Benign Salivary Tumors Research Articles

Anatomical study and clinical outcomes of endoscopic transoral surgery for benign salivary gland tumors in the parapharyngeal space

The existing literature provides little insight into the efficacy of transoral endoscopy in exposing benign tumors originating from salivary glands in the parapharyngeal space at the parotid gland base and resecting part of the deep lobe with a safe margin. This study aims to investigate the efficacy of the endoscopic transoral approach for the visualization and resection of such tumors.Through transoral endoscopic cadaveric dissections and surgical procedures, we examined the anatomical structures of the parapharyngeal space and the deep lobe of the parotid gland, identifying key anatomical landmarks. We conducted a retrospective analysis of 19 patients with benign salivary gland-derived tumors in the parapharyngeal space who underwent transoral endoscopic resection.Intraoperative visualization of the tumor pedicle and the deep lobe of the parotid gland was successfully achieved in all cases, allowing for resection with safe margins. During a median follow-up period of 54.0 months, imaging revealed no signs of recurrence.Endoscopic transoral approach provides effective visualization of the deep lobe of the parotid gland and the medial portion of the parotid bed from the parapharyngeal space. Benign tumors of salivary gland-derived in this area can be well exposed and safely resected with adequate margins.

Cellular Pleomorphic Adenoma of Minor Salivary Glands with Collagenous Crystalloids: A Peculiar Finding

Abstract Pleomorphic adenoma (PA) is a benign salivary tumor uncommonly seen in minor salivary glands. Collagenous crystalloids are an uncommon finding and may pose a diagnostic dilemma in cellular PA. We present a case of myoepithelial cell-rich PA of hard palate with paucity of chondromyxoid stroma and characteristic collagenous crystalloids.

Current Developments in Diagnosis of Salivary Gland Tumors: From Structure to Artificial Intelligence.

Salivary glands tumors are uncommon neoplasms with variable incidence, heterogenous histologies and unpredictable biological behaviour. Most tumors are located in the parotid gland. Benign salivary tumors represent 54-79% of cases and pleomorphic adenoma is frequently diagnosed in this group. Salivary glands malignant tumors that are more commonly diagnosed are adenoid cystic carcinomas and mucoepidermoid carcinomas. Because of their diversity and overlapping features, these tumors require complex methods of evaluation. Diagnostic procedures include imaging techniques combined with clinical examination, fine needle aspiration and histopathological investigation of the excised specimens. This narrative review describes the advances in the diagnosis methods of these unusual tumors-from histomorphology to artificial intelligence algorithms.

Particularities of pleomorphic adenoma of the parotid gland. Statistical data for the time period 2017-2022

The morbidity of benign and malignant tumors is constantly increasing. Pleomorphic adenoma is the most common benign salivary tumor, affecting the parotid gland. Its anatomical, histopathological and clinical characteristics, such as its location close to the facial nerve, the cellular pleomorphism, the incomplete capsule, the long asymptomatic evolution and the complications that may occur give it particularities that must be known before performing the surgical intervention. The study was conducted on a sample of 46 people hospitalized with benign parotid tumors in the Department of OMF Surgery of IMSP IMU, in the period 2017—2022, of which 41 patients were diagnosed with pleomorphic adenoma — 89.13%. The average age was 47.5 years, the highest frequency of adenoma being in the age group of 40-49 years. The distribution according to sex determined a slight prevalence in favor of the males — 53.65% of the total, the predisposition to predominantly affect the right or left parotid gland was not determined. Thus, the obtained data confirm the data from the specialized literature, which ranks the pleomorphic adenoma as the most common benign parotid tumor, the occurrence rate increasing with age.

Recent developments in the pathology of primary pulmonary salivary gland-type tumours.

Primary pulmonary salivary gland-type tumours are rare neoplasms that are thought to arise from seromucinous glands that are located in the submucosa of large airways. These neoplasms have clinical and pathologic features that are distinct from other pulmonary neoplasms. The majority of primary pulmonary salivary gland-type tumours are malignant, with the most common entities being mucoepidermoid carcinoma, adenoid cystic carcinoma, and epithelial-myoepithelial carcinoma. Less commonly seen are myoepithelial carcinoma, hyalinizing clear cell carcinoma, acinic cell carcinoma, secretory carcinoma, salivary duct carcinoma, intraductal carcinoma, and polymorphous adenocarcinoma. Benign salivary gland-type tumours of the lung include pleomorphic adenoma and sialadenoma papilliferum. Morphologic, immunophenotypic, and molecular features of these neoplasms are largely similar to salivary gland tumours elsewhere, and therefore the exclusion of metastatic disease requires clinical and radiologic correlation. However, the differential diagnostic considerations are different in the lung. The distinction of salivary gland-type tumours from their histologic mimics is important for both prognostication and treatment decisions. Overall, salivary gland type-tumours tend to have a more favourable outcome than other pulmonary carcinomas, although high-grade variants exist for many of these tumour types. Recent advances in our understanding of the spectrum of salivary gland-type tumours reported in the lung and their diversity of molecular and immunohistochemical features have helped to refine the classification of these tumours and have highlighted a few differences between salivary gland-type tumours of the lung and those primary to other sites.

Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic.

(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.

An Investigation of the Clinico-histopathologic Trend of Salivary Gland Tumors in Amir Alam Hospital During 2010- 2019: A Retrospective Study

Background: The incidence and mortality rates of salivary gland tumors have increased according to previous evidence. No study has so far focused on the trend of clinical and histopathologic patterns of salivary gland tumors in Iran. Therefore, the aim was to investigate the incidence and clinico-histopathologic trend of salivary gland tumors in a retrospective, cross-sectional, institutional study from 2010-2019 in Amir Alam hospital. Methods: The archived medical records were collected from patients with the histopathologic diagnosis of benign and malignant salivary gland tumors from Amir Alam hospital, Tehran during (April-April) 2010- 2019. Demographic data and histopathologic features, including tumor size, lymph node involvement, vascular invasion, perineural involvement, and histopathologic differentiation were retrieved, and the samples were categorized and reviewed based on the new classification of head and neck tumors. Finally, the frequencies of characteristics were determined and expressed as numbers (percentage values). Results: Of 1203 salivary gland tumors, 77.6% and 22.4% were benign and malignant, respectively. The incidence of benign tumors was increased from 37 (22.2%) in 2010 to 178 (364.9%) in 2019. In the collection of the total samples, the incidence of malignant tumors was relatively steady from 23 (13.8%) samples in 2010 to 27 (55.35%) in 2019. However, an increase in the incidence of tumors with low-grade differentiation was found from 12.5% in 2010 to 80% in 2019. Conclusions: The incidence of benign and malignant salivary tumors with a higher degree of malignancy had an increasing trend in Amir Alam hospital during 2010-2019.

Expression of Syndecan-1 and Cyclin D1 in Salivary Gland Tumors in Relation to Clinicopathological Parameters.

Salivary tumors have various morphological features and might share some histopathological findings. They are considered a problematic area in diagnosis due to complex clinicopathological features and different biological behavior. To identify the pathological behavior of salivary tumors immunohistochemically. This retrospective study involved thirty formalin-fixed paraffin-embedded blocks of salivary gland tumors. These tumors were stained immunohistochemically with syndecan-1 and cyclin D1. Chi-Square test was used to relate immunoscoring, intracellular localization, intensity, and invasion to different salivary tumors. The correlation of these two markers was done by spearman's rho test. P-value <0.05 was considered statistically significant. The mean age of the patients was 48.69 ± 17.7. The parotid gland was the most commonly reported site in benign tumors, and regarding malignant tumors, maxilla was the most prevalent site. Syndecan-1 in benign tumors showed a predominate score 3, most widely detected in pleomorphic adenoma. Malignant salivary tumors showed 89.4% positive expression with a more frequent score 3, most commonly found in adenocystic carcinoma. Cyclin D1 expressed in all benign salivary tumors, with prominent diffuse mixed intracellular localization in pleomorphic adenoma. Malignant tumors revealed an expression of 94.7%. Moderate scoring with mixed intracellular localization was recorded in adenocystic carcinoma, followed by mucoepidermoid carcinoma. There was a significant correlation between the two markers in response to the distribution of immunostaining in different cell compartments. Syndecan-1 and cyclin D1 showed a significant combined role in salivary tumor progression. Interestingly notable ductal-myoepithelial cells affect epithelial morphogenesis, and growth of pleomorphic adenoma was observed. Furthermore, basophilic cells of cribriform adenocystic carcinomas might control the aggressiveness and proliferation rate of these tumors.

Nonsebaceous Lymphadenoma of the Salivary Glands: A Potential Overdiagnosis Pitfall.

Nonsebaceous lymphadenoma is a rare benign salivary tumor. It is easily misdiagnosed as lymphoepithelial carcinoma, leading to overtreatment. Some patients experience sequelae after undergoing cervical lymph node resection and adjuvant treatment, so it is critical to distinguish these entities. We describe the histopathological and immunohistochemical features of this rare entity in 3 cases and discuss the differential diagnosis and histogenesis. Nonsebaceous lymphadenoma can be distinguished from lymphoepithelial carcinoma by the following histological features: There is a lymph node-like form at low magnification, with prominent proliferating epithelial nests but no destructive growth pattern; variable numbers of tubuloglandular components are always seen in proliferating epithelial nests, which transition to cystically dilated salivary ducts; no lesion necrosis exists; and mitotic figures are absent or rare. No patients experienced recurrence during the 8- to 69-month (mean, 29 months) follow-up.

Concurrent Warthin tumor and Kimura disease: a case report

BackgroundWarthin tumor (WT) is a common benign salivary tumor of the parotid gland. Clinically, it occurs in men in their fifth to seventh decades who typically smoke cigarettes. WTs have been reported with different head and neck neoplasms and other salivary gland tumors within the same or another salivary gland. Kimura disease (KD) is a rare chronic inflammatory disease with unknown etiology affecting young to middle-aged Asian men. KD presents as an asymptomatic nodule in the head and neck area, with regional lymphadenopathy and salivary gland involvement.Case presentationA 64-year-old Arabic man presented with a 10-year history of an asymptomatic swelling of the left face. Computed tomography showed a well-defined, multicystic mass with heterogeneous enhancement. The resected mass was composed of two distinct components. There was a well-demarcated proliferation of papillary and cystic oncocytic epithelium with lymphoid stroma, consistent with WT. Some areas exhibited sclerotic fibrosis, with multiple lymphoid follicles showing folliculolysis, follicular hyperplasia, and eosinophilic infiltrate. The patient’s immunoglobulin E level serum was elevated, confirming a coexisting KD. The patient underwent a left superficial parotidectomy, with no recurrence at a 30-month follow-up.ConclusionThis report describes the first concurrent case of WT and KD in the parotid gland.

TERT Promoter Mutation in Benign and Malignant Salivary Gland Tumors; A Cross-Sectional Study.

Telomere-related tumorigenesis mechanisms in the salivary gland, including mutation in the promoter region of TERT, have been rarely investigated. Therefore, the present study aimed to investigate the mutation in the promoter region of TERT in benign and malignant salivary gland tumors. This was a descriptive-analytical cross-sectional study. Tissue samples of 54 patients with primary salivary gland tumors sent to the pathology department of Rasool-e-Akram Hospital from September 2017 to September 2021 were examined. Fifteen samples including two groups of the most common benign tumors (n=5; 3 pleomorphic adenomas and 2 Warthin tumors) and four groups of the most common malignant tumors (n=10; 3 mucoepidermoid carcinomas, 3 adenoid cystic carcinomas, 2 acinic cell carcinoma, and 2 salivary duct carcinoma) were selected. The promoter region of TERT, including well-known hot spot regions, is sequenced using the Sanger sequencing method. Data were analyzed using statistical software R version 4.1.2. Of 15 salivary gland tumor specimens, consisting of 5 benign tumors and 10 malignant tumors after DNA sequencing, TERT promoter region mutation was only seen in one of the adenoid cystic carcinoma samples, located at -146 bp upstream from ATG (chr5: 1,295,250 C>T). TERT promoter mutation was not different in malignant and benign salivary tumors. Nonetheless, there are a few studies that report TERT promoter mutation in adenoid cystic carcinoma of the salivary gland, necessitating the need for further investigations.

The role of Inflammation in benign salivary glands tumours etiopathogenesis: an evaluation through the blood inflammatory biomarkers

The role of Inflammation in benign salivary glands tumours etiopathogenesis: an evaluation through the blood inflammatory biomarkers

Relevance of Inflammatory Biomarkers in Salivary Gland Cancers Management

Objective: Preoperative diagnostic investigation of salivary neoplasms leaves a fair share of doubtful cases that complicate the therapeutic choices. The aim of our study was to look for new means to support the decision-making process for their management. Inflammatory biomarkers could play an important role in this process. Methods: A retrospective chart review of salivary glands tumors was performed between January 2016 and September 2020 in our Department. The samples were divided in 2 groups basing on the histological result after surgery: 191 patients with benign salivary glands tumors (SGbt), and 47 with salivary glands cancer (SGc). 90 patients were randomly selected to form the control group (C group). Results: Statistically significant increase of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocite ratio (NLR) and systemic immune-inflammation index (SII) was reported in SGc group compared to SGbt group and control group (p<0.001). Statistical evaluation estabilished optimal threshold for PLR (164,2), NLR (3,11) and SII (517.5) that can discriminate the doubtful cases with specificity of 85-86% and 62% respectively, and sensitivity of 40-45% and 64% respectively. Conclusions: Inflammatory biomarkers can have a relevant role as diagnostic tools in doubtful cases. They could be performed in the clinical setting for guiding the treatment of these neoplasms. Keywords: Salivary glands tumors; Blood inflammatory biomarkers; NLR; SII; PLR

The role of immune surveillance in malignant transformation of benign salivary gland tumors.

Pleomorphic adenoma (PA), the most common salivary gland tumor, is a benign tumor that carries a risk of malignant transformation to various histologies of carcinoma ex pleomorphic adenoma (CA exPA). Recently, genomic analyses have provided deeper insights into the molecular biology of salivary gland cancers. However, the molecular processes that underlie the progression from PA to CA exPA are largely unknown. In this study, we used RNAseq data from CA ex PA of myoepithelial (n = 24) or salivary duct histology (n = 6), de novo myoepithelial carcinoma (n = 16) and de novo salivary duct carcinoma (n = 10), and compared their constituent immune tumor microenvironments. We found that increasing levels of immune infiltration and activation were associated with a generally lower probability of cancer developing ex-PA, suggesting that immune surveillance may constrain the malignant transformation of benign salivary tumors. More immunologically infiltrated tumors were more likely to have developed de novo. Taken together, these data suggest a role for tumor escape from immune surveillance in the development of CA exPA. The immune-cold microenvironments of CA ex PA tumors may in part explain their more aggressive clinical behavior.

Radiation Therapy After Surgical Resection Improves Outcomes for Patients With Recurrent Pleomorphic Adenoma

PurposePleomorphic adenoma is a benign salivary tumor that may recur multifocally. In case series, the benefit of radiation therapy (RT) for recurrent pleomorphic adenoma remains unclear. We hypothesized that the combination of surgery and adjuvant RT reduces risk of subsequent recurrence compared with surgery alone for recurrent pleomorphic adenoma. Methods and MaterialsPatients who received diagnoses of recurrent pleomorphic adenoma between 1980 and 2016 were identified using an institutional pathology database. Medical records were retrospectively reviewed to determine clinical, operative, pathologic, and imaging characteristics. Kaplan-Meier methods were used to estimate local control after surgery, stratified by completeness of resection and receipt of adjuvant RT. The association of variables with risk of subsequent local recurrence was analyzed using Cox proportional hazards model, and variance estimates were calculated to account for multiple recurrences in the same patient. Toxicities were prospectively recorded in a departmental database. ResultsA total of 49 patients presented with at least 1 recurrence, of which 28 were managed with surgery alone, and 21 were treated with surgery and RT. The median follow-up time after the initial recurrence was 48 months (range, 6-531 months). There were 35 subsequent recurrences; 34 after surgery alone and only 1 after surgery with RT. On multivariate analysis, adjuvant RT was associated with decreased risk of recurrence (hazard ratio, 0.09; 95% confidence interval, 0.02-0.41, P = .002), whereas increasing number of prior recurrences was associated with increased risk (hazard ratio, 1.23; 95% confidence interval, 1.13-1.35, P < .001). Common toxicities of RT included dermatitis, xerostomia, and mucositis. ConclusionsFor patients with recurrent pleomorphic adenoma, the addition of adjuvant RT after surgery is associated with a significant decrease in risk of subsequent tumor recurrence.

Carcinoma Ex-Pleomorphic Adenoma Diagnosis During Global Health Engagement Operations.

In global health engagement settings, performance of oncologic surgery is evaluated by understanding the host nation healthcare capacity to include inpatient care support and the available postoperative adjunctive therapy to include chemotherapy and radiation therapy. We present a case during Pacific Partnership 2018 of a patientwith a malignant facial mass diagnosed postoperatively. A literature review was conducted, searching specifically for cases related to pleomorphic adenoma (PA), carcinoma ex-PA, cases of misdiagnosis, and global health engagement operations. The patient presented without constitutional symptoms, clinical lymphadenopathy, or cranial nerve VII weakness with a preoperative host nation diagnosis of a benign salivary neoplasm (PA). Postoperatively, a gross total resection of the mass was diagnosed as high-grade adenocarcinoma-a carcinoma ex-PA of the parotid gland. Oncologic staging was noted to be advanced at T3N0, and the patient was referred back to the host nation surgeons for radiation oncology consultation and clinical surveillance to follow. Diagnosis of carcinoma ex-PA-a rare form of salivary gland malignancy-is not always straightforward because of its high degree of cellular heterogeneity, leading to inconsistencies in preoperative sampling results. This case addresses the preoperative diagnostic challenges associated with this type of malignancy, different types of possible treatment modalities aimed at reducing postoperative morbidity, and the preoperative and postoperative challenges that are critical to address during health engagement operations.

A rare basal cell adenoma (BCA) of the parotid gland ina male patient

Basal cell adenoma (BCA) is an uncommon, benign salivary tumor comprising 1-3% of salivary tumors. These tumors occur more commonly in women and patients older than 50 years of age. Patients typically present with a slow growing, well circumscribed mass. Overall BCA has a good prognosis with low rates of recurrence and malignant transformation. However, BCA membranous subtype undergoes malignant transformation at increased rates compared with the solid, tubular and trabecular forms. We present a rare case of a basal cell adenoma in a 57 year old male as well as a literature review.

Comparison of Diagnostic Reliability of p63 and Smooth Muscle Actin in Salivary Gland Neoplasms.

Salivary gland neoplasms pose considerable diagnostic difficulty owing to their diverse histological features in individual lesions and the presence of a number of types and variants & similar histological features with other tumor entities. Myoepithelial and basal cells play a significant role in the pathogenesis of salivary gland neoplasm. p63 and smooth muscle actin are more reliable markers for identifying these cells and not studied much comparing their reliability in the diagnosis of salivary gland neoplasms. Hence, the aim of this study is to evaluate and compare the diagnostic reliability of immunohistochemical markers such as p63 and smooth muscle actin (SMA) in the diagnosis of various benign and malignant salivary gland neoplasms. The study comprises of 18 samples categorized into two groups: Group I comprised 9 cases, of which 4 cases were Pleomorphic adenoma, 2 cases were Myoepithelioma, 2 cases of Basal cell adenoma and 1 case was Warthin's tumor; and Group II consisted of 9cases, of which 3 was Mucoepidermoid carcinoma, 1 cases were Myoepithelial carcinoma and 5 cases were Adenoid cystic carcinoma. The selected cases were subjected to immunohistochemistry (IHC) procedure to assess the expression pattern of p63 and smooth muscle actin. The obtained data was analysed statistically by using Mann-Whitney test. In SMA, strong positivity for epithelial and connective tissue components of benign salivary neoplasm is about 22.2%respectively. In malignant salivary neoplasm, SMA was strongly positive for the epithelial and connective tissue component of about 77.7% and 88.8% cases respectively. The difference in the connective tissue components was found to be statistically significant (U = 24, P = 0.032). P63 was strongly positive for the epithelial and connective tissue component of benign salivary neoplasm of about 33.3% and 11.1% cases respectively.In malignant salivary neoplasm, p63 was strongly positive for the epithelial component of about 66.6% cases and connective tissue is completely negative. Alpha-SMA can be utilized as reliable IHC markers for salivary gland neoplasms due to its diagnostic importance in tumors with myoepithelial origin indicative of the histogenesis of salivary gland tumors and even p63 can be used as specific markers for differentiation of malignant salivary gland tumors.

Recommended Imaging for Salivary Gland Disorders

Imaging modalities useful in the contemporary evaluation of salivary gland disorders are discussed. Salivary gland ultrasound—due to its wide applicability, versatility, availability, and low cost—is supported as a frontline evaluation and is frequently done as an in-office procedure by the treating surgeon. Contrast-enhanced CT may be as accurate as non-contrast CT in detecting sialolithiasis. Although conventional sialography (fluoroscopic salivary gland evaluation with ductal dilation and radiocontrast insufflation) was initially designed as a diagnostic procedure, more recently, reported experience has demonstrated it to result in improved salivary function for several disorders—including its use as treatment of juvenile recurrent parotitis. Conventional sialography remains the most accurate method to assess the full ductal anatomy and is superior to MRI sialography which fails to adequately image the more proximal ducts. For benign salivary tumors, US may obviate the need for further imaging and provide reliable estimation of tumor location. Salivary gland disorders are most efficiently imaged with in-office ultrasound. In settings where US cannot be performed, CT (with or without contrast) remains a reliable initial method to detect salivary gland abnormalities including sialolithiasis. MR sialography has become a useful modality for evaluating stenosis and may be considered when conventional sialography is not available.

Transoral robotic surgery in head and neck district: a retrospective study on 67 patients treated in a single center

BackgroundThe anatomical complexity of the oropharynx and the difficulty in reaching its distal portion have always conditioned the surgical accessibility.Robotic surgery represents an excellent alternative in the treatment of cervico-facial oncological diseases.MethodsThis series comprises all patients managed for head and neck cancer by Trans Oral Robotic Surgery TORS.The staging assessment, including neck ultrasound and total body PET/CT scan, was performed in each patient according to the TNM classification.All charts were recorded with the following data: name and surname, age, gender, date of surgery intra or post-operative hemorragia, tumor site, histology, TNM stage, robot set-up time, tumor resection time, whether or not tracheotomy was performed, whether or not neck dissection was performed, insertion of a nasogastric tube or gastrostomy, time to resumption of oral feeding, surgical margins, mean length of hospital stay, adjuvant treatment and follow-up.ResultsFrom February 2013 to February 2018, TORS was performed in 67 consecutive patients affected by head and neck tumours.We divided, our sample, in 3 subsites: supraglottic larynx, parapharyngeal space and oropharynx.Pathology reports confimed malignancy in 44 cases: 8 cases lymphomas, 36 cases of Squamous cell carcinoma (SCC), 5 cases of benign salivary glands tumors and 18 miscellaneous cases. Neck dissection was performed in 12 cases.Tracheotomy was perfomed in 3/67 cases for respiratory failures. A nasogastric tube was inserted at the end of the surgical procedure in 21 patients. The mean length of hospital stay was 10 days .Major complications included post-operative bleeding in 3 patients, 1 exitus for massive bleeding 20 days post-surgery and 1 respiratory failure treated with tracheotomy and monitoring in the Intensive Care Unit (ICU) for 3 days.ConclusionsRobotic surgery has been considered a valid alternative to traditional open treatment in many specializations with the advantages of an endoscopic procedure, with the same oncological and functional results and with fewer complications. The advantages of this type of surgical technique have been discussed, it is mandatory to focus on the indications and contraindications.