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Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope 2020; 131:571-579. [PMID: 32678921 DOI: 10.1002/lary.28912] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report descriptive statistics for minor parotidectomy complications. METHODS A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
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Affiliation(s)
- Silvia Lambiel
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pavel Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.,Center for Otorhinolaryngology-Maxillofacial and Head and Neck Surgery, La Tour Hospital, La Tour Medical Group, Meyrin, Switzerland
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Dulguerov P, Todic J, Pusztaszeri M, Alotaibi NH. Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables. Front Surg 2017; 4:26. [PMID: 28555187 PMCID: PMC5430411 DOI: 10.3389/fsurg.2017.00026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/19/2017] [Indexed: 01/24/2023] Open
Abstract
Background The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy. Methods A systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data. Results Pathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage. Conclusion Myxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences.
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Affiliation(s)
- Pavel Dulguerov
- Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Jelena Todic
- Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Marc Pusztaszeri
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Naif H Alotaibi
- Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
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Classification of parotidectomies: a proposal of the European Salivary Gland Society. Eur Arch Otorhinolaryngol 2016; 273:3307-12. [DOI: 10.1007/s00405-016-3916-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/01/2016] [Indexed: 11/26/2022]
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Su A, Apple SK, Moatamed NA. Pleomorphic adenoma of the vulva, clinical reminder of a rare occurrence. Rare Tumors 2012; 4:e16. [PMID: 22532914 PMCID: PMC3325743 DOI: 10.4081/rt.2012.e16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/06/2012] [Accepted: 02/02/2012] [Indexed: 11/29/2022] Open
Abstract
Pleomorphic adenoma, also known as mixed tumor, is a benign tumor which typically presents as a painless and persistent mass. The majority of pleomorphic adenomas involve the salivary glands, most commonly the parotid gland. Other sites include breast and skin. It is a rare tumor in the vulva. In this article we are reporting a case of pleomorphic adenoma of labia with characteristic pathologic and clinical findings, as reminder of a common benign neoplasm occurring with rare locality.
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Affiliation(s)
- Albert Su
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Fukushima M, Miyaguchi M, Kitahara T. Extracapsular dissection: minimally invasive surgery applied to patients with parotid pleomorphic adenoma. Acta Otolaryngol 2011; 131:653-9. [PMID: 21254958 DOI: 10.3109/00016489.2010.543148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS We performed extracapsular dissection (ECD) on 31 patients with pleomorphic adenoma, including 7 deep lobe cases. ECD is minimally invasive and has limited complications compared with other conventional parotidectomy procedures. This is the first report on performance of ECD in patients with deep lobe parotid pleomorphic adenomas. Surgeons who are capsule-conscious can perform ECD with good results. OBJECTIVE Pleomorphic adenoma, the most common benign neoplasm occurring in the parotid gland, has a constant frequency of recurrence and facial paralysis in patients after surgery. ECD is one of the surgical procedures performed on patients with these tumors, but its validity is still unclear because of its similarity to enucleation. METHODS We performed ECD in patients with untreated parotid neoplasms that were clinically diagnosed as benign before surgery. Of these, resected samples from 31 patients were histologically diagnosed as pleomorphic adenoma. RESULTS We achieved resection in patients with pleomorphic adenoma with no permanent facial paralysis or tumor recurrence, with a median follow-up time of 61 months (range 18-125 months).
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology, Head and Neck Surgery, Higashiosaka City General Hospital, Osaka, Japan.
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Nagi Hammed M. Parotid gland tumors in Tobruk, Libya. Libyan J Med 2007; 2:164-5. [PMID: 21503237 PMCID: PMC3078245 DOI: 10.4176/071029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Mohamed Nagi Hammed
- Department of surgery, Faculty of medicine,Omar Almokhtar University Al-Batnan Medical Teaching Center, Tobruk - Libya
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Nagi Hammed M. Parotid gland tumors in Tobruk, Libya. Libyan J Med 2007. [DOI: 10.3402/ljm.v2i4.4724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mohamed Nagi Hammed
- Department of surgery, Faculty of medicine, Omar Almokhtar University Al-Batnan Medical Teaching Center, Tobruk - Libya
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Zbären P, Tschumi I, Nuyens M, Stauffer E. Recurrent pleomorphic adenoma of the parotid gland. Am J Surg 2005; 189:203-7. [PMID: 15720991 DOI: 10.1016/j.amjsurg.2004.11.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Revised: 04/15/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgery of recurrent pleomorphic adenoma presents an increased risk of facial nerve injury and a considerable re-recurrence rate. METHODS A series of 33 patients with first recurrence of pleomorphic adenoma of the parotid gland was analyzed. The data were derived from medical records as well as from interviews and clinical examinations of all living patients. Histologic material of the initial and recurrent tumor were reviewed. RESULTS Multifocal recurrence and carcinoma in pleomorphic adenoma were observed in 73% and 9% of patients, respectively. The incidence of permanent partial facial nerve injury after surgery was 23% in patients with initial enucleation and 14% in those with initial superficial parotidectomy (including 1 patient with facial nerve resection and 1 patient with a partial facial paresis before recurrence surgery). A subsequent recurrence occurred in 6 patients, all with initial enucleation after a mean time interval of 9 years. CONCLUSIONS The preservation of the facial nerve was possible in all but 1 patient treated for the first recurrence with a relatively low rate of permanent partial facial paresis because of the use of the operating microscope and facial nerve monitor. To evaluate the re-recurrence rate, a follow-up of at least 10 years is necessary.
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Affiliation(s)
- Peter Zbären
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, University of Berne, CH-3010 Berne, Switzerland.
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Piekarski J, Nejc D, Szymczak W, Wronski K, Jeziorski A. Results of extracapsular dissection of pleomorphic adenoma of parotid gland. J Oral Maxillofac Surg 2004; 62:1198-202. [PMID: 15452805 DOI: 10.1016/j.joms.2004.01.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Current opinion that extracapsular dissection is in fact a euphemism for enucleation prompted us to retrospectively identify all patients in whom the extracapsular dissection technique was used and to critically assess the value of this technique. PATIENTS AND METHODS The study includes all patients who underwent extracapsular dissection of parotid pleomorphic adenoma from 1979 to 2002 in our department (Department of Surgical Oncology, Medical University of Lodz, Poland). Ninety-eight cases were evaluated. Mean tumor diameter was 3.6 cm (range, 1.5 to 10 cm; median, 3 cm). RESULTS In 8 cases (8/98; 8.2%) local recurrence was observed. For the entire group, the probability of living 10 years without the recurrence of the disease was 0.58. The lowest probability of local recurrence was found in patients with tumors larger than 4 to 6 cm in diameter. In these cases, the extensiveness of resection was similar to superficial parotidectomy, which could explain the result. In 13 cases (13/98; 13.3%) capsular exposure was found and consequently microscopic disease was present at the excision margins. In 7 cases (7/98; 7.1%) capsular rupture took place during surgery. The persistent paresis of facial nerve was observed in 8 cases (8/98; 8.2%). CONCLUSION Extracapsular dissection of pleomorphic adenoma is a very demanding technique. Inevitable eventual clinical errors (eg, incomplete resection) lead to unacceptably high incidences of recurrences and complications. We do not advise this technique for the treatment of pleomorphic adenoma.
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Affiliation(s)
- Janusz Piekarski
- Department of Surgical Oncology, Medical University of Lodz, ul. Paderewskiego 4, 93-509 Lodz, Poland.
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Koral K, Sayre J, Bhuta S, Abemayor E, Lufkin R. Recurrent pleomorphic adenoma of the parotid gland in pediatric and adult patients: value of multiple lesions as a diagnostic indicator. AJR Am J Roentgenol 2003; 180:1171-4. [PMID: 12646477 DOI: 10.2214/ajr.180.4.1801171] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Recurrent pleomorphic adenoma of the parotid gland is a significant problem. Rates have been as high as 40% in some series of patients who have undergone surgery for the primary lesion. In the imaging literature, anecdotal case reports show multiple lesions in recurrent pleomorphic adenoma. Our aim was to analyze the imaging of a series of patients to determine the reliability of multiple lesions as a tool in diagnosing recurrent disease. MATERIALS AND METHODS Medical records of the patients with recurrent pleomorphic adenoma of the parotid gland referred to our institution were retrospectively reviewed. Before the second surgery, MR imaging had been performed in 15 patients. We retrospectively reevaluated and scored the MR imaging studies with particular attention paid to the location and number of the lesions and the remaining parotid gland tissue. RESULTS On the basis of imaging findings, eight patients underwent enucleation, superficial parotidectomy had been performed in four patients, and three patients underwent total parotidectomy. For our group, the lesions were multiple in 73.3% of patients. CONCLUSION To our knowledge, we present the first large series of imaging studies in recurrent pleomorphic adenoma of the parotid gland. Our findings show that recurrent pleomorphic adenomas are most likely to be multiple. Such multiplicity of lesions is a reliable diagnostic indicator of recurrent disease.
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Affiliation(s)
- Korgün Koral
- Department of Radiological Sciences, Center for the Health Sciences, UCLA School of Medicine, 650 Charles E. Young Dr., S., Los Angeles, CA 90095, USA
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Phillips PP, Olsen KD. Recurrent pleomorphic adenoma of the parotid gland: report of 126 cases and a review of the literature. Ann Otol Rhinol Laryngol 1995; 104:100-4. [PMID: 7857010 DOI: 10.1177/000348949510400203] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The records of 126 patients with recurrent pleomorphic adenoma of the parotid gland treated at our institution from 1965 to 1985 were retrospectively reviewed. Multiple variables were analyzed to determine tumor behavior and treatment results. Of the study patients, 61% were female and 39% male, with a mean age of 35.6 years at the time of treatment at our institution. The average follow-up period was 14.5 years. Tumor recurrence was 32.5% after one operation at our institution, 7.1% after two operations, and 1.6% after three. Malignant disease occurred in 9 (7.1%) patients. After all surgical procedures, partial facial nerve paralysis was noted in 13.5% and total paralysis in 5.5%. These results suggest low morbidity and good success in tumor eradication with an aggressive surgical approach.
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Affiliation(s)
- P P Phillips
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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Abstract
Two hundred fifteen patients (74.14%) with benign tumors and 75 patients (25.86%) with malignant tumors of the salivary glands were analyzed. One hundred eighty-five of these patients were followed for 1 to 20 years postoperatively. Of 150 benign tumors, recurrence was noted in 15 cases (9.75%). The 5-year recurrence rate was 7.82%. With the malignant tumors, recurrence was noted in 16 patients (51.6%). The 5-year recurrence rate was 27.75%.
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Affiliation(s)
- E Z Chang
- Department of Oral Surgery, SouthWestern Hospital, Chungking, Szechuan, People's Republic of China
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Abstract
A series of 336 parotidectomies, carried out for benign disease has been followed for up to 20 years. One hundred and thirty primary pleomorphic adenomas were treated by wide excision of the tumour after identification of the facial nerve. Recurrence occurred in only one patient and, although 20 patients (15 per cent) experienced some degree of facial nerve weakness postoperatively, there was only one case of permanent weakness.
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