Malignant Parotid Research Articles

Patterns of Lymph Node Metastasis in Parotid Cancer and Implications for Extent of Neck Dissection.

The role and extent of neck dissection in primary parotid cancer are controversial. Herein, we characterize patterns of lymph node metastasis in parotid cancer. Retrospective analysis. National Cancer Database. Patients with the 6 most common histologic subtypes of parotid cancer were selected. Primary outcomes were the distribution of positive lymph nodes by level and overall survival assessed by Cox analysis. Secondary outcomes included predictors of extended lymph node involvement (≥3 lymph nodes or Level IV/V involvement), via logistic regression. Six thousand nine hundred seventy-sevenpatients with acinic cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma (CExPA), mucoepidermoid carcinoma, and salivary duct carcinoma (SDC) were included. Among cN0 patients, 8.2% of low-grade tumor patients had occult nodal metastasis versus 30.9% in high-grade tumor patients. Elective neck dissection was not associated with an overall survival benefit (adjusted hazard ratio: 1.10; 0.94-1.30, p = .238). Among cN+ tumors, CExPA (odds ratio [OR]: 1.88, 1.05-3.39, p = .034) and high-grade pathology (OR: 3.03, 1.87-4.93, p < .001) were predictive of having ≥3 pathologic nodes. CExPA (OR: 2.13, 1.22-3.72, p = .008), adenocarcinoma (OR: 1.60, 1.11-2.31, p = .013), SDC (OR: 1.92, 1.17-3.14, p < .01), and high-grade pathology (OR: 3.61, 2.19-5.97, p < .001) were predictive of Level IV/V neck involvement. In parotid malignancy, nodal metastasis distribution is dependent on histology and grade. High-grade tumors and certain histologies (SDC and adenocarcinoma) had a higher incidence of occult nodes. Comprehensive neck dissection should also be considered for node-positive high-grade tumors, SDC, and adenocarcinoma.

Alternative parameterization approaches for modelling risk assessment in the presence of imbalance: An example using parotid malignancy

AbstractIn collaborative statistics, logistic regression models are commonly used with binary outcomes and reference cell coding for categorical predictors. However, despite the usefulness of reference cell coding schemes under many investigative objectives, it is not always appropriate to address research questions of interest. Investigators often consider modifying research questions to align with inference possible using reference cell coding. Alternative coding schemes can offer a more appropriate approach for the investigation. We explored application of deviation from means coding in determining how results from a diagnostic tool provide additional information on a patient's risk of disease with respect to the overall (naïve) risk at clinical presentation. We compared model parameterizations between using reference cell coding and deviation from means coding, by both unweighted and weighted approaches, for assessing risk of parotid malignancy, comparing patients with indeterminate FNAB results with the general (naïve) risk among presenting patients. Unweighted deviation from means coding estimates a 1.2‐fold increase in the odds of malignancy with an indeterminate FNAB result compared to the naïve odds of malignancy at clinical presentation (OR: 1.21 [95% CI: 1.63–2.32], p = 0.5699). The weighted approach takes into account the imbalance in the presenting population and estimates an increased risk (OR: 2.54 [95% CI: 1.52–4.26], p = 0.0004), which is more accurately representing the naïve risk at presentation and to answer the research question of interest. Using standard reference cell coding, an indeterminate result is associated with significantly higher odds than that of a negative result (OR: 5.20 [95% CI: 2.22–12.20], p = 0.0001), but this does not inform us as to the risk with respect to that inherent at clinical presentation and thus may not be useful for clinical decision making.

Pre-Radiation CT-Based Radiomic Features Predict Locoregional and Distant Failure in Locally Advanced Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> Locally advanced head and neck cancer treatment often involves aggressive multimodal therapy. While outcomes have improved in certain groups (HPV-positive disease), locoregional (LRF) and distant failure (DF) remain persistent problems. Accurate prediction of these risks would provide vital clinical insight; for instance, a patient with low LRF risk could be de-escalated, while a patient at high-risk for DF could be offered systemic options in lieu of aggressive local therapy. In this study we explore the use of CT-based radiomic features (quantitative sub-visual cues) for this purpose. <h3>Materials/Methods</h3> We identified patients with primary or recurrent locally advanced head/neck cancer treated between 2014-2020 who received a definitive or adjuvant RT course (naïve to RT prior). Histologies included squamous cell carcinoma (SCC), poorly differentiated carcinoma (nasopharyngeal or salivary origin), high-risk parotid malignancies, and skin SCC metastatic to the parotid/neck. Patients had at least 12 months of follow-up and charts were assessed for LRF and DF. CT simulation images were extracted from our treatment planning system, and specific contoured regions of interest (ROIs) were selected including the peritumoral region or post-surgical tumor bed (high-risk clinical tumor volume, CTV HR) and involved/elective neck levels (CTV Necks). CT scans were resampled to be isotropic and 3D radiomic features (Gabor wavelet, Hara lick, and CoLlAGe) were extracted from within CTV HR and CTV Necks ROIs. Using a Wilcoxon rank sum test, differential expression for each feature was calculated between patients experiencing treatment failure (LRF and DF) and those with no evidence of disease progression. A similar process was done with baseline clinical features including performance status, tumor stage, age, p16 status and smoking history. Where required, a chi-squared test was used for categorical clinical variables. <h3>Results</h3> 95 patients were analyzed (45 definitive, 50 adjuvant). There were 17 LRF (17.9%) and 16 DF (16.8%) events. 304 radiomic features were extracted from CTV HR and CTV Necks (the latter was only performed for patients with bilateral neck contours). 2 features extracted from CTV HR ROIs were significantly associated with LRF and 29 features with DF (p < 0.05). 30 features extracted from CTV Necks ROIs were significantly associated with LRF and 0 features with DF (p < 0.05). There were no statistically significant clinical features associated with LRF or DF. <h3>Conclusion</h3> CT-based radiomic features derived from specific ROIs in simulation images were associated with both LRF and DF events, which was not the case for canonical clinical features. Interestingly, the CTV HR was more prominently associated with DF, whereas the CTV Necks was associated with LRF. Further studies with larger, more diverse datasets are needed to refine this model and provide a path for clinical validation.

Metastatic parotid gland malignancy: A preliminary study in an eastern Chinese population

ObjectiveThis study aimed to determine the incidence and clinicopathological patterns of metastatic carcinoma of the parotid gland. MethodNinety patients with parotid gland metastases admitted to our hospital between January 2003 and December 2018 were included in this study. Clinical and pathological data were obtained from the medical records and follow-ups. Kaplan-Meier analysis was used to assess overall survival of patients. ResultsAmong the 90 patients, parotid gland metastases originated from the head and neck in 86 (95.6%), from non-head and neck in 4 (4.4%), from the oral cavity in 30(33.3%), and from the eyelid in 21 (23.3%). Among the 85 cases with parotid gland lymph node metastasis, 45 (52.9%) were diagnosed with extra-lymph node metastasis. The capsule of the parotid lymph nodes was thinner than that of the cervical lymph nodes (P < 0.05). Hematogenous metastases to the parotid gland (only five cases) were rare, mainly from the non-head and neck malignancies. Patients with oral squamous cell carcinoma and meibomian adenocarcinoma with parotid metastatic disease had poorer overall survival (P < 0.05). ConclusionEastern China population analysis showed that parotid gland metastases usually arise from oral squamous cell carcinoma and eyelid, but rarely from cutaneous squamous cell carcinoma. Most cases metastasize to the parotid lymph nodes via the lymphatic system and are prone to extranodal extension with little or no facial nerve involvement. These findings have important implications for the treatment of metastatic parotid malignancies.

PULMONARY INVOLVEMENT WITH PLEOMORPHIC ADENOMA: 30-YEAR EXPERIENCE WITH THIS RARE ENTITY AT A TERTIARY REFERRAL CENTER

PULMONARY INVOLVEMENT WITH PLEOMORPHIC ADENOMA: 30-YEAR EXPERIENCE WITH THIS RARE ENTITY AT A TERTIARY REFERRAL CENTER

Multimodal magnetic resonance imaging for the diagnosis of parotid gland malignancies: systematic review and meta-analysis.

BackgroundTo systematically evaluate the qualitative diagnostic value of multimodal magnetic resonance imaging (MRI) for parotid gland tumors. However, there is still a lot of controversy in this area, and the results of different studies are not consistent. Therefore, it is necessary to use meta method to analyze the significance of multimodal MRI in the diagnosis of parotid gland tumors.MethodsThis study aimed to assess the diagnostic performance of multimodal MRI for parotid gland malignancies. We performed a search in the databases of the Cochrane Library, PubMed, Web of Science, Embase, Chinese BioMedical Literature (CBM). Quality evaluation and data extraction were performed for the included articles, and meta-analysis was performed on the included studies using Stata 15.0 software.ResultsAfter screening, a total of 5 relevant documents met the standards and were included. The results of analysis showed that the MRI with diffusion-weighted imaging (MRI-DWI) combined sensitivity and specificity were 0.54 (0.22–0.83) and 0.93 (0.79–0.98). The MRI with dynamic contrast-enhanced (MRI-DCE) combined sensitivity and specificity were 0.81 (0.48–0.95) and 0.95 (0.92–0.97). The pooled area under the curve (AUC) of the MRI-DWI was 0.89 (95% CI: 0.86–0.91) and the pooled area under the curve (AUC) of the MRI-DCE was 0.96 (95% CI: 0.94–0.97).DiscussionThe results of meta-analysis showed that multimodal MRI had good sensitivity, specificity and high sensitivity in the diagnosis of parotid gland carcinoma. However, there is high heterogeneity, which needs to be verified by a large number of clinical studies.

Facial Nerve Repair following Acute Nerve Injury.

Background Acute facial nerve iatrogenic or traumatic injury warrants rapid management with the goal of reestablishing nerve continuity within 72 hours. However, reconstructive efforts should be performed up to 12 months from the time of injury since facial musculature may still be viable and thus facial tone and function may be salvaged. Methods Data of all patients who underwent facial nerve repair following iatrogenic or traumatic injury were retrospectively collected and assessed. Paralysis etiology, demographics, operative data, postoperative course, and outcome were examined. Results Twenty patients underwent facial nerve repair during the years 2004 to 2019. Data were available for 16 of them. Iatrogenic injury was the common category ( n = 13, 81%) with parotidectomy due to primary parotid gland malignancy being the common surgery ( n = 7, 44%). Nerve repair was most commonly performed during the first 72 hours of injury ( n = 12, 75%) and most of the patients underwent nerve graft repair ( n = 15, 94%). Outcome was available for 12 patients, all of which remained with some degree of facial paresis. Six patients suffered from complete facial paralysis (50%) and three underwent secondary facial reanimation (25%). There were no major operative or postoperative complications. Conclusion Iatrogenic and traumatic facial nerve injuries are common etiologies of acquired facial paralysis. In such cases, immediate repair should be performed. For patients presenting with facial paralysis following previous surgery or trauma, nerve repair should be considered up to at least 6 months of injury. Longstanding paralysis is best treated with standard facial reanimation procedures.

The role of perineural invasion in parotid malignancy outcomes: A systematic review and meta-analysis

PurposeAt present, perineural invasion is used as a histologic indicator of aggressive salivary gland disease. In other head and neck malignancies, perineural invasion impacts staging of cancer lesions and therefore affects treatment options. ObjectiveTo compare survival outcomes in primary parotid malignancies with and without perineural invasion.A systematic review pooled data from the scientific literature in patients with any primary parotid malignancy to investigate the prognosis of those with perineural invasion. Data SourcesPubMed (Medline), Scopus and Cochrane databases were queried from inception to July 2020 without any initial search constraints. Additional publications were included from review of pertinent articles. Study SelectionOur inclusion criteria included primary parotid cancers with reported perineural invasion on survival outcomes. Exclusion criteria were non-English language text, non-human studies, reviews, textbooks, abstracts, case reports and case series. Two authors independently reviewed articles for inclusion. Of the initial 465 records, 83 articles were reviewed in full to yield a final collection of 14 studies. Data Extraction and SynthesisPRISMA-p guidelines were used in the reporting of our studies. A MOOSE Checklist was also used. MINORS criteria were applied to assess risk of bias. Random-effects models were used to estimate pooled effect sizes. No institutional review board review was needed for our study.Main Outcomes and Measures: Primary study outcomes were set prior to data collection and included overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and distant-metastasis-free survival (DMFS) in patients with and without perineural invasion. ResultsFourteen studies contributed to this meta-analysis. Compared to patients without perineural invasion, the pooled rate of mortality (HR = 3.64), time to recurrence (HR = 3.56), disease-specific mortality (HR = 2.77) and distant metastasis (HR = 3.84) was significantly higher for patients with PNI (all p <.001). Controlling for perineural invasion status, no moderator was associated with these survival outcomes (all p >.05). Given the clinical severity of perineural invasion, few studies were null as shown in a panel of publication bias plots. ConclusionPerineural invasion portends a poor survival outcome in patients with parotid malignancies.Level of Evidence: 1.

Symptoms: Unilateral Hearing Loss and Facial Paresis

Symptoms: Unilateral Hearing Loss and Facial Paresis

Surgery for parotid gland cancer-controversial and proven aspects

Due to the rarity of primary parotid malignancies, there are currently only limited clinical study data on the optimal surgical therapy. Parotid malignancies encompass abroad spectrum of more than 20different histological subtypes with varying biology, which thus represents a challenge for even experienced pathologists and head and neck surgeons with proven expertise in salivary gland surgery. The aim of this review article is to provide an overview of the current literature on surgical therapy of the primary tumor and the cN0 neck as well as treatment of the facial nerve, and to shed light on the various controversial aspects of this topic. In salivary gland oncology there is atrend towards safe (R0) but more conservative surgery. Currently, less-invasive surgical approaches could potentially be applied in asmall subgroup with carefully selected caudally located and R0-resected "low-grade tumors" in stages T1-T2 and cN0 in relatively young patients with high compliance and more in the context of structured clinical studies. Elective neck dissection in the case of cN0 status should be carried out if risk factors for occult cervical lymph node metastasis (T3-T4a, "high-grade subtypes," advanced age, lymphangitic carcinomatosis) are present. In cases of small "low-grade parotid carcinomas," narrow resection margins or even microscopic tumor residues on the facial nerve can potentially be adequately compensated with adjuvant radiation therapy. However, due to the lack of solid data, the significance of the actual effect of the radiation in this situation should be viewed with great caution.

Clinical features in salivary gland lymphoepithelial carcinoma in 10 patients: Case series and literature review.

ObjectiveLymphoepithelial carcinoma (LEC) accounts for 0.4% of malignant tumors of the salivary gland and 0.8% of parotid gland malignancies. Over the past 50 years, less than 300 cases have been reported in the literature. The purpose of this study was to investigate the characteristics of salivary gland LEC.MethodsWe retrospectively reviewed the medical records and analyzed clinical data obtained from 10 patients seen at our hospital between 2005 and 2020 with salivary gland LEC.ResultsAll patients presented with a self‐palpable, non‐tender, hard swelling, or lump near the jaw or infra‐auricular region. Most cases (n = 8) were of solitary tumors, and enhancing patterns on computed tomography mainly were homogenous (n = 8). Interestingly, eight patients tested positive for the Epstein–Barr encoding region in in situ hybridization. Still, only three patients had detectable circulating Epstein–Barr virus (EBV) DNA, and one patient had detectable EBV IgA. All patients underwent complete tumor resection, followed by radiotherapy, and six also underwent chemotherapy. Nine patients became disease‐free within 5 years, and one died due to disease 4 years after surgery.ConclusionAlthough rare and considered to be a high‐risk malignancy, LECs have favorable treatment outcomes. Circulating EBV DNA is still not considered a marker for preoperative assessment or postoperative treatment response. The role of EBV DNA requires further investigation.Level of Evidence: 4

Minimally invasive temporalis tendon transposition and upper lid lipofilling for immediate and secondary facial reanimation in patients treated for malignant tumors of the parotid gland

Treatment for facial nerve-invading parotid malignancies usually results in complete facial palsy. The authors present a novel technique to treat facial palsy following radical parotid surgery and retrospectively evaluate results in terms of soft tissue symmetry at rest and during smiling and eyelid closure using the eFACE system.9 patients with facial palsy following parotid malignancies resection or undergoing parotidectomy with planned facial nerve resection for tumor invasion were treated with the association of mini-invasive temporalis flap rotation and upper lid lipofilling to restore symmetry of the middle facial third at rest and during smiling and eyelid closure. The technique was employed during the same surgical session as the tumor removal or for secondary facial reanimation.Systematic eFACE evaluation demonstrated significant improvement in static nasolabial fold depth orientation and oral commissure position, palpebral fissure narrowing during eye closure, and oral commissure movement and nasolabial fold depth and orientation with smile (p respectively .008, .011, 0.008, 0.035, 0.011, 0.008, and 0.011, Wilcoxon's test). Furthermore, all patients described subjective improvement of corneal discomfort.The presented technique appears promising in treating facial palsy in oncological patients, representing a potential alternative to other more complex reconstructive techniques.

Cancer-specific and overall survival of patients with primary and metastatic malignancies of the parotid gland - A retrospective study

The aim of this study was to display the cancer-specific and overall survival of patients with primary and metastatic malignancies of the parotid gland. In this retrospective study all patients with primary parotid malignancy and metastatic cutaneous squamous cell carcinoma (cSCC) of the parotid gland treated surgically with curative intent at a tertiary care institution were included. Patients were followed with regards to their oncologic outcome for a minimum of two years. Management approaches, overall, and cancer-specific survival were compared between patients with primary and secondary parotid gland carcinomas. Ninety-four patients (43 patients with primary parotid malignancy; 51 patients with metastatic cSCC of the parotid gland) were included. Patients with metastatic cSCC were older (p = 0.001) and more frequently male (p = 0.002). Adjuvant therapy (p = 0.001) and neck dissection (p = 0.009) were more frequently performed among patients with metastatic cSCC of the parotid gland than among those with primary parotid malignancy. Mean follow-up was 50 (95% CI: 40–65) months. Five-year cancer-specific survival was 87.3% among patients with primary parotid malignancies and 54.5% among patients with metastatic cSCC (p = 0.006). Cancer-specific survival of patients with metastatic cSCC of the parotid gland is still low. An earlier diagnosis of parotid metastases of cSCC may potentially lead to a better prognosis.

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed: Is Homolateral Vessel or Nerve Depletion a Contraindication?

Facial paralysis reconstruction can be difficult in extensive defects after complex facial or cranial base tumor resection and radiotherapy or when primary smile reanimation attempt has failed. The surgical challenge is more complicated when defects are associated with recipient vessels or nerves depletion. This scenario has not been well described in the literature, and the present article will address the alternatives that plastic surgeons may use in these circumstances. Seventy-five patients operated in the Hospital Gregorio Marañon between 2008 and 2020, for dynamic reconstruction of facial paralysis, were retrospectively evaluated, collecting data about previous facial nerve surgeries, radiotherapy, chemotherapy, recipient nerve for motor restoration and vessels used for free flaps, type of neurovascular free flap (NVFF), and functional score before and after the facial reanimation surgery. Patients presenting recipient vessel and/or nerve depletion after several facial surgeries requiring a variation from the common NVFF surgical protocol were included in this study. Six cases (8%) with facial paralysis and absent recipient homolateral vessels or nerves after severe cranial base surgery, parotid malignancies, or schwannoma surgery were included. Two patients had an immediate functional reconstruction during the oncologic resection surgery, and 4 patients had a delayed reconstruction. Three patients had previous reconstruction with free flaps, and the vascular pedicles of previous flaps were used for the new NVFF. In the other 3 cases, interposition vein grafts to the contralateral recipient vessels were required to perform NVFF. Masseteric nerve in 4 cases, hypoglossal nerve and posterior branch of the deep temporal nerve in 1 case each, were used as recipient nerves. House-Brackmann score improved in all patients after surgery. Neurovascular free flap can be successfully performed to restore facial motion after depletion of homolateral recipient vessels or nerves after previous facial or cranial base surgeries. In these cases, interposition vascular grafts or the pedicle of previous flaps are essential to provide vascularization as well as an optimal orientation of flaps, to reach recipient nerves in a 1-step procedure.

Sonoelastographic characterization of parotid and submandibular lesions our initial experience: A prospective observational study

Context: Sonoelastography is an emerging noninvasive imaging modality used for the assessment of soft tissue lesions. Parotid and submandibular glands are relatively superficial structures which can be easily assessed and examined to characterize the lesions. Aim: The aim of the present study is to evaluate the sonoelastographic features of various benign and malignant parotid and submandibular gland lesions, and correlate their findings with pathology. Materials and Methods: In a prospective observational study conducted in Acharya Vinoba Bhave Rural Hospital of JNMC College, Sawangi, Wardha, 24 patients who presented with salivary gland lesions were evaluated with sonoelastography during 2 years. Results: The most common age group in this study was 51–60 years, followed by 31–40 years. Benign lesions were more common than malignant ones. Higher values of strain ratio were seen in cases of malignant tumours correlating well with score of 3 and 4 on elastography. Conclusions: Sonoelastography is a recent advance in ultrasound for the evaluation of salivary gland lesions showing good correlation with pathology so it can be employed routinely in presurgical evaluation.

Primary basaloid squamous cell carcinoma of the parotid gland mimicking metastasis of basal cell carcinoma of the contralateral periorbital region: case report

Basaloid squamous cell carcinoma (BSCC) in the head and neck area is extremely rare. World Health Organization defined BSCC as a high-grade variant of squamous cell carcinoma composed both of basaloid and squamous components. Due to its histologic similarity to other parotid gland malignancies it can be easily misdiagnosed. We report first case of BSCC arising from parotid gland in Europe and second in the world literature. A 72-year-old female patient was referred to the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University in Poland due to the tumor arising from the right parotid gland. Patient had history of multiple excisions of recurrent basal cell carcinoma (BCC) of the left periorbital region. We performed total parotidectomy with facial nerve preservation. Postoperative radiotherapy (PORT) was carried out, and the patient received 70 Gy in 30 fractions on the parotid gland area due to the fact that the tumor adhered to the facial nerve trunk and branches, additionally 60 Gy on the neck area in I, II and III levels. To distinguish the tumor of the parotid gland from the possible metastasis from BCC of the left medial canthal region previous histopathological slides were also reexamined and compared with histopathological examination of removed parotid gland tumor. Histological examination confirmed a rare case of BSCC arising from the parotid gland. 14 months of the follow up did not show local recurrence or distant metastasis.

Histopathological and Immunohistochemical Analysis of Rare Parotid Tumours: A Case Series

Malignant salivary gland tumours are rare representing only 2% of all head and neck malignancies. The most common malignant salivary gland tumour is mucoepidermoid carcinoma followed by adenoid cystic carcinoma while parotid is the most common site. But there are presence of other rare variants with diverse biological feature of maliganacy including Salivary Duct Carcinoma (SDC), basal cell adenocarcinoma, Carcinoma ex Pleomorphic Adenoma (CXPA), polymorphous adenocarcinoma which represent 1-5% of all salivary gland neoplasm. They typically are high-grade carcinomas with presence lymph nodal metastases. Hereby, author report 5 rare cases of parotid gland malignancy detected by histopathological examination along with confirmation by immunohistochemical examination. A 60-year-old and 65-year-old male diagnosed with salivary duct carcinoma of left parotid and right parotid respectively with ipsilateral cervical lymph node involvement but peripheral resection margins were free from tumour invasion. A 50-year-old female diagnosed with basal cell adenocarcinoma of left parotid with lymph node metastasis and resection margin was involved by the tumour. A 60-year-old male presented with recurrent swelling in left parotid region, diagnosed as carcinoma ex pleomorphic adenoma with lymph node involvement in a case of pleomorphic adenoma of parotid, reported previously. A 52-year-old male presented with right-sided parotid region swelling for last six months having Fine Needle Aspiration Cytology (FNAC) report of pleomorphic adenoma. Parotidectomy revealed diagnosis of polymorphous adenocarcinoma while surgical resection margins were free. Surgery is the main mode of treatment in these tumours. Involvement of resection margins, extraparotid extension, lymphovascular and perineural invasion along with lymph node metastasis are the common indicator for postoperative radiation therapy.

Indications and Outcomes of Parotidectomy in Saudi Children: Experience From Two Tertiary Centers

IntroductionChildren can present with a wide variety of parotid diseases. However, most of them do not require surgical treatment. The indications of parotid surgery in children may differ from those in adults. In this study, we aim to review the indications and outcomes of parotidectomy in our pediatric population.MethodsRetrospective review of the medical records of patients who underwent parotid surgery at age <18 years in two tertiary centers over a 14-year period.ResultsA total of 18 parotidectomies were performed on 18 patients with a mean age of 13.5 years. All patients presented with a parotid mass. The most common procedure was superficial parotidectomy followed by total parotidectomy. Ten patients were diagnosed with a benign parotid disease (55.6%). The most common benign disease was pleomorphic adenoma. There were eight cases of parotid malignancy constituting 44.4% of all patients and 57% of patients presenting in the age range of 12-17 years. Mucoepidermoid carcinoma was the most common malignancy (six patients). Fine needle aspiration biopsy was performed in 12 children with a sensitivity, specificity, and overall accuracy of 62.5%, 50%, and 58.6%, respectively. The most common complication was temporary facial weakness (33.3%) which resolved in a mean time of 2.5 months. No disease recurrences were identified.ConclusionsParotidectomy is uncommon in the pediatric age group. Children with a solid parotid tumor have a higher risk of parotid malignancy when compared to adults. A parotid mass presenting in the second decade of life is more likely to be malignant than benign.

The role of total parotidectomy in high-grade parotid malignancy: A multisurgeon retrospective review

PurposeDetermine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection. Materials & methodsRetrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported. Results75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively. ConclusionParotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.

Value of dynamic contrast enhanced MRI in differential diagnostics of Warthin tumors and parotid malignancies

To define an algorithm for differential diagnostics of parotid malignancies and Warthin tumors (WTs) based on dynamic contrast enhanced MRI (DCE-MRI). 55 patients with parotid tumors treated surgically were analyzed. Of which, 19 had parotid malignancy and 36 had WTs confirmed with postoperative histopathological examination. Accuracy of DCE-MRI parameters (Tpeak and WR) was compared with the histopathological diagnosis. ROC analysis was performed to determine sensitivity and specificity of DCE-MRI with various Tpeak and WR cut-off values. WT showed significantly lower median Tpeak and higher median WR than malignant lesions. The cut-off values for Tpeak and WR providing maximum sensitivity (84.2%) and specificity (86.1%) for malignant tumors were Tpeak > 60 s and WR ≤ 30%. Different diagnostic algorithm, i.e., lower cut-off value for Tpeak (Tpeak = 60 s), increases sensitivity of DCE-MRI in differentiating parotid malignancies from WTs. However, WR > 30% seems to be a key diagnostic criterion for benign lesions. Precise and reliable preoperative diagnostics of parotid tumors aids in careful surgical planning, thereby assisting in achieving sufficient surgical resection margins and facial nerve preservation.