Midcheek Mass Research Articles

Accessory salivary tissue presenting as a mid-cheek mass: A case report

Accessory parotid glands are salivary tissue collections seen as separate glandular mass detached from the main parotid gland lying on the masseter muscle. It develops from the branching of the blind end of the parotid tube and by glandular proliferation of secretory and stromal structures. They are anatomical variations seen in the mid cheek region with a frequency of 21% to 56% found in autopsy studies. The following case report depicts a case of accessory parotid gland presenting as a mid-cheek mass in the right buccal mucosa.

Management of Basal Cell Adenoma of Accessory Parotid Gland Through Transoral Approach: Report of a Rare Case With Review

Diagnosis of mid-cheek mass has always been a diagnostic dilemma for clinicians. The incidence of the accessory parotid gland (APG) has been well documented in the literature. However, a diverse spectrum of pathologies can arise from this accessory parotid tissue. Basal cell adenoma is a rare benign tumor that predominantly affects the parotid gland. Its occurrence in the accessory parotid gland has been documented in 9 cases till date. Surgical approaches for the management of such APG lesions have been in debate. This report documents a case of Basal Cell Adenoma arising in accessory parotid tissue in a 55-year-old woman who was treated by transoral excision. This paper also reviews previously documented cases of all APG lesions and attempts to elucidate the rationale for selecting an appropriate surgical approach.

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.

Tumor model for surgical simulation to assess a minimally invasive endoscopic approach for midcheek mass removal

IntroductionThe midcheek is considered one of the most important facial area due to its involvement in mimic expression and communication. Pathology of this district is complex due to the variety of soft tissue belonging to the face. We propose a surgical simulation, to assess the feasibility of a new minimally invasive endoscopic approach for midcheek mass removal. Technical reportThis study was performed on four cadavers, at the Anatomy Laboratory of the University of Tubingen. In all the cadavers 3 cm3 of Acquasil Dent Sply Ultra were injected via trans-cutaneous along the nasolabial fold to simulate a midcheek mass. Three incisions in concealed areas were performed to create an access to reach the anterior compartment of the face. By using the Optical Dissector with distal spatula and a 30° endoscope we provided a wide surgical window and a greater exposure to isolate, dissect and remove the midcheek tumor model safely. ConclusionThe proposed endoscopic technique allowed us to visualize and preserve all the key anatomic structures of the midcheek region. Due to its nature, the suggested material may provide a valid tumor model for surgical training also in other districts.

Accessory parotid gland: its surgical importance

Introduction: Accessory parotid gland is separated normal tissue from the main parotid gland, lying over the parotid duct. Accessory parotid gland is more prone for parotid tumors than main parotid gland. The accessory parotid is the site of congenital and acquired lesions. It usually presents as mid cheek swelling. Mid cheek incision may damage branches of facial nerve. Material & Method: Forty parotid glands were dissected from 20 cadavers during a period of 2 years from 2014 to 2016. Dissections were carried out at Chirayu Medical College & Hospital, Bhopal. Result: Out of 40 parotid glands dissected, accessory parotid glands were observed in 3 cases on right side. Incidence was found to be 7.5% for the present study. Accessory parotid gland was observed on right side lying on parotid duct detached from the main mass of the parotid gland. In case 2, accessory parotid was observed lying on parotid duct and here gland has two different ducts draining separately. Conclusion: Accessory parotid gland is the commonest site for pleomorphic adenoma. It may present as a slowly progressive mid cheek mass. They are more in accessory parotid than main mass of parotid gland. The accessory parotid not often mentioned variant is separate from main parotid gland should be addressed properly to ensure complete removal of disease. This is very important in malignancy for surgical clearance.

Midcheek mass: 10 year of clinical experience

This is a literature review and retrospective chart review of ten years experience on the treatment of midcheek masses in our department. The purpose of this study is to provide the reader with an overview of the pathology of this complex anatomic area focusing the attention on the differential diagnosis and the recent surgical strategies.From May 2002 to December 2012 we enrolled 22 consecutive patients studied for masses located in the midcheek area. Only four studies were found in the literature describing the experience of individual centres reporting few cases of midcheek masses. Combined with the previously reported 37 cases, we describe 22 lesions for a total of 59 cases. Patients were evaluated with a head and neck clinical and instrumental examination. Apart from 4 cases treated with intramuscular infiltration of botulinum toxin for masseter hypertrophy, surgical approach to the lesions was varied: 10 patients received an external approach (standard parotidectomy approach or face-lift-type approach); 6 patients had the lesion removed through an intraoral approach; in 2 cases a direct skin incision was performed. In our series we found a significant rate (55.5%) of temporary complications in all the procedures performed (external, intraoral, direct skin approach). This study aims to emphasize the role of endoscope assisted surgery as a possible alternative to the traditional approaches for the management of well selected benign midcheek masses.It would be advisable to increase the study of the endoscopic anatomy of the midcheek area in order to standardize the procedure and better define the surgical indications.

Adenocarcinoma, NOS of the Accessory Parotid Gland

A 41-year-old man was referred to our university clinic by a local physician for further examination of a left mid-cheek mass, suspected to be a benign subcutaneous tumor. The patient had noticed the indolent mass three years previously, which had slowly increased in size. Clinically, the mass in the left mid-cheek area showed good mobility, was elastic and hard, had a smooth surface, and was 10 mm in the greatest dimension. Cervical lymph nodes were not palpable. Facial paralysis was not recognized. The results of laboratory examinations, including serum and urine amylase levels, were within normal ranges. Imaging studies, including ultrasonography, computed tomography (CT), and magnetic resonance imaging, revealed a well-circumscribed and homogeneously well-enhanced solitary mass, 6 × 12 mm in size, anterior to the front edge of the left parotid gland and on the outer layer of the masseter muscle (Figure 1 and 2). These findings suggested a benign tumor derived from the APG, facial nerve, or blood vessel. Ultrasound-guided fine needle aspiration Abstract

A Rare Case of Chronic Sialadenitis of Accessory Parotid Gland

The accessory parotid gland is salivary tissue adjacent to stenson's duct that is separated from the main parotid gland and lying on masseter muscle. It has secondary duct empting into the stenson's duct. The differential diagnosis of mid-cheek masses include pathology arising from normal anatomic structures or from variations of normal accessory parotid gland tissue. Surgical resection is the treatment of choice for the accessory parotid gland tumor. We report a case of accessory parotid gland with chronic sialadenitis in a 26years old male with the diagnosis and treatment. Accessory parotid gland pathologies should be included in the differential diagnosis of a patient presently with a mid-cheek mass.

Accessory parotid gland tumors

Tumors of accessory parotid gland are considered in the differential diagnosis of a mid cheek mass. Parotidectomy is the procedure of choice. All pathological types of parotid main gland tumors occur in the accessory parotid gland also. Presenting as a mid cheek or infrazygomatic mass, the tumors of this accessory parotid gland are notorious for recurrences, if adequate margins are not achieved. We describe two such cases of such a tumor. 40-year-old male with a slowly progressive mid cheek mass was operated by a mid cheek incision. Histopathology of the tumor was pleomorphic adenoma. Facial nerve paresis recovered complelety in 6 months. A 52-year-old female with progressive mid cheek mass who underwent parotidectomy and neck dissection by a modified Blair's incision was diagnosed with extranodal marginal zone lymphoma with focal transformation to a diffuse large B-cell lymphoma. Chemotherapy with CHOP regime was initiated. There was no recurrence at 6 months of follow-up. Lymphoma of accessory parotid gland is a very rare tumor. Standard parotidectomy incision is advocated to prevent damage to facial nerve branches.

Cavernous Hemangioma of the Accessory Parotid Gland

We report a rare case of a hemangioma arising from the accessory parotid gland. The patient, a 45-year-old woman, complained of a right midcheek mass. Magnetic resonance imaging showed a well-defined mass located in the right buccal space, anterior to the masseter muscle, and adjacent to the Stensen duct. The mass had high T2-weighted signal intensity and showed strong patchy enhancement with gadolinium. This mass was surrounded by a common capsule with the accessory parotid gland. These findings indicated a hemangioma originating from the accessory parotid gland. The mass was completely removed by an intraoral approach without postoperative facial palsy, skin deformity, and difficulty in secreting saliva. Histologic examination of the tumor revealed multiple, thin-walled, and dilated blood vessels, confirming the diagnosis of a cavernous hemangioma. Magnetic resonance imaging was extremely useful in diagnosing the mass as a hemangioma before surgery, clarifying relationships between the mass and adjacent structures and determining the surgical approach to the mass.

Oncocytic Carcinoma of the Accessory Lobe of the Parotid Gland

Oncocytic carcinoma is a rare tumor of the parotid gland. An additional case, characterized by an exceptional localization in the accessory lobe of the parotid gland, never reported to date in the literature, is described. The clinical and histologic difficulties in relationship to the diagnosis of a midcheek mass consisting of an unusual tumor are emphasized.

Parotidotomy approach for a midcheek mass: A new surgical strategy

To report the feasibility and the results of a new surgical strategy for midcheek masses we called the parotidotomy approach. Retrospective consecutive case series. Characteristics, surgical outcome, and cosmetic result of cases managed using the parotidotomy approach were collected by retrospectively reviewing medical records. The standard superficial parotidectomy approach was modified to dissect facial nerve branches selectively to obtain a symmetric facial contour. The parotid gland was fully bisected along the course of the zygomatic and buccal branches of the facial nerve to provide access to the midcheek mass. The bisected parotid gland was repositioned after mass excision. Seven patients (3 males and 4 females) were included in this study. The parotidotomy approach was accomplished in two cases with a malignant tumor (one acinic cell carcinoma, one low-grade mucoepidermoid carcinoma), four with a benign tumor (two pleomorphic adenoma, one basal cell adenoma, one facial nerve schwannoma), and in one case with a chronic inflammatory lesion (chronic sialadenitis). In no case was facial nerve paralysis or Frey's syndrome noticed after this approach. For the two malignant tumors, there was no evidence of recurrence or metastasis at 2-year and 2.5-year follow-ups. Six of the seven patients were fully satisfied with the cosmetic results of surgery. The remaining patient had a mild sunken deformity of the midcheek where the mass had been located. To manage midcheek masses we modified the standard parotidectomy approach. This new surgical strategy, which we named the parotidotomy approach, provides surgically safe and cosmetically excellent results for midcheek masses.

副耳下腺に発生した唾液腺導管癌例

Salivary duct carcinoma is an uncommon, relatively unknown, and clinically aggressive carcinoma of salivary origin. Recently, we treated a rare case of salivary duct carcinoma arising from the accessory parotid gland. The patient was a 68-year-old male who complained of left cheek swelling. The mass was located in left mid-cheek. Fine needle aspiration biopsy and open biopsy of the mid-cheek mass revealed malignant cells, but the pathological diagnosis was not settled. The mass in the mid-cheek was resected en-block including the buccal branches of the facial nerve, the superficial parotid gland, a part of the masseter muscle, and the skin right above the tumor. A pathological examination identified comedo necrosis and a final diagnosis of salivary duct carcinoma was made. The patient was treated with postoperative radiation therapy and has been free of tumors for 10 months.

Prudent management of the mid-cheek mass: revisiting the accessory parotid gland tumor.

The head and neck surgeon's fascination with parotid surgery arises from the gland's spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid-cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided. This is a retrospective review of our experience with four accessory parotid gland neoplasms and five other masses mimicking this lesion. A literature review and retrospective chart review. Over a 6-year period, we have encountered four true accessory lobe tumors, all pleomorphic adenomas. These presented very similarly to four other more commonly encountered masses not of salivary origin and one normal but hyperplastic accessory parotid gland. All were removed through a wide parotidectomy-style approach modified by extending incisions anterosuperiorly and inferoanteriorly. The only complication was a minor salivary fistula in one patient. There were no permanent facial paralyses. Accessory parotid gland neoplasms are rare and may present as innocuous extraparotid mid-cheek masses. A high index of suspicion, prudent diagnostic skills (including fine-needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and meticulous surgical approach (extended parotidectomy-style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions.