Accessory Parotid Gland Tumors Research Articles

Research progress in accessory parotid gland tumor surgery

In salivary gland disease, accessory parotid gland (APG) lesions are relatively low, and tumor is the most common manifestation. Currently, surgery is the primary treatment method for APG tumors. Although numerous surgical procedures are available, there is no standard protocol. Due to the location of the APG in the midcheek area, the complications and aesthetic concerns connected with conventional surgery for treating APG tumors sometimes cause significant distress to patients. With the progress of medical technology as well as improving patients' aesthetic and functional requirements, surgical excision methods and incision design are constantly improving. More beautiful and minimally invasive treatments, such as concealed transoral approach and endoscopically aided extracapsular dissection of APG, have been gradually developed. This review focuses on surgical techniques, benefits, and drawbacks of APG tumor surgery that have been carried out and provides an outlook based on the preliminary application of endoscopically assisted accessory parotid tumor resection.

Lessons From a Case of Failed Attempt to Remove Pleomorphic Adenoma of the Accessory Parotid Gland via Transoral Approach

An accessory parotid gland is salivary gland tissue that exists separately anterior to the parotid gland. Since malignant tumors can be found in about 50% of accessory parotid tumors, the standard treatment is radical resection via externa l approach. However, with the development of endoscopic surgery in the head and neck field, the transoral approach using an endoscope is also being tried. Although this technique could remove benign tumors without skin incision, there may be cases where removal via transoral approach may prove difficult. The authors experienced a case of failed attempt to remove pleomorphic adenoma in the accessory parotid gland via transoral approach in a 24-year-old male patient. We analyzed the causes of surgical failure in this case from various perspectives. We believe that our lessons from this failed case could help determine the appropriate surgical indications of transoral approach in the accessory parotid gland tumor.

Transoral Excision of a Large Accessory Parotid Gland Tumor.

Accessory parotid gland (APG) tumors account for 1% to 7% of all parotid gland neoplasms but are more likely to be malignant than main parotid gland tumors. Management of APG neoplasms entails surgical excision. Four primary approaches to resection have been described in the literature with varying facial nerve outcomes. We report a case of a 4-cm APG pleomorphic adenoma utilizing a transoral approach for excision without postoperative facial nerve injury. A transoral approach is known to mitigate patients' cosmetic concerns; however, prior reports utilized endoscopic assistance on patients with smaller tumors. We conclude that large APG tumors can be excised through a transoral approach without undue risk to the distal facial nerves, though this transoral approach ultimately may not be appropriate for malignant neoplasms or difficult dissections.

Transoral Parotidectomy.

Transoral parotidectomy allows for the management of parapharyngeal space tumors and accessory parotid gland tumors without the need for a transfacial/transparotid or mandible splitting procedure. It is a minimally invasive approach that permits a faster recovery and with a lesser risk of facial palsy.

Surgical management and outcomes of accessory parotid gland neoplasms: A systematic review.

To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms. MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials. A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Studies were included if they reported surgical management and outcomes of patients with accessory parotid gland neoplasms. After screening 3532 records, 15 studies were included with a total of 187 patients. Benign tumors consisted of 61.5% of cases. External open, transoral, and preauricular endoscopic approaches were used for 82.3%, 11.3%, and 6.5% of cases, respectively. Accessory lobe resection alone, concurrent with partial parotidectomy, and concurrent with total parotidectomy were used in 54.8%, 43.0%, and 2.2% of cases, respectively. Complication rates were similar between histology groups (7.8% benign vs. 8.3% malignant, p=0.82). Accessory lobe resection with concurrent partial parotidectomy had the lowest overall complication rate (6.3%). Resections limited to the accessory lobe were found to have an overall complication rate of 8.7%. The results offer an overview of the surgical management and complications for accessory parotid gland tumors. Overall surgical complication rates found in these case series may be lower for management of accessory gland tumors than rates available in the literature for tumors within the main parotid gland.

Management of accessory parotid gland tumours: 32-year experience from a single institution and review of the literature

Accessory parotid gland tumours (APGTs) are very rare. Regarding their anatomical location, an adequate surgical approach is necessary to provide safe resection and satisfactory postoperative results. The aims of this study were to present our tertiary centre experience in surgical treatment and management of APGTs and to review the literature regarding their treatment, particularly in terms of surgical modalities. Data of 13 patients with primarily surgically treated APGTs have been collected and analysed. Well-documented English-literature articles of surgically treated APGTs have been extracted from the PubMed, Scopus and Web of Science databases ending in May 2018, and analysed. Mean age at diagnosis was 41.1 years. The most common benign histological subtype was pleomorphic adenoma (53.8%), while mucoepidermoid carcinoma (23.1%) was most common in malignant counterparts. The malignancy rate was 38.5%. Postoperative results were satisfactory, and the follow-up period was uneventful in all patients except one who died of locoregional recurrence. A total of 57 papers with reported series in APGTs have been identified with a total of 306 APGT cases. From oncological, functional and aesthetic standpoints, approaches through a standard parotidectomy provide satisfactory results.

Mucosa-Associated Lymphoid Tissue Lymphoma Affecting the Accessory Parotid Gland in Sjogren Syndrome: Case Report and Immunohistochemical Analysis

Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of non-Hodgkin lymphoma, often described as affecting the parotid glands (PGs) in Sjogren syndrome (SS). Accessory parotid gland (APG) represents ectopic salivary tissue distant and separate from the main PG, observed in 21% to 61% of the general population. The incidence of PG tumors is more common in APG than in PG; however, APG lymphoma is a rare condition. A 30-year-old woman with a diagnosis of primary SS was referred, presenting with a nodule in the buccal mucosa, with 1 month of evolution. Histopathologic examination showed atypical lymphoid proliferation and plasma cells, germinal centers and lymphoepithelial lesions, supported by typical PG parenchyma. Immunohistochemistry revealed positivity for CD45, CD20, bcl-2, and kappa light chain restriction. Ki-67 labeling index was less than 5%. APG tumors are clinically rare but should be considered in the differential diagnosis of a mid-cheek mass, especially in SS.

Accessory parotid gland as an anatomical variation. Case report

The accessory parotid gland is a rare anatomical variation in human population (20%). This article presents a case report about the accessory parotid gland found during a dissection practice. Accessory parotid gland tumors have clinical importance for the relation with buccal nerve; also in tumor cases can be an afferent of perineural tumoral spread. This information may be important to anatomist, dentist and doctors interested in studying and exploring facial structures and tumor in oral region.

Nerve Integrity Monitor（NIM）が有用であった副耳下腺多形腺腫例

Because accessory parotid gland tumors are relatively rare, no standard management method has been established yet. In this paper, we describe the surgical approach and usefulness of facial nerve monitoring in a patient with pleomorphic adenoma of the accessory parotid gland. The patient, a 61-year-old female, presented with a painless, hard mass on the left cheek. We performed surgical resection of the tumor by the peri-auricular-cervical flap approach. The buccal branch of the facial nerve was easily detected on the tumor by nerve integrity monitoring (NIM). No postoperative facial nerve palsy was observed. Histopathology of the resected tomor, which measured 23×17×18 mm in size, revealed that it was a pleomorphic adenoma. NIM was useful in the for safe resection of the accessory parotid gland tumor.

副耳下腺腫瘍例

An accessory parotid gland refers to the presence of salivary gland tissue in front of the main parotid gland. It is reported to occur at a rate of approximately 21%–70% in the general population, and a tumor arising from an accessory parotid gland is rare, accounting for 1%–7% of all parotid gland tumors. Herein, we report a case of accessory parotid gland tumor encountered by us.

Adenoid cystic carcinoma of the accessory parotid gland

Accessory parotid gland is a small salivary gland tissue separated from main part of parotid gland. It is located on the masseter muscle anterior to the Stensen's duct. Tumors of accessory parotid gland are rare. In this article, we report an unusual case of adenoid cystic carcinoma involving accessory parotid gland. The patient presented with a progressively growing mass in the middle portion of her cheek. She underwent a partial parotidectomy including both the superficial and accessory lobes. The histopathologic diagnosis was adenoid cystic carcinoma of cribriform type.

Warthin’s Tumour in Accessory Parotid Gland

The accessory parotid gland is salivary tissue separated from the main parotid gland and lying on masseter muscle. The accessory parotid gland is not rare, according to cadaver studies, but neoplasm in the accessory parotid gland is rare. Surgical excision is the treatment of choice for the accessory parotid gland tumour. It is important to identify the buccal branch of the facial nerve to avoid injury to the facial nerve. Herein we describe a case of accessory parotid gland tumor in a 30 years old lady. Histopathological diagnosis was Warthin’s tumour which is very rare in female. DOI: http://dx.doi.org/10.3329/bjo.v20i1.22017 Bangladesh J Otorhinolaryngol; April 2014; 20(1): 43-45

Evaluation of usefulness of fine-needle aspiration cytology in the diagnosis of tumours of the accessory parotid gland: a preliminary analysis of a case series in Japan

Conclusion: The accuracy and sensitivity of fine-needle aspiration cytology (FNAC) in this analysis were not satisfactory, and the false-negative rate seemed to be higher than for parotid tumours. The possibility of low-grade malignancy should be considered in the surgical treatment of accessory parotid gland (APG) tumours, even if the preoperative results of FNAC suggest that the tumour is benign. Objectives: Little is known about the usefulness of FNAC in the preoperative evaluation of APG tumours, probably due to the paucity of APG tumour cases. We examined the usefulness of FNAC in the detection of malignant APG tumours. Methods: We conducted a retrospective analysis of 3 cases from our hospital, along with 18 previously reported Japanese cases. We compared the preoperative FNAC results with postoperative histopathological diagnoses of APG tumours and evaluated the accuracy, sensitivity, specificity and false-negative rates of FNAC in detecting malignant APG tumours. Results: There were four false-negative cases (19.0%), three of mucoepidermoid carcinomas and one of malignant lymphoma. One false-positive result was noted in the case of a myoepithelioma, which was cytologically diagnosed as suspected adenoid cystic carcinoma. The accuracy, sensitivity and specificity of FNAC in detecting malignant tumours were 76.2%, 60.0% and 90.9%, respectively.

副耳下腺腫瘍5手術例の成績

副耳下腺腫瘍手術におけるアプローチ方法には，一定の見解が得られていない。今回，5例の自験例の検討を行い，アプローチ方法について考察した。2010年9月から2013年4月までの2年8か月間に直上切開で手術を行った副耳下腺腫瘍は5例であった。平均年齢55歳，男性3例，女性2例。良性腫瘍3例，悪性腫瘍2例であった。5例とも充分な術野展開が可能で，末梢側での顔面神経の確認・温存は容易であった。また，筋上皮癌症例では咬筋合併切除を行った際の操作に困難な点はなかった。さらに，術後整容は良好であった。以上の結果は腫瘍直上切開の有用性を示すものであり，敬遠すべき方法でないと思われた。

Surgical treatment of accessory parotid gland tumours

An accessory parotid gland is located preauricular buccal area and it's duct is separated from main duct of parotid gland. Tumours arised from accessory parotid gland is not so often, however, we experienced five cases with tumours considered to develope from the accessory parotid gland from 1996 to 2010. All tumours were performed the surgical removal under the general anaesthesia. The skin-incision lines were used the sigmoid-like temporal-preauricular-submandibular incision lines according to the peripheral technique for the conservation of facial nerves.

Review of accessory parotid gland tumors: Pathologic incidence and surgical management

ObjectiveThe current study presents our experience with accessory parotid gland masses and reviews the literature on accessory parotid tumor incidence and surgical management. Based on our results, we advocate a standard parotidectomy approach with routine facial nerve dissection at the time of excision. Study DesignWe performed a retrospective chart review and comprehensive literature review on incidence of accessory parotid gland neoplasms. MethodsA retrospective chart review of all patients with mid-cheek masses treated by the senior author was conducted from January 2003 to January 2009. The tumor size at presentation, FNA biopsy, pathologic diagnosis, and surgical treatment were recorded for 13 patients. ResultsIn the case series, 54% of lesions were benign (n=7) and 46% were malignant (n=6) including benign pathologies of 4 pleomorphic adenomas, 2 lymphadenitis, 1 monomorphic adenoma and malignant pathologies of 2 mucoepidermoid carcinoma, 2 B-cell lymphomas, 1 adenocarcinoma, and 1 myofibrosarcoma. Surgical intervention was performed on all patients with standard parotidectomy incision for accessory parotid mass excision after identification and tracing of facial nerve and its branches. ConclusionThe present study provides support for a standard parotid incision with identification of the facial nerve at the time of surgical incision as this resulted in successful excision of accessory parotid tumors with favorable cosmetic results and without facial paralysis or tumor recurrence. Literature review of 152 cases of accessory parotid gland lesions, revealed a pooled incidence of 70% benign and 30% malignant.

Salivary Duct Carcinoma of the Accessory Parotid Gland

Objective: 1) Present a rare case of salivary duct carcinoma of the accessory parotid gland (APG). 2) Understand the current prevalence, diagnosis, and management of benign and malignant tumors of the APG.Method: This study includes a case presentation and literature review. The literature review included articles from October 1966 to January 2010 and included all cases of accessory parotid gland tumors in adults.Results: One hundred and nineteen cases with 19 different tumor types were reported in the accessory parotid gland (APG). Pleomorphic adenoma and mucoepidermoid carcinoma represented 50% and 23%, respectively. There were no previously reported salivary duct carcinomas of the APG. Forty percent of APG neoplasms were malignant. This malignancy rate was comparable to previous studies reporting a higher rate of malignant tumors in the APG compared with 15% to 20% in parotid tumors. A standard parotidectomy remains the preferred approach with less risk to the facial nerve compared with direct cheek re...

Pleomorphic adenoma of the accessory parotid gland misdiagnosed as glomus tumour

Accessory parotid gland tumours are rare and should be included in the differential diagnosis of neoplasms in the midcheek region.

副耳下腺腫瘍の臨床的検討

Accessory parotid gland tumors are relatively rare; hence, adequately detailed clinical analyses of these tumors are difficult to perform at a single institution. In this report, we describe the findings for 65 patients [29 men, 36 women; median age, 51 (9-81) years] with accessory parotid gland tumors, consisting of 4 cases documented by us and 61 cases previously reported by other Japanese authors. Approximately 50% of the patients were treated in an otolaryngology department, while the remaining patients were treated in plastic surgery, oral surgery, or dermatology departments. In 4 patients, the results of preoperative fine-needle aspiration cytology indicated that the tumor was benign; however, the postoperative histopathology results revealed malignant tumors. The frequencies of malignant and benign tumors were 44.6% (n = 29) and 55.4% (n = 36), respectively. Mucoepidermoid carcinoma and pleomorphic adenoma were the most frequent types of malignant and benign accessory parotid gland tumors, respectively. Among the various surgical methods that were used, such as direct cheek and intraoral incisions, a standard parotidectomy incision was the most preferred treatment approach for these tumors. Recently, an endoscopic approach has also been found to yield satisfactory results. An optimal approach should be selected after evaluating the advantages and disadvantages of these methods. No definite guidelines are available regarding the choice of elective neck dissection and postoperative radiation therapy for malignant accessory parotid gland tumors. Although tumor resection (plus elective neck dissection) and postoperative radiation therapy have been frequently performed for various kinds of malignant accessory parotid gland tumors to date, additional studies are needed regarding the criteria for selecting elective neck dissection and postoperative radiation therapy. Since the malignancy rate for accessory parotid gland tumors is higher than that for parotid gland tumors, the possibility of malignancy (especially mucoepidermoid carcinoma and carcinoma ex pleomorphic adenoma) should be considered when resecting accessory parotid gland tumors, even if the results of preoperative fine-needle aspiration cytology indicate that the tumor is benign.

Coincidental Tumors in the Main and an Accessory Parotid Gland

Introduction. We are presenting a rare case of a patient who developed simultaneous tumors in the main parotid gland (MPG) and an accessory parotid gland (APG). The APG tumor was not recognized when the more prominent MPG tumor was excised. We will discuss the clinical features of this case. Case presentation. A 66-year-old woman was referred to our department with a painless right cheek mass. Her past medical history was notable for a right MPG tumor excision at the age of 62. A retrospective review of the original MRI films revealed that a small APG tumor was present prior to the removal of the MPG tumor. Conclusion. Although the coincidental presence of the MPG and APG tumors is quite rare, this case shows the importance of iden- tifying the smaller and potentially more sinister lesion involving the APG when it is present while preparing for the MPG tumor excision.