Facial Nerve Invasion Research Articles

Impact of facial nerve resection in parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric propensity score-based analysis

ObjectivesThe management of the facial nerve (FN) is a major issue in parotid cancer, especially when there is no preoperative facial palsy and FN invasion is discovered intraoperatively. The aim of this study was to assess the impact of FN resection in patients with parotid cancer abutting the FN, without pretreatment facial palsy, using a propensity score matching. Materials and methodsData from all patients treated between 2009 and 2020 for a primary parotid cancer abutting or invading the FN but without pretreatment facial palsy were extracted from the national multicentric REFCOR database. Three different definitions of tumors abutting the FN were used for sensitivity analyses, in a retrospective setting. Propensity score matching was used to assess the impact of FN resection on disease-free survival (DFS), overall survival (OS) and locoregional recurrence-free survival (LRRFS). ResultsA total of 163 patients with parotid cancer abutting or invading the FN without pretreatment facial palsy were included. Among them, 99 patients (61 %) underwent FN resection. After overlap weighting and multiple imputation, no benefit of FN resection over preservation was found in terms of OS (HR = 1.21, p = 0.6), DFS (HR = 0.88, p = 0.5) and LRRFS (HR = 0.99, p = 1).Sensitivity analyses revealed similar results, and no significant efficacy was found in the subgroup analyses. ConclusionIn this retrospective study with propensity score analysis, FN resection did not improve survival outcomes in patients without preoperative facial palsy treated surgically for a primary parotid cancer abutting the FN. In line with recent guidelines, the results of this study suggest that FN preservation should be considered whenever possible in this specific group of patients.

Noteworthy Factors to Decide Therapeutic Strategy for Carcinoma ex Pleomorphic Adenoma of Parotid Gland: A Preliminary Study Statistical Analysis of 22 Cases from Single Institution.

Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor, and its prognosis is determined by the histological progression beyond the adenoma capsule. However, a preoperative evaluation of the histological progression remains challenging, and there is no consensus regarding treatment strategies for CXPA. Herein, we aimed to predict the histological progression preoperatively and develop an appropriate treatment strategy for CXPA. We retrospectively reviewed 22 patients with parotid gland CXPA recorded at our hospital. The clinicopathological characteristics were assessed, and survival analysis was performed. T3≤ or N+ were common in widely invasive CXPA (WICXPA) (p < 0.05). A tumor diameter > 40 mm and the N+ status were associated with poor prognosis considering overall survival (OS) and locoregional recurrence rate (LRC) (p < 0.05). Patients with facial nerve paralysis exhibited better OS and LRC than those without facial nerve paralysis. More than 90% of patients with WICXPA experienced distant metastases. Meanwhile, there were no cases of recurrence or death due to intracapsular and minimally invasive CXPA. A preoperative advanced T stage or N+ status was suspected as WICXPA. Tumors > 40 mm in size and N+ status necessitate high-intensity local treatment. Facial nerve invasion can be controlled by nerve resection. Postoperative systemic therapy could control distant metastases.

Cystic Salivary Duct Carcinoma Penetrated by Facial Nerve.

Salivary duct carcinoma is a rare malignant salivary gland tumor that mainly has solid features. When it occurs in the parotid gland, it can invade the facial nerve and cause facial nerve paralysis. However, in our case, the salivary duct carcinoma exhibited cystic features on computed tomographic imaging, and the facial nerve passed through the cyst. Total parotidectomy with level-I to -III dissections was performed and nerve passing through the tumor was sacrificed. The patient received postoperative radiotherapy and was clinically and radiologically followed-up for every 3 months. Recurrence or distant metastasis was not reported. To the best of our knowledge, this is the first case involving a salivary duct carcinoma with cystic features and facial nerve invasion. Here, we report a first case of cystic salivary duct carcinoma of the parotid gland which uncommonly undergo cystic change and penetrated by facial nerve and successfully resected without causing facial nerve injury.

Preoperative Magnetic Resonance Image and Computerized Tomography Findings Predictive of Facial Nerve Invasion in Patients with Parotid Cancer without Preoperative Facial Weakness-A Retrospective Observational Study.

Simple SummaryFacial nerve invasion in parotid cancer affects survival outcomes as well as functional outcomes after surgery-based treatment. Normal facial muscle function before surgery does not always exclude the possibility of involvement of the facial nerve by a tumor. Especially in patients without facial palsy, accurate evaluation of invasion before surgery is necessary to plan optimal facial nerve resection and reconstruction. Various findings are obtained from preoperative radiological findings, such as CT and MRI. We evaluated the role of these radiological findings in predicting nerve invasion. Large tumor, spiculated margin, and anterolateral location may suggest a high risk of nerve involvement even in patients with normal preoperative facial function. These findings may help surgeons to avoid unexpected facial nerve invasion and to make adequate surgical plans to get optimal oncological and functional outcomes. (1) Background: Facial nerve resection with reconstruction helps achieve optimal outcomes in the treatment of facial nerve invasion (FNI) of parotid cancer. Preoperative imaging is crucial to predict facial nerve reconstruction. The radiological findings of CT or MRI may predict FNI in the parotid cancer even without facial paralysis. Methods: We retrospectively reviewed the records of 151 patients without facial nerve paralysis before surgery who had undergone tumor resection. Previously untreated parotid cancers were included. (2) Results: The median follow-up duration was 62 months (range: 24–120 months). The FNI (+) group (n = 30) showed a significantly worse 5-year overall survival compared with the FNI (−) group (75.5 vs. 93.9%; hazard ratio = 4.19; 95% confidence interval: 1.74–10.08; p = 0.001). The tumor margin, tumor size, presence in the anterolateral parotid region (area 3), retromandibular vein involvement, distance from the stylomastoid foramen to the upper tumor margin, and a high tumor grade were significant factors related to FNI in the univariate analysis. A spiculated tumor margin, the tumor size (2.2 cm), and presence in area 3 were factors predicting FNI in the logistic regression model (p = 0.020, 0.005, and 0.050, respectively; odds ratio: 4.02, 6.40, and 8.16, respectively). (3) Conclusions: The tumor size (≥2.2 cm), spiculated margin, and presence in area 3 as presented in CT and MRI may help clinicians preoperatively predict FNI in patients with parotid cancer and establish an appropriate surgical plan.

Predictors of distant metastasis in acinic cell carcinoma of the parotid gland

BACKGROUNDAiCC is a primarily indolent disease process. Our aim with this study is to determine characteristics consistent with rapidly progressive AiCC of the parotid gland.AIMTo report on patients with metastatic lung disease from AiCC and potential correlative factors.METHODSSingle-institution retrospective review of patients treated at the University of Michigan between 2000 and 2017. Univariate analyses were performed.RESULTSA total of 55 patients were identified. There were 6 patients (10.9%) with primary AiCC of the parotid gland who developed lung metastases. The mean age at diagnosis for patients with lung metastases was 57.8 years of age, in comparison to 40.2 years for those without metastases (P = 0.064). All 6 of the patients with lung metastases demonstrated gross perineural invasion intraoperatively, in comparison to none of those in the non-lung metastases cohort. Worse disease-free and overall survival were significantly associated with gross perineural invasion, high-grade differentiation, and T4 classification (P < 0.001).CONCLUSIONAiCC of the parotid gland is viewed as a low-grade neoplasm with good curative outcomes and low likelihood of metastasis. With metastasis, however, it does exhibit a tendency to spread to the lungs. These patients thereby comprise a unique and understudied patient population. In this retrospective study, factors that have been shown to be statistically significant in association with worse disease-free survival and overall survival include presence of gross facial nerve invasion, higher T-classification, and high-grade disease.

Histological characteristics of intra-temporal facial nerve paralysis in temporal bone malignancies.

To describe the histopathologic findings and clinical presentation of intra-temporal facial nerve invasion in primary and metastatic malignancies of the human temporal bone (TB). Retrospective analysis of all medical records of patients diagnosed with peripheral facial nerve palsy (PFnP) of a malignant origin was performed. Temporal bones underwent standard processing for histologic examination. Hematoxylin and eosin (H&E)-stained slides were examined by light microscopy. The histologic findings were compared to premortem clinical data. Eighteen TBs were identified in 16 patients. The male to female ratio was 9:7. The median (range) age of death was 56.5 years (27 months to 75 years). The median time interval from facial nerve injury to death was 5.5 months. There were 11 carcinomas and seven sarcomas identified. Primary TB malignancies were identified in seven TBs (39%), and the rest (11 TBs, 61%) were of metastatic origin. Complete facial nerve paralysis (House-Brackmann [HB] grade VI), was the most common clinical presentation affecting nine patients (10 TBs, 56%). Neural involvement was multifocal in nature (16 of 18 TBs, 89%). The most commonly involved cranial nerve (CN) VII segment was the meatal segment (13 TBs, 72%), followed by the labyrinthine, tympanic, and vertical segments (nine, eight, and six TBs, respectively). PFnP can be the result of local, regional, or distant malignancy, and is associated with poor survival. The facial nerve can serve as a route of tumor progression intracranially. Whereas every segment of CNV II can be violated by tumors, not all PFnP are related to direct tumor invasion. 4 Laryngoscope, 130:E358-E367, 2020.

Molecular features of adenoid cystic carcinoma with an emphasis on microRNA expression.

Molecular features of adenoid cystic carcinoma with an emphasis on microRNA expression.

Factors affecting survival and locoregional control in head and neck cSCCA with nodal metastasis.

To determine factors affecting locoregional control (LRC) and disease-specific survival (DSS) in patients presenting with regionally metastatic cutaneous squamous cell carcinoma (cSCCA) of the head and neck. Retrospective review. Upon review of institutional pathology database to identify patients with metastatic cSCCA, 62 subjects met the inclusion criteria between 2009 to 2012. Cox proportional hazard ratios for DSS and LRC were calculated for tumor, patient, lymph node, and treatment variables. These factors included primary site, primary tumor grade, primary tumor perineural invasion, extent of primary tumor invasion, age, immune status, parotid nodal status, invasion of facial nerve by parotid tumor, cervical nodal status, extracapsular spread, number of nodes involved, adjuvant radiation therapy, and chemotherapy. All variables were analyzed to determine impact on LRC and DSS. A disease-specific Kaplan-Meier curve was determined for the entire cohort. Five-year survival was 56% for all patients. The presence of extracapsular spread (ECS) and bone involvement of the primary tumor site resulted in statistically significant decreases in DSS (hazard ratio (HR) 41.3 and 270, respectively; P = 0.02 and P = 0.008, respectively) and LRC (HR 8.41 and 11.1, respectively; P = 0.005 and P = 0.04, respectively). The remaining factors had no statistically significant effect on DSS or LRC. The presence of ECS in the metastatic lymph node and of bone invasion by the primary tumor appear to be important to the outcome of patients with metastatic cSCCA. These factors should be considered when developing multidisciplinary care plans and future investigations. 4. Laryngoscope, 1881-1886, 2018.

Postoperative [¹²⁵I] seed brachytherapy in the treatment of acinic cell carcinoma of the parotid gland: with associated risk factors.

This retrospective study was undertaken to analyze data from patients receiving iodine-125 ([(125)I]) seed brachytherapy postoperatively for the treatment of acinic cell carcinoma (ACC) of the parotid gland along with the following risk factors: residual tumor, recurrent tumor, facial nerve invasion, positive resection margins, advanced tumor stage, or tumor spillage. Twenty-nine patients with ACC (17 females, 12 males; age range, 13-73 years; median age, 37.3 years) were included. Median follow-up was 58.2 months (range, 14-122 months). Patients received [(125)I] seed brachytherapy (median actuarial D90, 177 Gy) 3-41 days (median, 14 days) following surgery. Radioactivity was 18.5-33.3 MBq per seed, and the prescription dose was 80-120 Gy. The 3-, 5-, and 10-year rates of local control were 93.1, 88.7, and 88.7 %, respectively; overall survival was 96.6, 92, and 92 %; disease-free survival was 93.1, 88.4, and 88.4 %; and freedom from distant metastasis was 96.6, 91.2, and 91.2 %. Lymph node metastases were absent in all patients, although two patients died with distant metastases. Facial nerve recovery was quick, and no severe radiotherapy-related complications were noted. Recurrence history, local recurrence, and distant metastasis significantly affected overall survival. Postoperative [(125)I] seed brachytherapy is effective in treating ACC and has minor complications. Patients with a history of recurrence showed poor prognosis and were more likely to experience disease recurrence and develop metastases.

Facial Nerve Invasion by Basal Cell Carcinoma

Facial Nerve Invasion by Basal Cell Carcinoma

Microvascular Free Tissue Transfer for Facial Reanimation of the Paralyzed Face

Preoperative facial weakness may be caused by extracranial, intratemporal, or intradural facial nerve invasion by a variety of benign and malignant lateral skull base or posterior fossa neoplasms. Interposition facial nerve grafting is not possible when the paralysis is longstanding, when the facial musculature must be resected, or if a proximal facial nerve stump is not available. In these situations, the best possible alternative is free tissue transfer when the goal is restoring dynamic facial function. This paper outlines the use of microvascular free tissue transfer techniques that can be used for both defect reconstruction and dynamic facial reanimation. The most commonly used free flaps for facial reanimation are the gracilis, latissimus dorsi, serratus anterior, and inferior rectus abdominus muscle.

Prognostic value of a three-grade classification in primary epithelial parotid carcinoma: Result of a histological review from a 20-year experience of total parotidectomy with neck dissection in a single institution

BackgroundThe tumour grading of primary parotid cancers (PPCs) remains controversial. MethodsA 20-year standardised single centre treatment has been assessed retrospectively. The histological review of 155 consecutively treated parotid malignancies identified 96 suitable cases for univariate and multivariate survival analyses. ResultsTreatment involved total parotidectomy, neck dissection and post-operative radiotherapy in, respectively, 91.7%, 83.3% and 70.4% of cases. The 5-year overall survival, disease-specific and recurrence-free survival rates were 79.4%, 83.5% and 70.8%, respectively. Univariate analysis confirmed the classical prognostic factors, i.e. age>60 years, male gender, facial palsy, hardness of the tumour, clinical stage, tumour grade, facial nerve invasion and lymph node metastases. Multivariate analysis identified a three-grade classification just after the clinical stage as the most important prognostic factor. ConclusionThis study identifies the prognostic significance of intermediate grade tumours.

Predicting facial nerve invasion by parotid gland carcinoma and outcome of facial reanimation

We sought to define risk factors for facial nerve involvement in parotid gland carcinoma and assess the outcome of facial nerve reanimation. Medical records were reviewed of 66 patients who underwent surgery for parotid carcinoma in 2000–2007 at a tertiary hospital. Patient and tumor characteristics were compared between patients with and without facial nerve involvement and were analyzed on their influence on functional outcome following reanimation. Facial nerve involvement was verified intraoperatively in 24 patients, of whom 16 underwent reanimation during ablative surgery. Deep lobe invasion was significantly associated with intraoperative finding of facial nerve involvement. Tumors larger than 4 cm and salivary duct carcinoma had an obvious trend for facial nerve involvement. House-Brackmann score at 12 months was 3-4 in most patients. Deep lobe involvement and large tumor size may identify patients at risk of facial nerve involvement. Reanimation is associated with good functional outcome regardless of patient's age.

Malignant parotid tumor and facial palsy

To evaluate risk factors for postoperative facial palsy in patients with parotid carcinoma. We conducted a retrospective chart review of patients with parotid carcinoma who underwent parotidectomy at National Taiwan University Hospital from 1980 to 2000. Eighty-eight patients with a mean age of 53 +/- 17 y were recruited. Sixty patients (68.2%) experienced postoperative facial palsy. Tumor size of larger than 4 cm was associated with an increased incidence of facial palsy (P = 0.0422). Facial palsy was noted in 95.5 percent of patients with facial nerve involvement and 51.3 percent of patients without facial nerve involvement (P = 0.0004). Of 42 patients with tumor over the deep lobe, 37 (88.1%) had facial palsy but only 50 percent (23 of 46) of those with tumor over the superficial lobe had facial palsy (P = 0.0001). There were no significant associations between histopathology and facial palsy. Increasing tumor size, deep lobe tumor location, and tumor invasion of facial nerve increased the incidence of postparotidectomy facial palsy. By paying attention to these risk factors a reduction of postoperative facial nerve palsy my be achieved.

Facial Paralysis Associated With Glomus Jugulare Tumors

To review the intraoperative findings and facial nerve management in nine patients who presented with facial paralysis associated with glomus jugulare tumors. A retrospective analysis of patient medical records. Tertiary care academic medical center. All patients who presented with facial paralysis and a glomus jugulare tumor who underwent surgical resection of their tumors at our institution. A postauricular infratemporal fossa approach for tumor removal and greater auricular interposition neural repair. Intraoperative facial nerve findings and long-term facial recovery. One hundred two patients underwent a postauricular infratemporal approach for resection of glomus jugulare tumor from July 1988 through July 2005. Nine of these patients presented with ipsilateral facial paralysis. The medial surface of the vertical segment was invaded by tumor in all nine cases. Facial recovery at 2 years was House-Brackmann Grade III in eight patients and Grade IV in one individual. Facial recovery did not significantly change after 2 years (mean follow-up of 7.4 years). Facial nerve invasion of the vertical segment occurred in 9 (9%) of 101 patients in our series. Facial nerve resection with interposition grafting resulted in House-Brackmann Grade III in eight (89%) of nine patients. Facial nerve dissection and preservation was not possible when preoperative facial paralysis was evident.

耳下腺悪性腫よう７４例の臨床的検討―治療法と成績―

The clinical features of 74 patients (39 men, 35 women; mean age, 62 years) with malignant parotid tumors were retrospectively investigated. According to the TNM Classification, 4 patients were classified as T1, 9 as T2, 6 as T3, and 55 as T4. Fifty cases were staged as N0, 9 as N1, 14 as N2 and 1 as N3. Tumors located in both lobes of the parotid gland were the most frequent type of tumor (49%). Twenty-four percent of the 74 patients exhibited facial nerve palsy before treatment. Facial palsy was found predominantly in cases with a higher T classification or with deep lobe occupation. Histopathologically, sixteen tumor types were observed; mucoepidermoid carcinoma was the most common. The overall five-year and ten-year survival rates determined using the Kaplan-Meier method were 65% and 61%. The factors influencing a poor outcome were T4 classification (p=0.0189), an N+ stage (p<0.0001), and facial palsy (p<0.0001). As for the major histopathologic types, the five-year survival rates were 69% for mucoepidermoid carcinoma, 48% for adenocarcinoma, 71% for adenoid cystic carcinoma, and 100% for acinic cell carcinoma and malignant mixed tumor. With respect to the treatment modality, patients who were classified as T1 or T2 and whose tumors were located in the superficial lobe without facial nerve invasion could be satisfactorily treated with only a superficial lobectomy conserving the facial nerve. A total parotidectomy with total removal of the facial nerve seemed necessary for T3 and T4 cases, especially those with adenocarcinoma or mucoepidermoid carcinoma. Modified neck dissection may be necessary for N0 cases, especially those with adenocarcinoma, adenoid cystic carcinoma or undifferentiated carcinoma. Nerve grafting after total nerve resection is recommended for a better quality of life.

Surgical management of the facial nerve in the presence of malignancy about the face

Approximately 5% of cutaneous squamous carcinomas demonstrate perineural spread (PNS) affecting, most frequently, the facial and trigeminal nerves. Cutaneous cancers demonstrating subclinical (histologic) PNS require postoperative radiotherapy after excision, whereas those cancers with clinical facial nerve invasion require more radical excision, removing nerve and parotid, followed by adjuvant irradiation. Local control rates vary with the extent of PNS—90% for minimal subclinical invasion, 60% for extensive invasion, and 50% when there is nerve dysfunction. Parotid cancers may also invade the facial nerve, and approximately 12 to 15% of patients with parotid malignancy have facial nerve dysfunction at presentation. These patients need radical parotidectomy and adjuvant radiotherapy, but they have a relatively poor prognosis—an approximately 45% chance of 10-year survival when nerve function is abnormal preoperatively. The extent of surgery for parotid cancer should be governed by tumor size and the macroscopic appearance of the facial nerve. Tumors less than 4 cm in diameter can usually be resected by limited parotidectomy, preserving the nerve; however, every effort should be made to achieve clear surgical margins. Adjuvant radiotherapy is recommended for large or high-grade tumors, positive margins, and perineural extension, because it improves local control. However, there may be little impact on survival.

Prognostic Variables in Parotid Gland Cancer

We performed a retrospective review of 178 previously untreated patients with primary malignant neoplasms of the parotid gland treated at our institution between 1960 and 1985. Patients were followed up for a median of 7.5 years. Fifty-nine percent underwent surgery alone, and 40% underwent surgery and radiation therapy. Univariate and multivariate analyses established the prognostic influence of cancer stage, cancer grade, histologic type, presence of lymphatic invasion, perineural invasion, tumor size, extension beyond the parotid gland fascia, cervical adenopathy, quality of margins, and patient age and gender. Survival was influenced most by tumor grade, tumor size, presence of positive cervical lymph nodes, and facial nerve invasion. The risk of local-regional recurrence was most affected by cervical adenopathy and tumor size. Distant metastases were predicted by tumor grade and size. At last contact, 39% of patients were alive and free of disease, while 26% had died of the disease. We analyzed the optimal surgical procedure and the rationale for the selection of combined treatment.

Primary Fallopian Canal Glomus Tumors

Primary fallopian canal glomus tumor has been reported only once previously, although the occurrence of glomus body tissue in the fallopian canal was documented many years ago. Facial paresis as a presenting symptom of glomus tumors is well known, as is facial nerve invasion by glomus tumors. However, a primary fallopian canal glomus tumor that extends extratemporally to the pes anserinus is unusual. Although facial nerve grafting may be necessary for removal of some glomus jugulare tumors, the need for facial nerve grafting appears to be uniform in the patients with primary fallopian canal glomus tumors. The primary fallopian canal glomus tumors that we report did not involve the jugular fossa or the Jacobson's branch of the glossopharyngeal nerve. Both tumors did extend to the middle ear and mastoid and followed the facial nerve extratemporally. The latter features appear to typify primary fallopian canal glomus tumors.