography to exclude a neoplasm. A complete superficial parotidectomy with preservation of the main duct was done in all cases. Fifteen patients developed temporary facial nerve weakness postoperatively and 7 developed Frey's syndrome. There were no cases of permanent facial nerve palsy. Nineteen patients reported complete resolution of their symptoms and 3 patients had mild persisting symptoms that did not necessitate any further treatment. Histologically there was evidence of sialadenosis in one case and benign lymphoepithelial lesion in another; the others showed evidence of chronic sialadenitis of varying degrees of severity. Fifteen patients had postoperative sialograms, of which 11 showed evidence of some filling of residual parotid gland parenchyma and in 8 patients there was filling of a normal-looking accessory lobe. In this series, superficial parotidectomy with preservation of the main duct was safe and effective, with minimal long-term complications, for most patients with chronic parotid sialadenitis that was unresponsive to conservative measures and, in some patients, it allowed some preservation of function. The potential damage to the facial nerve and the cosmetic problems associated with a total or near-total parotidectomy were avoided.
Collapse
Affiliation(s)
- M A Amin
- SW London Maxillofacial Service, Queen Mary's University Hospital, Roehampton, London, UK
| | | | | |
Collapse
|
17
|
Affiliation(s)
- C C Whitelaw
- Department of Pediatrics, University of Louisville School of Medicine, KY 40292, USA.
| | | |
Collapse
|
18
|
Bates D, O'Brien CJ, Tikaram K, Painter DM. Parotid and submandibular sialadenitis treated by salivary gland excision. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:120-4. [PMID: 9494003 DOI: 10.1111/j.1445-2197.1998.tb04720.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of the present study was to compare and contrast the clinicopathological features and treatment outcome of chronic sialadenitis involving the parotid and submandibular glands, among patients who were treated by excision of the affected gland. METHODS In a series of 88 patients treated over an 8-year period, 47 had parotid sialadenitis and 41 had submandibular sialadenitis. In the parotid group, 63% of patients were symptomatic for longer than 6 months compared with 27% in the submandibular group. Calculi were implicated in the disease process in 24% of patients with parotid sialadenitis, compared with 73% of patients with submandibular disease. RESULTS Patients with parotid sialadenitis had superficial (n = 14) or near-total parotidectomy (n = 35), while those with submandibular sialadenitis underwent total gland excision. Complications occurred twice as frequently in the parotidectomy group. The rate of temporary facial nerve weakness was 29% after parotidectomy while marginal mandibular nerve dysfunction occurred after 12% of submandibular excisions. Both procedures were highly effective in permanently relieving the symptoms of sialadenitis. CONCLUSIONS Parotid sialadenitis is infrequently associated with stones and tends to run a longer course before surgical intervention is necessary. Submandibular sialadenitis usually presents earlier, is secondary to calculi and requires early intervention.
Collapse
Affiliation(s)
- D Bates
- Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
19
|
|
20
|
O'Brien CJ, Malka VB, Mijailovic M. Evaluation of 242 consecutive parotidectomies performed for benign and malignant disease. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1993; 63:870-7. [PMID: 8216065 DOI: 10.1111/j.1445-2197.1993.tb00362.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between 1987 and 1992, one surgeon performed 242 parotidectomies in 229 patients. Among 97 patients with benign disease, pleomorphic adenoma (46) and sialo-adenitis (28) predominated, while metastatic melanoma (22) and squamous cell carcinoma (21) were the most common diagnoses among 132 patients with malignancy. The extent of parotidectomies were: 114 'appropriate' resections, 77 complete superficial parotidectomies, 35 near-total conservative and 14 radical total resections. The facial nerve was sacrificed in 19 operations and reconstructed in four. One hundred and five patients had a concomitant neck dissection and 45 patients had adjuvant radiotherapy. Postoperative facial nerve function was normal in 90% of patients with localized tumours and 55% of patients overall. Patients with sialo-adenitis or deep lobe tumours and those having a neck dissection were at greatest risk of facial weakness despite nerve preservation. At a median follow up of 34 months, 13 patients had developed tumour recurrence and attempts at salvage surgery have generally been disappointing.
Collapse
Affiliation(s)
- C J O'Brien
- Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | |
Collapse
|