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Murugan RS, Maniam R, Dhanasekarapandiyan V, Hariharan G. Characteristics, Surgical Management, and Outcomes of Parotid Gland Masses in the Pediatric Age Group: A Single Tertiary Institute Experience. J Indian Assoc Pediatr Surg 2023; 28:415-420. [PMID: 37842213 PMCID: PMC10569271 DOI: 10.4103/jiaps.jiaps_100_23] [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: 05/06/2023] [Revised: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 10/17/2023] Open
Abstract
Context Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children have different characteristics from those that occur in adults. When they occur in the pediatric age group, malignancy has to be ruled out. Subjects and Methods This is a retrospective study of children who presented to our institute, a tertiary care referral hospital for children <12 years, with parotid swellings during the 5-year period between April 2018 and March 2023. The children who underwent surgical management for parotid lesions, in the form of parotidectomy, were included in the study. Children who were treated by nonoperative management were excluded from the study. Results Twelve children were included. Of the 12 children, three (25.0%) children had malignancy, four (33.33%) children had benign tumors, three (25.0%) children had vascular malformations, and the remaining two (16.67%) children had inflammatory etiology. All children underwent superficial/total parotidectomy, depending on the involvement of superficial and/or deep lobe. Of the three malignant parotid tumors, two were of mucoepidermoid carcinoma and one was myoepithelial carcinoma. One of the children with mucoepidermoid carcinoma had recurrence. Conclusions Facial nerve-sparing parotidectomy is the treatment for neoplastic and inflammatory lesions. Initially, lymphovascular tumors were treated aggressively with parotidectomy. Neck node dissection should be performed only in children with fine-needle aspiration cytology-confirmed nodal metastases during primary surgery. Adjuvant treatment may be required in selected cases.
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Affiliation(s)
- Raghunath Sambandam Murugan
- Department of Paediatric Surgery, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India
| | - Raghul Maniam
- Department of Paediatric Surgery, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India
| | - Vembar Dhanasekarapandiyan
- Department of Paediatric Surgery, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India
| | - G. Hariharan
- Department of Paediatric Surgery, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India
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2
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Crawford KL, Lee YJ, Hom M, Rosenthal EL, Orosco RK, Nguyen QT. Identification of Degenerated Murine Facial Nerves With Fluorescence Labeling After Transection Injury. Otolaryngol Head Neck Surg 2023; 169:234-242. [PMID: 36758958 DOI: 10.1002/ohn.262] [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: 08/22/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Delayed peripheral nerve repair is complicated by nerve degeneration and atrophy that can prevent identification. We use a murine facial nerve transection model to demonstrate the efficacy of ALM-488 (bevonescein) in labeling degenerated facial nerves with quantitative image analysis and qualitative survey data. STUDY DESIGN Prospective cohort study. SETTING Laboratory. METHODS Ten wild-type mice underwent transection of the lower facial nerve division with subsequent degeneration. Either 9 (n = 5 mice) or 12 (n = 5 mice) weeks later, mice underwent intravenous infusion of ALM-488 with in vivo real-time fluorescence imaging (FL) of the facial nerve. Using ImageJ, the mean gray value of each nerve segment under white light reflectance (WLR) and FL was compared to that of adjacent soft tissue to calculate the signal-to-background ratio (SBR). A survey was distributed to evaluate the perceived utility of ALM-488 in surgeon identification of degenerated nerves. RESULTS The mean SBR of degenerated nerves was 1.08 (standard deviation [SD]: 0.07) under WLR and 2.11 (SD: 0.31) under FL (p < 0.001). In mice with degenerated nerves, survey participants identified on average 3.01 (SD: 1.84) nerve branches under WLR and 5.73 (SD: 1.88) under FL (p < 0.0001). Under FL, 47 of 48 survey responses correctly identified isolated, degenerated nerves; in contrast, only 12 responses identified degenerated nerves under WLR (p < 0.0001). CONCLUSION Preoperative intravenous infusion of ALM-488 with FL improves the identification of degenerated facial nerves. ALM-488 also improves surgeon confidence in nerve identification, particularly in degenerated nerve branches that are not visible with WLR.
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Affiliation(s)
- Kayva L Crawford
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Marisa Hom
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Ryan K Orosco
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
- Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California San Diego, California, San Diego, USA
| | - Quyen T Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
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3
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Xu W, Zhang X, Wu Y, Zhu Y, Liu S, Lu H, Yang W. Recurrent pleomorphic adenoma of the parotid gland: A population-based study with emphasis on re-recurrence and malignant transformation. Head Neck 2023; 45:697-705. [PMID: 36563305 DOI: 10.1002/hed.27286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to analyze the prognostic determinants for re-recurrence and malignant transformation of parotid recurrent pleomorphic adenoma (RPA). METHODS Between January 2011 and December 2020, all the cases of RPA of the parotid gland at our single institution were reviewed. RESULTS A total of 168 patients were included in this study, with a median age of 41.5 years, and 20 (11.9%) patients developed re-recurrence during follow-up. It has been evidenced that recurrence times (single or multiple) was an independent prognostic factor for recurrence-free survival (p = 0.0264). A total of 26 (15.48%) patients experienced malignant transformation of parotid RPA, and older age (>45 year old), male sex, and higher clinical tumor staging (T3-T4) were significantly associated with malignant transformation of parotid RPA. CONCLUSIONS Recurrence times was an independent prognostic factor for re-recurrence of parotid RPA, and older male with high T-stage may more easily develop malignant transformation.
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Affiliation(s)
- Wanlin Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xu Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yifan Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yun Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shengwen Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hao Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wenjun Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
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Younes A, Taher MF, Sidhom I, Zekri W, Zaky I, Elfendy H, Taher AN, Khedr SA, Gamal R, Ahmed G. Parotid gland masses: outcomes in the pediatric age group. J Egypt Natl Canc Inst 2023; 35:2. [PMID: 36740629 DOI: 10.1186/s43046-023-00161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/12/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Childhood parotid neoplasms appear to have different characteristics from adults. This point, in addition to the rarity of these tumors, reflects the challenges faced in diagnosing and treating parotid neoplasms in children. PATIENTS AND METHODS This retrospective study included all children who presented to the Children's Cancer Hospital Egypt (CCHE, 57357) with parotid masses from January 2008 to December 2020. RESULTS Twenty-one patients were included. Malignant neoplasms were found in 12 (57.1%) of which mucoepidermoid carcinoma was the most common. Benign neoplasms were found in 6 (28.6%) all of them were pleomorphic adenoma, and non-neoplastic lesions were found in 3 (14.3%). Superficial, deep, or total parotidectomy was performed according to the involved lobes. The facial nerve was sacrificed in three cases because of frank invasion by the tumor. Neck dissection was considered in clinically positive lymph nodes and/or T3/4 masses. Complications occurred in 7 (33.3%) all were of the malignant cases. Adjuvant radiotherapy was restricted to high-risk cases (7 cases). Recurrence occurred in two cases, and one patient died of distant metastasis. Fine needle aspiration cytology (FNAC) showed 88.9% sensitivity and 100% specificity for diagnosing malignant neoplasms. The correlation of radiological and pathological staging was fair (66.74% for overall staging). CONCLUSIONS Parotidectomy is the backbone treatment for benign and malignant pediatric parotid tumors. Neck nodal dissection should be considered after preoperative FNAC of suspicious nodes. Adjuvant radiotherapy is considered only in high-risk tumors. Preoperative FNAC of parotid masses and clinically suspicious lymph nodes is highly recommended.
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Affiliation(s)
- Alaa Younes
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Surgical Oncology, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Mohammad Fouad Taher
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt. .,Department of Surgical Oncology, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt.
| | - Iman Sidhom
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Pediatric Oncology, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Wael Zekri
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Pediatric Oncology, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Iman Zaky
- Department of Radiodiagnosis, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Radiodiagnosis, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Habiba Elfendy
- Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Pathology, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Azza Niazy Taher
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Radiation Oncology, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Suzan Adlan Khedr
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Rana Gamal
- Department of Clinical Research, Children Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Gehad Ahmed
- Department of General Surgery, Faculty of Medicine, Helwan University, Helwan, Egypt
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5
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Recurrent Pleomorphic Adenoma of the Parotid Gland: Experience of 128 Patients with First Recurrence. JOURNAL OF ONCOLOGY 2020; 2020:6645340. [PMID: 33424971 PMCID: PMC7775151 DOI: 10.1155/2020/6645340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 11/17/2022]
Abstract
Objective Recurrence is common after inappropriate surgical procedures for parotid pleomorphic adenoma (PA). However, there are some controversies regarding intraoperative tumor rupture and disease recurrence; therefore, our goal was to clarify this relationship by describing our experience with 128 cases of recurrent parotid PA. Methods Patients suffering from a first recurrence of parotid PA were prospectively enrolled, and data regarding the operation, pathology, immunohistochemistry, and recurrence pattern (outside the previous surgical field vs. inside the previous surgical field) were extracted and analyzed. The recurrent lesions were divided into two groups based on the location of nodularity. Results Thirty-five patients had recurrent disease outside the previous surgical field; there were 105 nodules with a mean size of 1.0 (range: 0.4-3.0) cm and 983 nodules with a mean size of 1.55 (range: 0.5-4.5) cm within the field, and the difference was significant (p=0.001). The mean values of Ki-67 in nodules outside of and within the previous surgical field were 4.7% (range: 2%-10%) and 2.1% (range: 1%-7%), respectively, and the difference was significant (p < 0.001). In nodules outside the previous surgical field, cell-rich nodules were noted in 71.6% of cases; in nodules within the previous surgical field, cell-rich nodules were found in 30.4% of cases, and the difference was significant (p < 0.001). Conclusion Tumor rupture is not the only cause of disease recurrence, and recurrent PAs outside the previous surgical field are smaller in size, have higher Ki-67 expression, and have more cell-rich nodules than those within the surgical scar.
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Rooker SA, Van Abel KM, Yin LX, Nagelschneider AA, Price DL, Olsen KD, Janus JR, Kasperbauer JL, Moore EJ. Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland. Head Neck 2020; 43:1088-1096. [PMID: 33275822 DOI: 10.1002/hed.26570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/26/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recurrent pleomorphic adenoma (PA) can be a lifelong disease, and rates of subsequent recurrence are high. METHODS Patients between 2000 and 2015 were identified. Primary outcome was subsequent recurrence after surgical salvage. RESULTS Twenty-seven of 84 patients developed a subsequent recurrence. Risk factors for subsequent recurrence included a higher number of previous recurrences (P < .01), worse preoperative facial nerve function (P < .01), and deep parotid lesion(s) (P < .01). Interval since last surgery was protective (P < .01), specifically >10 years since last surgery (P < .01). For patients with a >10-year interval since their last surgery, the subsequent recurrence-free rate at 10 years follow-up was 80.2% vs 31.8%. CONCLUSIONS For patients presenting with a >10-year interval since their last surgery, subsequent recurrence rates are low, which may allow for as needed surveillance recommendations. For patients presenting with recurrent PA and ≤10 years since their last surgery, a closer surveillance is warranted.
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Affiliation(s)
- Steven A Rooker
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel L Price
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D Olsen
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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7
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Rooker SA, Nagelschneider AA, Moore EJ, Yin LX, Price DL, Janus JR, Kasperbauer JL, Van Abel KM. Recurrent pleomorphic adenoma of the parotid gland: A comparison of radiographic and pathologic tumor burden. Am J Otolaryngol 2020; 41:102642. [PMID: 32682193 DOI: 10.1016/j.amjoto.2020.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare recurrent pleomorphic adenoma tumor burden as detected on magnetic resonance and computerized tomography imaging with postoperative histopathology. MATERIALS AND METHODS 44 patients were identified at a tertiary medical center between 2000 and 2015. Patients were included if they had viewable preoperative imaging and a postoperative diagnosis of recurrent pleomorphic adenoma. Primary outcomes were differences in the number and size of lesions detected on imaging and pathology. RESULTS The size in greatest dimension between pathology and imaging was not significant on aggregate MRI + CT (p = 0.78), MRI (p = 0.41), or CT (p = 0.69). There were more lesions found on pathology compared to both aggregate MRI + CT (p = 0.003) and CT alone (p = 0.014). The number of lesions between MRI and pathology failed to reach significance (p = 0.06). On univariate analysis, the interval between imaging and pathology (recurrent surgery) did not significantly affect the number of lesions detected (p = 0.18). On multivariable analysis, CT as the primary imaging modality and >1 recurrence was independently associated with greater inaccuracy with respect to number of lesions detected (p = 0.006; p = 0.008). CONCLUSION The size of the largest lesion on pathology can be accurately determined with imaging. Compared to MRI, CT scans significantly underpredict the number of lesions found on pathology. MRI should be prioritized unless contraindications exist. These findings will help guide imaging choice, preoperative planning, and patient counseling.
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Yin LX, Van Abel KM, Rooker SA, Nagelschneider AA, Olsen KD, Price DL, Janus JR, Kasperbauer JL, Moore EJ. Risk factors for carcinoma ex pleomorphic adenoma in patients presenting with recurrence after resection of pleomorphic adenoma. Head Neck 2020; 43:419-427. [PMID: 33043539 DOI: 10.1002/hed.26489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In patients presenting with recurrent pleomorphic adenoma (rPA), clinical evaluation can fail to recognize carcinoma ex PA (cxPA). We aim to identify the risk factors for cxPA. METHODS This is a single institution retrospective case-control study from 2000 to 2015. CxPA was diagnosed based on surgical pathology. Demographics, clinical, and social histories were collected. RESULTS A number of 13/106 (12.3%) patients were diagnosed with cxPA, of which only 4/13 (31%) had clinical features suspicious for malignancy. Compared to benign rPA, factors associated with cxPA included age >50 (odds ratio [OR] 6.67, 95% confidence interval [CI]: 1.71-25.98, P < .01), >10 pack-years of smoking history (OR 3.36, 95% CI: 1.01-11.14, P = .04), and the largest tumor being >2 cm on pathology (OR 4.42, 95% CI: 1.14-17.10, P = .03). CONCLUSIONS In patients presenting with rPA, risk factors for malignant transformation include age >50, significant smoking history, and tumors larger than 2 cm. Clinical signs of malignancy such as rapid growth or pain are not always present.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven A Rooker
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | | | - Kerry D Olsen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Malard O, Thariat J, Cartier C, Chevalier D, Courtade-Saidi M, Uro-Coste E, Garrel R, Kennel T, Mogultay P, Tronche S, Varoquaux A, Righini CA, Vergez S, Fakhry N. Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part II: Management of recurrent pleomorphic adenoma of the parotid gland. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:45-49. [PMID: 32800715 DOI: 10.1016/j.anorl.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The authors present the guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) for the management of recurrent pleomorphic adenoma (RPA) of the parotid gland. METHOD A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted, based on the articles retrieved and the work group members' individual experience. There were then read and re-edited by an independent reading group. The proposed recommendations were graded A, B or C on decreasing levels of evidence. RESULTS Complete resection under neuromonitoring is recommended in case of RPA. The risks of progression and malignant transformation, which are higher the younger the patient, have to be taken into consideration. The risk of functional sequelae must be explained to the patient. MRI is recommended ahead of any surgery for parotid RPA, to determine extension and detect subclinical lesions. Radiotherapy should be considered in case of multi-recurrent pleomorphic adenoma after macroscopically complete revision surgery at high risk of new recurrence (microscopic residual disease), in case of RPA after incomplete resection, and in non-operable RPA.
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Affiliation(s)
- O Malard
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU Hôtel Dieu, Nantes, France
| | - J Thariat
- Département de Radiothérapie, Centre François Baclesse, Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie Université, Caen, France
| | - C Cartier
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - D Chevalier
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Lille, France
| | - M Courtade-Saidi
- Service d'Anatomie et Cytologie Pathologiques, Institut Universitaire du Cancer de Toulouse Oncopole, Inserm CRCT-Équipe 11, Toulouse, France
| | - E Uro-Coste
- Service d'Anatomie et Cytologie Pathologiques, Institut Universitaire du Cancer de Toulouse Oncopole, Inserm CRCT-Équipe 11, Toulouse, France
| | - R Garrel
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - T Kennel
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - P Mogultay
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - S Tronche
- Société Française d'ORL et Chirurgie Cervico-Faciale, France
| | - A Varoquaux
- Service de radiologie du Pr Chagnaud, Hôpital de la Conception, AP-HM, AMU, Faculté de Médecine Timone CNRS-Center for Magnetic Resonance in Biology and Medicine, France
| | - C A Righini
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Grenoble Alpes (CHUGA), France
| | - S Vergez
- Service d'ORL et de Chirurgie de la Face et du Cou, Hôpital Larrey, CHU de Toulouse, Département de Chirurgie, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - N Fakhry
- Service d'ORL et Chirurgie de la Face et du Cou, Hôpital de la Conception, APHM, Aix-Marseille Université, Marseille, France.
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Valstar MH, Andreasen S, Bhairosing PA, McGurk M. Natural history of recurrent pleomorphic adenoma: implications on management. Head Neck 2020; 42:2058-2066. [PMID: 32187769 DOI: 10.1002/hed.26137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/18/2020] [Accepted: 03/05/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Treating recurrent pleomorphic adenoma (RPA) aims to reduce risk of malignant transformation (MT) while avoiding facial nerve injury. Our objective was to systematically investigate this natural history of RPA and address the current rational for its treatment. METHODS The follow-up data of two nationwide series of PA was pooled with a focus on risk of MT and analyzed against the literature. RESULTS The combined nationwide data (n = 9003 PA patients) showed 3.1% with first recurrence of which 6.2% were malignant. In the literature first RPA rate was >7% at 20 years follow-up. MT occurred in 0% to 7%, and facial nerve damage increased from with each surgery 3% to 16% at first RPA to 18% to 30% at second RPA. CONCLUSIONS RPA showed a characteristic course with surgery being unreliable and damage to the facial nerve. The risk of MT was low. This might give flexibility towards a more conservative approach of management.
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Affiliation(s)
- Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oral-Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Patrick A Bhairosing
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Scientific Information Service, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark McGurk
- Department of Head and Neck Surgery, University College Hospitals, London, UK
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Lin YQ, Wang Y, Ou YM, Dong SY, Wang YD. Extracapsular dissection versus partial superficial parotidectomy for the treatment of benign parotid tumours. Int J Oral Maxillofac Surg 2019; 48:895-901. [PMID: 30871850 DOI: 10.1016/j.ijom.2019.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/26/2018] [Accepted: 01/28/2019] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial superficial parotidectomy (PSP). A comprehensive literature investigation was conducted by searching electronic databases. A systematic review and meta-analysis of comparative studies were performed to assess ECD and PSP for the treatment of BPTs with fixed-effects models. The outcomes analysed were transient or permanent facial nerve injury, Frey syndrome, recurrence rate, infection, and salivary fistula/sialocele. A total of 1641 patients from seven studies (1120 ECD-treated and 521 PSP-treated patients) were included in this meta-analysis. Transient facial nerve injury (odds ratio (OR)=0.28, 95% confidence interval (CI): 0.11-0.71; p=0.008) and Frey syndrome (OR=0.12, 95% CI: 0.03-0.48; p=0.003) were less prevalent in the ECD group. The rates of permanent facial nerve injury (OR=0.77, 95% CI: 0.35-1.70; p=0.520), recurrence rate (OR=0.17, 95% CI: 0.02-1.75; p=0.14), infection (OR=0.70, 95% CI: 0.07-6.67; p=0.76), and salivary fistula/sialocele (OR=0.40, 95% CI: 0.06-2.66; p=0.350) were similar in both groups. Although there was a trend that ECD showed a reduced risk for complications, the present results are not sufficient to conclude that ECD is more beneficial than PSP.
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Affiliation(s)
- Y Q Lin
- Department of Maxillofacial Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Y Wang
- The Central Laboratory of The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Y M Ou
- Department of General Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - S Y Dong
- Department of Stomatology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Y D Wang
- Department of Stomatology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
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12
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Mc Loughlin L, Gillanders SL, Smith S, Young O. The role of adjuvant radiotherapy in management of recurrent pleomorphic adenoma of the parotid gland: a systematic review. Eur Arch Otorhinolaryngol 2018; 276:283-295. [DOI: 10.1007/s00405-018-5205-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/09/2018] [Indexed: 02/03/2023]
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13
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Kanatas A, Ho MWS, Mücke T. Current thinking about the management of recurrent pleomorphic adenoma of the parotid: a structured review. Br J Oral Maxillofac Surg 2018. [PMID: 29526342 DOI: 10.1016/j.bjoms.2018.01.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pleomorphic adenoma is the most common tumour of the parotid gland, and can recur after excision. Recurrent pleomorphic adenoma can be a challenge to treat, and has variable outcomes. The aim of this review was to summarise current thinking in its management, which may be helpful to clinical teams and could improve patients' health-related quality of life. We searched several online databases using the key terms pleomorphic adenoma, recurrent pleomorphic adenoma, parotid gland tumours, parotid surgery, radiotherapy and parotid pleomorphic adenoma, and parotid surgery outcomes. Information collected included sample size, recurrence rate, condition of the facial nerve, type of operation, adjuvant treatments associated with recurrence, and clinical outcome. We screened 2301 papers, of which 49 were eligible. There was no consensus among authors about management. There are few if any randomised studies, and so conclusions in most papers were based on coherent arguments. Pleomorphic adenomas of the parotid tend to recur after long intervals, with a propensity towards multifocal disease, and the risk of recurrence (which depends on the initial surgical technique) is higher when the initial operation was done at a young age, after enucleation, and if the initial margins were invaded. Published conclusions suggest that the accepted management varies from observation in selected cases to total parotidectomy with or without postoperative radiotherapy.
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Affiliation(s)
- A Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, LS1 3EX.
| | - M W S Ho
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, LS1 3EX.
| | - T Mücke
- Department of Oral and Maxillofacial Surgery, Malteser Klinikum, Krefeld, North Rhine-Westphalia, Germany.
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Abu-Ghanem Y, Mizrachi A, Popovtzer A, Abu-Ghanem N, Feinmesser R. Recurrent pleomorphic adenoma of the parotid gland: Institutional experience and review of the literature. J Surg Oncol 2016; 114:714-718. [PMID: 27468730 DOI: 10.1002/jso.24392] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/19/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recurrent pleomorphic adenoma (PA) of the parotid gland is a challenging surgical issue with controversy regarding management and long term outcome. METHODS All patients who were operated for recurrent PA of the parotid gland between the years 1991 and 2013 were reviewed. Patient demographics, clinicopathologic variables, and operative details were collected retrospectively. RESULTS A total of 22 patients were operated for recurrent PA of the parotid gland. Mean interval between recurrences was 7 and 6 years for first recurrence and second recurrence, accordingly. Second recurrence was significantly influenced by younger age at initial treatment (P = 0.009). Only two patients (9%) with a recurrence developed facial nerve paralysis following surgery. Adjuvant radiotherapy was given to nine patients with no evidence of disease progression or recurrence. There were no cases of malignant transformation. CONCLUSIONS Recurrent PA of the parotid gland tends to occur in long intervals in a multifocal pattern. Adjuvant radiotherapy could be suggested as an alternative for surgery. J. Surg. Oncol. 2016;114:714-718. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviram Mizrachi
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Rabin Medical Center, Petah Tikva, Israel
| | - Nora Abu-Ghanem
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Feinmesser
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Goldie S, Sandeman J, Cole R, Dennis S, Swain I. Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery. J Surg Case Rep 2016; 2016:rjw057. [PMID: 27106613 PMCID: PMC4840583 DOI: 10.1093/jscr/rjw057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients' ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases.
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Affiliation(s)
- Simon Goldie
- Otolaryngology Department, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, United Kingdom
| | - Jack Sandeman
- Otolaryngology Department, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, United Kingdom
| | - Richard Cole
- Plastic Surgery Department, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, United Kingdom
| | - Simon Dennis
- Otolaryngology Department, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, United Kingdom
| | - Ian Swain
- Faculty of Science and Technology, Bournemouth University, Dorset, United Kingdom
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McGarry JG, Redmond M, Tuffy JB, Wilson L, Looby S. Metastatic pleomorphic adenoma to the supraspinatus muscle: a case report and review of a rare aggressive clinical entity. J Radiol Case Rep 2015; 9:1-8. [PMID: 26629288 DOI: 10.3941/jrcr.v9i10.2283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We report a case of a 65-year-old female with a recurrent right parotid pleomorphic adenoma (PA) 24 years after initial surgical excision. Positron-emission tomography (PET) and computed tomography (CT) demonstrated an unusual suspicious FDG-avid erosive rim enhancing mass centered in the right supraspinatus muscle. Cytology from CT-guided aspiration of the mass was consistent with a histologically benign PA, and the patient was diagnosed with metastatic pleomorphic adenoma (MPA). The patient later developed diffuse pulmonary metastases and died within 3 months. MPA, although rare, is recognised as a potentially lethal malignant complication of recurrent or longstanding benign PA. As no biochemical or genetic parameters are predictive of malignant change, patients presenting with recurrent PA should be considered for screening for metastatic disease.
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Affiliation(s)
| | - Maeve Redmond
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - John B Tuffy
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Lorraine Wilson
- Blackrock Clinic Nuclear Medicine PET CT centre, Blackrock, Co. Dublin, Ireland
| | - Seamus Looby
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
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Witt RL, Eisele DW, Morton RP, Nicolai P, Poorten VV, Zbären P. Etiology and management of recurrent parotid pleomorphic adenoma. Laryngoscope 2014; 125:888-93. [PMID: 25289881 DOI: 10.1002/lary.24964] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 02/04/2023]
Abstract
The objective of this review study was to encompass the relevant literature and current best practice options for this challenging, sometimes incurable problem. The source of the data was Ovid MEDLINE from 1946 to 2014. Review methods consisted of articles with clinical correlates. The most important cause of recurrence is enucleation with rupture and incomplete tumor excision at operation. Incomplete pseudocapsule, extracapsular extension, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule are also likely linked to recurrent pleomorphic adenoma. Most recurrent pleomorphic adenoma are multinodular. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Treatment of recurrent pleomorphic adenoma must be individualized. Total parotidectomy, given the multicentricity of recurrent pleomorphic adenoma, is appropriate in many patients, but may be inadequate to control recurrent pleomorphic. There is accumulating evidence from retrospective series that postoperative radiation therapy results in significantly better local control.
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Affiliation(s)
- Robert L Witt
- Department of Otolaryngology-Head & Neck Surgery, Christiana Care/Thomas Jefferson University, Newark, Delaware, U.S.A
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18
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Massive multinodular head and neck recurrence of parotid gland pleomorphic adenoma: a case report. Case Rep Otolaryngol 2014; 2014:914021. [PMID: 25045569 PMCID: PMC4089853 DOI: 10.1155/2014/914021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/18/2014] [Accepted: 06/01/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction. The optimal initial management of parotid pleomorphic adenomas reduces the risk of recurrence and malignant transformation. Surgery of recurrence can be difficult in multinodular disseminated forms. Case Report. A 67-years-old patient was referred for management of a large multifocal recurrence of a pleomorphic adenoma operated on 23 years ago. The clinical and radiological assessment found parapharyngeal, infratemporal, and prestyloid invasion, with nodules in the sternocleidomastoid muscle. Excision by transmandibular approach was performed. The pathologist found a multinodular recurrent pleomorphic adenoma without criteria of malignancy. Postoperative radiotherapy was performed. Discussion. Multinodular forms and incomplete resections are the most important factors that are thought to predispose to recurrence. A precise analysis of the extension by preoperative MRI is essential. Adjuvant radiotherapy can be given in these recurrent multifocal forms.
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19
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Mantsopoulos K, Koch M, Klintworth N, Zenk J, Iro H. Evolution and changing trends in surgery for benign Parotid tumors. Laryngoscope 2014; 125:122-7. [DOI: 10.1002/lary.24837] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/29/2014] [Accepted: 06/17/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Michael Koch
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Nils Klintworth
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology; Head and Neck Surgery; Augsburg Hospital; Augsburg Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology; Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
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20
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Liu H, Wen W, Huang H, Liang Y, Tan X, Liu S, Liu C, Hu M. Recurrent Pleomorphic Adenoma of the Parotid Gland. Otolaryngol Head Neck Surg 2014; 151:87-91. [PMID: 24671460 DOI: 10.1177/0194599814528098] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/25/2014] [Indexed: 11/16/2022]
Abstract
Objective To determine the benefit to postoperative facial function of intraoperative facial nerve monitoring (IFNM) during recurrent pleomorphic adenoma (RPA) parotid surgery. Study Design Cohort study with planned data collection. Setting Chinese PLA General Hospital. Subjects and Methods Fifty-eight RPA parotidectomies were performed between 2004 and 2012. Recurrence was confirmed by histopathologic examination. None of the patients had preoperative facial palsy. Electromyography-based IFNM was used in 28 patients; 30 patients were unmonitored. The durations of surgery and the severity of postoperative facial nerve palsy were compared between the 2 groups. Results There were no significant differences between the 2 groups in the incidence of immediate or permanent facial paralysis after RPA parotidectomy ( P = .95 and P = .36, respectively). However, the differences in the average duration of surgery and the severity of postoperative facial nerve palsy after total parotidectomy or wide resection were significant ( P < .01 and P = .01, respectively). In contrast, these differences were not significant after superficial parotidectomies ( P = .43 and P = .49, respectively). The average recovery time of temporary facial nerve paralysis was significantly shorter in the monitored group compared with the unmonitored group, independent of surgical technique ( P < .01). Conclusion The use of IFNM during total or wide resection RPA parotidectomy reduced the duration of surgery and the incidence of postoperative facial paralysis and enhanced recovery. However, there was little impact on facial nerve outcomes when IFNM was used during superficial RPA parotidectomy.
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Affiliation(s)
- Huawei Liu
- Department of Stomatolagy, Chinese PLA General Hospital, Beijing, China
| | - Weisheng Wen
- Department of Stomatolagy, Chinese PLA General Hospital, Beijing, China
| | - Haitao Huang
- Department of Stomatolagy, Chinese PLA General Hospital, Beijing, China
| | - Yongqiang Liang
- College of Stomatology, Hebei United University, Tangshan, China
| | - Xinying Tan
- Department of Stomatolagy, Chinese PLA General Hospital, Beijing, China
| | - Sanxia Liu
- Department of Stomatolagy, Chinese PLA General Hospital, Beijing, China
| | - Changkui Liu
- Department of Stomatolagy, Chinese PLA General Hospital, Beijing, China
| | - Min Hu
- Department of Stomatolagy, Chinese PLA General Hospital, Beijing, China
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21
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Is radiotherapy necessary for pleomorphic adenoma? Am J Otolaryngol 2014; 35:276-7. [PMID: 24290577 DOI: 10.1016/j.amjoto.2013.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 11/20/2022]
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22
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Jardel P, Fakhry N, Makeieff M, Ferrie JC, Milin S, Righini C, Lacout A, Costes V, Malard O, Marcy PY, Guevara N, Odin G, Bensadoun RJ, Thariat J. [Radiation therapy for pleomorphic adenoma of the parotid]. Cancer Radiother 2014; 18:68-76. [PMID: 24387927 DOI: 10.1016/j.canrad.2013.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/21/2013] [Accepted: 09/04/2013] [Indexed: 10/25/2022]
Abstract
Parotid pleomorphic adenoma is the most frequent tumor of salivary glands. The prognosis depends on the recurrences because they could lead to iatrogenic events (facial paralysis). Moreover the risk of malignant transformation increases with the number of local relapses. This article aims at reviewing histological and radiological criteria and the surgical techniques. To improve local control, adjuvant irradiation (in first intention or after recurrence) may be useful but is still controversial for benign tumors in young patients with a risk of radio-induced cancer. We listed studies in which adjuvant radiotherapy was used so as to define its place in the treatment strategy. Prognostic factors were found by some authors. Other studies have to be done before strong evidence-based recommendations are issued.
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Affiliation(s)
- P Jardel
- Service d'oncologie radiothérapie, PRC, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - N Fakhry
- Service d'ORL et chirurgie cervicofaciale, hôpital de La Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - M Makeieff
- Département d'ORL et chirurgie cervicofaciale, hôpital Gui-de-Chauliac, CHRU de Montpellier, 34295 Montpellier cedex 5, France
| | - J-C Ferrie
- Service d'imagerie médicale, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - S Milin
- Service de cytologie et d'anatomie pathologiques, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - C Righini
- Clinique universitaire d'ORL, pôle tête et cou et chirurgie réparatrice, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - A Lacout
- Service d'imagerie, clinique du Pont-Rouge, 15000 Aurillac, France
| | - V Costes
- Service d'anatomie et cytologie pathologiques, hôpital Gui-de-Chauliac, CHRU de Montpellier, 34295 Montpellier cedex 5, France
| | - O Malard
- Service d'ORL et chirurgie cervicofaciale, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - P-Y Marcy
- Service d'imagerie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - N Guevara
- Service d'ORL et chirurgie cervicofaciale, institut universitaire de la face et du cou, 33, avenue Valombrose, 06189 Nice, France
| | - G Odin
- Service d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice, France; Institut universitaire de la face et du cou, 33, avenue Valombrose, 06189 Nice, France; Université Nice-Sophia-Antipolis, 33, avenue Valombrose, 06189 Nice, France
| | - R-J Bensadoun
- Service d'oncologie radiothérapie, PRC, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - J Thariat
- Service d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice, France; Institut universitaire de la face et du cou, 33, avenue Valombrose, 06189 Nice, France; Université Nice-Sophia-Antipolis, 33, avenue Valombrose, 06189 Nice, France.
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Kerawala C, Brennan PA, Cascarini L, Godden D, Coombes D, McCaul J. Management of tumour spillage during parotid surgery for pleomorphic adenoma. Br J Oral Maxillofac Surg 2014; 52:3-6. [DOI: 10.1016/j.bjoms.2013.05.143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 05/18/2013] [Indexed: 11/29/2022]
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Wallace AS, Morris CG, Kirwan JM, Werning JW, Mendenhall WM. Radiotherapy for pleomorphic adenoma. Am J Otolaryngol 2013; 34:36-40. [PMID: 22959365 DOI: 10.1016/j.amjoto.2012.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to update our experience in treating pleomorphic adenoma with radiotherapy (RT). MATERIALS AND METHODS This is a retrospective analysis of 25 patients treated with RT alone (2 patients) or combined with surgery (23 patients), with follow-up ranging from 1.8 to 34.9 years (median, 10.5 years). RESULTS Local control was achieved in 13 (75%) of 16 patients with subclinical disease and 5 (56%) of 9 patients with gross disease. Overall local control was achieved in 18 (72%) of 25 patients. The 5-, 10-, and 15-year overall local control rates were 76 %, 76%, and 68%, respectively. Ten patients died of the following causes: recurrent disease, 2; malignant transformation, 2; and intercurrent disease, 6. At last follow-up, 14 patients were alive without evidence of disease, and 1 patient was alive with disease. Dental carries and transient facial nerve deficits were the most common complications. No patients developed severe complications subsequent to RT. CONCLUSIONS In patients at high risk for developing recurrent pleomorphic adenoma after surgery, RT is effective in controlling subclinical disease.
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Riffat F, Mahrous AK, Buchanan MA, Fish BM, Jani P. Safety of extracapsular dissection in benign superficial parotid lesions. J Maxillofac Oral Surg 2012; 11:407-10. [PMID: 24293931 PMCID: PMC3485475 DOI: 10.1007/s12663-012-0349-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/07/2012] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The current practice for removal of clinically benign superficial parotid lesions is an appropriate superficial parotidectomy with a cuff of normal parotid tissue for complete pathological clearance. This technique requires the identification of the facial nerve at the main trunk and dissection of the segment of the facial nerve deep to the lesion. The reported major complications of this procedure include temporary or permanent facial nerve weakness, Frey's syndrome and salivary leaks. In order to avoid these complications, a local extracapsular dissection technique can be utilised in the management of small inferiorly located benign lesions of the parotid gland. METHODS A retrospective case note review was performed for all parotidectomies between 2004 and 2009 in Addenbrooke's Hospital, Cambridge by the senior authors. RESULTS A total of 172 cases were identified out which 46 underwent an extracapsular dissection. The average size of these lesions was 1.9 cm (0.9-2.4 cm) with all universally located inferior or posterior to the angle of the mandible. The pathologies were 14 pleomorphic adenomas, 24 Warthin's tumours, 6 lymphangiomas and 2 simple cysts. There were no post-operative facial nerve weaknesses, Frey's syndrome or salivary leaks within the extracapsular dissection group. The median follow-up of these patients were 4.6 years (2-6 years) with 6 patients lost to follow-up. No recurrences have been noted in the cohort at follow-up.
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Affiliation(s)
- F Riffat
- Department of Otolaryngology and Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
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Fu H, Wang J, Wang L, Zhang Z, He Y. Pleomorphic adenoma of the salivary glands in children and adolescents. J Pediatr Surg 2012; 47:715-9. [PMID: 22498386 DOI: 10.1016/j.jpedsurg.2011.10.067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pleomorphic adenomas (PAs) of the salivary glands are rare in children and adolescents. We reviewed the clinical manifestations, pathologic features, treatment, and prognosis of salivary gland PA in 90 children and adolescents. METHODS Clinical data including age, sex, location, symptoms, the period of evolution of the symptoms, pathologic type, and surgical treatment were evaluated. RESULTS The median age was 16.5 years old. There was a 1.43:1 female-to-male ratio. The parotid gland was the most commonly affected major gland (56.7%), and the palate, the most common site of minor salivary gland involvement. Ultrasonography and computed tomography were performed in most cases for diagnosis. Superficial parotidectomy or total parotidectomy with facial nerve dissection and preservation was the most common surgical procedure. Submandibular triangle dissection was applied to all submandibular PAs. Classic-type PA was the most common histologic subtype (43.3%). CONCLUSIONS Salivary gland PAs in children and adolescents have different characteristics compared with their adult counterparts in regard to histologic subtype and location. Surgical removal is the best treatment option for PAs in children and adolescents.
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Affiliation(s)
- Honghai Fu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Shanghai Jiao-tong University, Shanghai Ninth People's Hospital, Shanghai, China
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Pitak-Arnnop P, Dhanuthai K, Hemprich A, Pausch NC. Does Pleomorphic Adenoma Really Require Total Parotidectomy? Ann Surg Oncol 2010; 18 Suppl 3:S248-9. [PMID: 21387127 DOI: 10.1245/s10434-010-1466-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Indexed: 11/18/2022]
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