Parotid Area Research Articles

Parotid Gland Suspension Combined with Rhytidectomy to Recontour the Lower Face and Neck Enlargement Caused by Benign Parotid Hypertrophy.

Lower face and neck aging and facial shape changes are usually caused by soft tissue descent. During lower face and neck enlargement, parotid hypertrophy is an important influence factor of morphologic changes in the periauricular regions. Most plastic surgery techniques greatly improve the shape of the lower face and neck, but ignore the manipulation of the parotid gland. We aimed to resolve the lower face and neck enlargement caused by parotid hypertrophy. Thus, we performed parotid gland suspension combined with rhytidectomy to improve the lower face and neck contour. This retrospective study recruited 22 patients who underwent parotid gland suspension combined with rhytidectomy from 2012 to 2020. The evaluation of patient outcomes was performed by selecting items from the FACE-Q scale. Surgical procedures involved parotid gland exposure and parotid fascia suspension. Patient-perceived age appraisal indicated a younger appearance with follow-ups for approximately 3-10year after the surgery (mean ± standard deviation - 5.53 ± 3.67). Patients had a high satisfaction level for facial appearance (67.15 ± 16.84), lower face (74.69 ± 21.22), and contour of the parotid gland areas of the neck (65.76 ± 23.62). The lower face and neck contours were narrowed and tightened. The parotid gland area showed a remarkable improvement after surgery. Parotid gland suspension combined with rhytidectomy obtained an outstanding improvement. This method can achieve a better lower face and neck contour, especially in patients with benign parotid hypertrophy or lower face and neck enlargement in periauricular regions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Analysis of clinical manifestations and imaging features of facial nerve schwannomas

Objective:To explore the clinical manifestations and imaging characteristics, and to clarify the imaging value in the diagnosis of facial nerve schwannomas. Methods:Retrospectively analyze the data of 23 patients with facial nerve schwannomas confirmed by surgery and pathology in the Department of Otorhinolaryngology of the First Affiliated Hospital of the Air Force Military Medical University from September 2020 to September 2022, including 8 males and 15 females, aged 18-66 years old. Summarize and analyze their clinical symptoms, specialized examinations, and imaging findings. Results:The clinical manifestations were facial nerve paralysis in 15 cases（2 cases of HB Ⅳ, 6 cases of HB Ⅴ, 7 cases of HB Ⅵ）, hearing loss in 14 cases（5 cases of conductive deafness, 2 cases of mixed deafness, and 7 cases of severe sensorineural hearing loss）, 8 cases tinnitus, 7 cases ear pain, 4 cases dizziness, 4 cases headache, 2 cases ear pus, and parotid gland tumors in 6 cases presenting as local masses. Endoscopic examination revealed 8 cases of external ear canal tumors and 3 cases of intratympanic tumors. Combining temporal bone HRCT, MRI enhanced scanning, and CPR imaging techniques, 1 case involved the internal auditory canal segment, 2 cases in the tympanic segment, 6 cases in the parotid gland area. A total of 14 cases involved two or more segments of the internal auditory canal segment, the labyrinthine segment, geniculate ganglion, the tympanic segment, and the mastoid segment. When the tumors were large, adjacent structures were involved. It was found that 8 cases invaded the external auditory canal and tympanic cavity, ossicles were displaced or bony destruction; 3 cases invaded the jugular foramen area, and 1 case grew to the middle cranial fossa region with temporal lobe brain parenchymal compression. Conclusion:The clinical manifestations of facial nerve schwannomas are diverse. The combination of various imaging techniques will be conducive to topical and qualitative diagnosis and provide an important basis for treatment strategies.

The use of derma-fat grafts to eliminate defects during operations on the parotid glands

Introduction. The effectiveness of surgical treatment of parotid gland tumors is determined by the frequency of local relapse and functional and aesthetic results, which are determined not only by the anatomical and functional safety of the facial nerve. It is also very important to level aesthetic deformities of the parotid region and reduce the severity of frey’s syndrome. Aim. To retrospectively analyze the use of dermal fat grafts to correct defects during operations on the parotid glands. Materials and methods. Our study included 7 patients (2 men and 5 women) who were treated at the Leningrad Regional Clinical Oncology Dispensary named after L. D. Roman from 2021 to 2022. The average age of the patients was 49.7 years (42–64 years), the average follow-up period was 20.4 months (19–22 months). All patients underwent total / subtotal resection of the parotid gland; we used an abdominal dermal fat graft to close the defect. Histological examination of the surgical material revealed a pleomorphic adenoma of the parotid gland in 5 cases; in 2 cases, a ma-lignant tumor (adenocystic carcinoma and basal cell carcinoma of the salivary glands), which required adjuvant radiation therapy in radical doses. To assess aesthetic and functional results in the recipient and donor areas, we developed and used a questionnaire. Results. 6–8 months after the end of treatment, 5 patients completed questionnaires. 4 people indicated complete symmetry of the face, one patient indicated an average depression. 3 patients did not note any pain in the parotid area, 2 patients had minor discomfort that did not cause any problems. Only one respondent noted redness of the face when eating, which did not cause him any problems; the rest of the survey participants did not find these changes. None of the survey participants noted the appearance of sweat on their face when eating. Conclusion. The use of dermal fat grafts can improve the aesthetic and functional results of treatment in patients undergoing operations on the parotid glands. This technique is quite easy to use and does not significantly increase the time of surgical intervention. A derma-fat graft does not make it difficult to monitor disease relapses.

PACULIARITIES OF CLINICAL PRESENTATION, DIAGNOSIS, AND TREATMENT FOR INJURIES OF THE LARGE SALIVARY GLANDS

Background. Salivary gland lesions of various genesis are quite widespread among patients, tumorous processes involving these organs make up 2.2-3.7% of the total number of head and neck tumors, 78-82% of salivary gland tumor cases, and sialoadenitis, which makes 3.8-6.7% of the total number of inflammatory diseases of maxillofacial organs. The initial diagnostic imaging for parotid gland tumors typically involves an ultrasound examination; however, it does not definitively indicate the need for surgical intervention. While computed tomography or magnetic resonance imaging are not obligatory elements of patient assessment, they may be recommended in specific instances to facilitate accurate treatment planning.
 Fine-needle aspiration biopsy can serve as an obligatory diagnostic test, irrespective of whether an ultrasound examination has been conducted, particularly when there are suspicions of atypical presentations of polymorphic adenoma. Incisional biopsy is contraindicated, as it frequently leads to neoplastic implantation, thereby increasing the risk of recurrence of polymorphic adenomas and malignant neoplasms.
 The purpose of the study is to conduct a comparative analysis of the data of clinical examinations, laboratory tests, surgical treatment, complications and postoperative results, taking into account the prevalence of tumor and inflammatory processes of the parotid salivary glands.
 Material and methods. We have conducted a retrospective study of the medical histories of 174 patients operated on at the Department of Maxillofacial Surgery of the “Poltava Regional Clinical Hospital named after M.V. Sklifosovsky”.
 Results. According to our data, pleomorphic adenoma was the most common benign tumor, and mucoepidermoid carcinoma was the most frequently detected malignant tumor. Regarding initial presentations, the primary observation was a tumor mass in 96.1% of all cases. Additional findings included incidental lesions detected during imaging studies and localized pain or inflammation. Isolated occurrences of inadvertent lesions during imaging of neoplasms have also been documented. Palpation was recognized as an excellent clinical parameter for topographic localization and classification of lesions for malignancy, with proven value in the specimen due to its high sensitivity for demonstrating nodules in the superficial lobe (97.1%) and high specificity for nodules in the deep lobe. We established that the average evolution time of benign tumors was approximately three times longer than that of malignant tumors. These data are consistent with literature data that malignant tumors are more aggressive and have a rapid evolution, while benign, in turn, have an insidious onset and slow growth. During intraoperative examination, high specificity is desirable because it can reliably exclude malignancy, preventing unnecessary radical interventions. Another intervention that we have analyzed in the treatment of benign tumors is dermal parotidectomy, which showed a recurrence rate similar to superficial parotidectomy, although with a lower rate of serious complications (12.4% less on average). It has been found that the choice of this intervention is mainly related to the incidence of recurrence, and in 51-56% of cases in patients with a previous fine-needle aspiration biopsy.
 Conclusion. According to this study, taking into account the experience of our clinic, the presence and visualization of a single nodule in the parotid area is the main clinical manifestation of parotid gland cancer. Pleomorphic adenoma is the most common histological type, and facial nerve-sparing subtotal parotidectomy is the best treatment for these patients.

Radiation Therapy in the Management of Cutaneous Squamous Cell Carcinoma Metastatic to the Parotid: A 50-Year Single Institution Experience

Cutaneous squamous cell carcinoma (cSCC) represents 20% of skin cancers of the head and neck, and metastatic spread to the parotid area lymph nodes (PALN) are found in 1-3% of cases. Herein, we present the updated results of the largest single institution experience using radiation therapy (RT) in the management of patients (pts) with PALN metastases from cSCC in North America. Our hypothesis is the addition of pts treated with modern RT would maintain acceptable efficacy with a favorable toxicity profile. With IRB approval, we retrospectively reviewed all pts diagnosed with cSCC metastatic to PALN treated at our institution with >6 months follow up. All pts were staged by the O'Brien staging system. Fifteen pts (10%) were treated preoperatively, 111 (72%) post operatively, and 28 (18%) with RT alone. Most pts were treated with three dimensional conformal RT (3DCRT) or a combination of 3DCRT and electron therapy (n = 112), while 31 pts were treated with intensity modulated RT (IMRT). There were 115 pts treated once daily fractionation and 39 pts being treated twice per day. We estimated disease control and survival, including local (parotid) control (LC), neck control (NC), local-regional control (LRC), distant metastasis free survival (DMFS), cause specific survival (CSS), and overall survival (OS) using the cumulative incidence method. Treatment toxicities were documented per CTCAEv3. From November 1969 to December 2019, 154 pts were included. Median age at RT initiation was 66 years (range, 28-89). Fifty-two pts (33.8%) had an unknown location of a primary, while the most common identifiable locations of a primary were the temple, helix, and forehead. Forty-eight percent of pts had P2 or P3 disease with 26 of these pts being N1 or N2. Forty-six percent of pts were current or former smokers. Median follow up for this cohort was 4.9 years (range, <0.1 - 34.0) with 8 pts being lost to follow up. The overall 10-year Kaplan-Meier estimates for LC, NC, LRC, DMFS, CSS, and OS were 82%, 93%, 77%, 92%, 76%, and 31%, respectively. Eighty-one percent of treatment failures occurred within 2 years of treatment. LC was improved with IMRT (100%) compared to non-IMRT (78%) treatment (p = 0.005), with no other outcomes differing between the cohorts. There were 31 treatment complications were reported with 13 being ³ grade 3. Our results represent the 10-year outcomes for the largest reported single institution experience of RT for cSCC metastatic to PALN showing favorable clinical outcomes with an acceptable toxicity profile. There was improved LC for pts treated with IMRT compared to 3DCRT/electrons; yet these did not translate to significant changes in other clinical outcomes.

995 Cavernous Sinus Thrombosis Secondary to Dental Neglect

Abstract Background Cavernous sinus thrombosis is a rare, potentially life-threatening condition often caused by a cervicofacial bacterial infection. Prompt diagnosis and management improve prognosis and help prevent permanent complications. Clinical case A 54-year-old man with a background of alcohol excess attended the emergency department following a collapse at home. He presented with a potassium of 1.5 and a firm right parotid swelling with associated facial nerve weakness and was admitted to ICU for management of severe sepsis and electrolyte disturbance. CT imaging out of hours showed swelling of right parotid and submandibular areas and generalised oedema parapharyngeally. Further clinical examination by the maxillofacial team noted a right sided 6th nerve palsy, raising concern about intracranial spreading infection from a dental source and MRI was requested. The patent continued to deteriorate and developed bilateral chemosis and proptosis. MRI scan confirmed bilateral cavernous sinus thrombosis and right cerebral hemisphere subdural collection and the patent was transferred to a neurosurgical unit for a craniotomy, temporal lobe washout and dental clearance. Upon further review of imaging by a specialist head and neck radiologist the cavernous sinus thrombosis was noted on the initial scans. Conclusions Raise awareness of this condition and its management – much rarer more now due to antibiotics in developed world. Importance of thorough clinical examination to pick up subtle signs such as cranial nerve palsies. Vital to have multidisciplinary involvement in diagnosis and management; both radiology to help with diagnosis and neurosurgery, ENT and maxillofacial to carry out surgery as required.

Refining Target Volume Coverage After Parotidectomy for Cutaneous Squamous Cell Carcinoma: Omission of the Cervical Neck From the Radiation Field

For patients without pathologic evidence of cervical disease after neck dissection for cutaneous squamous cell carcinoma involving the parotid region, inclusion of the ipsilateral cervical neck in the postparotidectomy radiation volume is routinely performed. We report our experience with selective avoidance of the ipsilateral neck for patients undergoing postoperative radiation to the parotid bed. From January 2014 to December 2023, a total of 30 consecutive patients underwent postoperative radiation after parotidectomy for cutaneous squamous cell carcinoma involving the parotid area. All patients had previously had a neck dissection confirming pathologic N0 disease. Treatment was delivered using intensity modulated radiation therapy to a median dose of 60 Gy (range, 56-66 Gy). The radiation target volumes included the parotid bed only, with deliberate avoidance of the ipsilateral cervical neck. The median pathologic tumor size of the parotid tumor was 3.3 cm (range, 0.2-9.4 cm). Final pathologic evaluation showed positive microscopic margins in 8 patients (27%), perineural invasion in 17 patients (57%), and facial nerve involvement in 6 patients (20%). There were no isolated nodal failures. One patient developed an ipsilateral neck recurrence approximately 8 months after completion of radiation therapy. This occurred 2 months subsequent to the development of local recurrence. The 5-year actuarial rates of local (parotid) control, neck control, and overall survival were 87%, 97%, and 76%, respectively. Omission of the ipsilateral neck from the parotid volume does not compromise disease control for pathologically N0 patients undergoing postoperative radiation for cutaneous squamous cell carcinoma involving the parotid region. Practical implications are discussed.

Neonatal Parotitis: A Case Report and Review of the Literature.

Neonatal parotitis is a rare disease. Between 1970 and 2011 only 44 cases have been reported in the English literature. In this case report, we describe a case of neonatal parotitis caused by Group B streptococcus (GBS). Additionally, we performed a review of the recent literature. We found 18 new cases published between 2011 and 2020. These cases were analyzed together with the 44 cases published before 2011. All patients presented with swelling over the parotid area, with varying degrees of local inflammation and general symptoms. Purulent discharge from the Stensen's duct was present in 85% of the patients. The swelling was usually unilateral (84%). In total 70% of the patients were male. Prematurity was reported in 29% of the cases. The most common isolated pathogen was Staphylococcus aureus (68%). Only 5 cases were found describing GBS as the causative pathogen in neonatal parotitis. In most of the cases treatment with intravenous antibiotics was successful, 27% of the patients needed surgical drainage. The reported outcomes were good. When comparing GBS cases and non-GBS cases there seems to be a difference in presenting symptoms and pathophysiology, with GBS patients presenting without purulent discharge form the Stensen's duct and with more severe generalized symptoms. Additionally, all GBS patients had a positive blood culture, compared to 27% of the non-GBS patients, which indicates that in GBS cases the major route of parotid infection is hematogenous, compared to a retrograde flow from the oral cavity to the parotid gland in non-GBS cases.

Heerfordtův syndrom – vzácná manifestace sarkoidózy z pohledu ORL lékaře

Summary Sarcoidosis is a systemic granulomatous disease that mainly affects the pulmonary and lymphatic systems. In its rare, acute forms, it can manifest as Lofgren’s syndrome (combination of erythema nodosum, bilateral pulmonary hilar lymphadenopathy, joint pain, fever and general symptoms) and even more rarely as Heerfordt’s syndrome (combination of fever, anterior uveitis, bilateral edema of the parotid area and uni or bilateral facial nerve paresis). Although this dia­gnosis is rare, it belongs to the differential dia­gnosis of sudden paresis of the facial nerve and swelling of the parotic area. In our case report, we describe Heerfordt’s syndrome in a 50-year-old woman. The pathophysiology, symptomatology, dia­gnosis, and treatment of this rare syndrome are discussed. Key words sarcoidosis – uveoparotid fever – facial nerve paresis

Congenital giant progressive parotid hemangioma in an infant treated successfully with propranolol and steroids

An otherwise healthy baby girl was born normally and a small birth mark like spot on her right parotid area appeared around two weeks of age. This spot went on growing gradually with growth of the body in infancy.

Case Report: Infantile Hemangioma Near Right Parotid Grows after Cessation of Breast Feeding by Mother Who Was Taking Propranolol

A healthy four-week-old, full-term female presented to an outside emergency room with rapid swelling of the right parotid area, which was tentatively diagnosed as acute parotitis on ultrasound and discharged home with antibiotics. Within 72 hours the swelling had increased, and the patient presented to our Emergency Department. Imaging with ultrasound and MRI demonstrated homogenous vascularity consistent with hemangioma. History revealed that the patient’s mother had been on propranolol for congenital tachycardia pre- and post-natally. She had been breast-feeding up until a few days before the parotid swelling started but had been transitioning to formula. The infant was started on propranolol (goal dose 2mg/kg/day) with rapid improvement. This case raises the question of whether maternal propranolol consumption has an effect on hemangioma proliferation in the breast-fed newborn (and pre-natally). In review of the literature, propranolol is reported as the safest beta-blocker for treating hypertension in pregnant and lactating mothers as the plasma protein binding is upwards of 90%. Propranolol is metabolically transformed in the liver and excreted in the urine. The half-life of the medication, the pH of the breast milk, and the lipophilic nature of the breast milk affect the concentration of propranolol in breast milk. A study showed that if the mother took approximately 160mg/day of propranolol and the infant consumed the usual amount of breast milk (100-150ml/kg/day) the maximum propranolol load is presumed to be 32µ/24hours (8µ/kg in a 4kg infant). Infantile hemangiomas usually proliferate by two weeks of age. The proliferation in this child occurred later at approximately four weeks of age after the mother on propranolol weaned breast milk. When treating infants with hemangiomas, it is important to obtain maternal medication history, especially if treatment with propranolol is being considered. Corresponding Author: Lauren Sall, MD, 19751 East Kings Ct., Grosse Pointe Woods, MI 48236

Meta-Analysis of the Efficacy of Cimetidine in the Treatment of Mumps

Objective: To compare the efficacy of cimetidine and ribavirin in the treatment of mumps by meta-analysis. Methods: Controlled trials of cimetidine and ribavirin in the treatment of mumps were searched through China National Knowledge Infrastructure (CNKI), Wanfang data, Cqvip, Pubmed, The Cochrane Library and EMBase databases up to September 2022. The effective rate, the time of swelling regression in parotid gland area and the rate of adverse reactions were analyzed by Review Manager 5.3 software. Results: The final 10 articles included 920 children, including 427 in the trial group and 447 in the control group. Meta analysis showed that the effective rate of cimetidine in the treatment of mumps was higher than that of ribavirin in routine treatment, with a statistically significant difference (odds ratio [OR] = 5.2, P &lt; 0.00001); The time of swelling regression was statistically significant (OR = -1.28, P &lt; 0.00001); The difference of adverse reaction rate was not statistically significant (OR = 0.73, P = 0.62). Conclusions: Compared with ribavirin, cimetidine is more effective in the treatment of mumps, with shorter swelling regression time without increases of adverse reactions.

Perceptive Hierarchy of Facial Skin Lesions: An Eye-tracking Study.

Equal importance is given to every skin lesion in treatment guidelines and severity grading systems for facial lesions. Face recognition studies suggest differentially perceived areas of the human face. The aims of this study were to quantify the visual attention given to facial skin lesions and to explore their hierarchy. Eye movements were tracked in 118 participants who viewed 135 faces with facial skin lesions. The main effect of the image was significant (F[9, 1053]=15.631, p < 0.001, η2=0.118), which implied a difference in the total visual attention between images depicting skin lesions in different aesthetic units. Lesions in the frontal area received the highest area- specific attention, while lesions in the right parotid area had the smallest effect. Using objective computational clustering, 2 very distinct zones of visual attention were identified: the ocular, nasal, perioral, and frontal areas attracted high visual scrutiny and the remaining areas attracted little attention. However, the presence of skin lesions in the high-attention region resulted in a decrease in total visual attention to the face. The main effect of the aesthetic unit was significant (F[15, 1755]=202.178, p < 0.001, η2=0.633). More than 63% of attention-drawing potential of facial skin lesions depends on their anatomical location, which should be considered in disease severity grading and treatment planning.

Complete response of recurrent oral squamous cell carcinoma treated with cetuximab in combination with radiotherapy: A case series.

Salvage surgery for recurrent oral squamous cell carcinoma (OSCC) often leads to a poor quality of life (QOL). The present study described three cases that resulted in favorable locoregional control with cetuximab in combination with radiotherapy (Cmab + RT). Case 1 had regional recurrence of OSCC at the lower right mastoid area 4 months after primary surgery. Case 2 had regional recurrence of OSCC at the parotid area 7 months after primary surgery. Case 3 had local recurrence of OSCC at the masticatory muscle and Rouviere's lymph nodes 1 year and 3 months after primary surgery. In all cases, Cmab + RT was performed, and disease-free survival was confirmed 4 months, 2 years and 6 months, and 10 months after Cmab + RT, respectively. Immunohistochemically, all resected tumors had no expression of 110-kDa catalytic subunit of class IA phosphatidylinositol 3-kinase (PI3Kp110α). In conclusion, if salvage surgery for recurrent OSCC results in a significantly low QOL, then shifting to chemoradiotherapy may be appropriate as a treatment strategy. In addition, strong evidence indicated that PI3Kp110α expression is associated with Cmab therapy efficacy.

Superficial versus total parotidectomy for metastatic cutaneous squamous cell carcinoma and melanoma of the head and neck: a systematic review.

The extent of parotidectomy in the management of regional metastatic disease is controversial. This systematic review aimed to appraise data from studies evaluating superficial and total parotidectomy in metastatic cutaneous squamous cell carcinoma and cutaneous malignant melanoma of the head and neck. A systematic search of PubMed, Embase and Cochrane Library was performed. The protocol was registered with Prospero (CRD42020217962). A total of five studies evaluated cutaneous malignant melanoma. Only one compared outcomes of superficial and total parotidectomy: they found higher parotid area recurrence following superficial parotidectomy. Seven studies reported outcomes following cutaneous squamous cell carcinoma; some studies found higher regional recurrence and reduced survival in total parotidectomy, but there was likely selection bias in these studies. Others found no difference in survival between superficial and total parotidectomy. The effect of the extent of parotidectomy on outcomes is unclear in cutaneous malignant melanoma and cutaneous squamous cell carcinoma. This systematic review highlights the need for well-designed studies to direct better care.

Parotid Gland Stem Cell Preservation during Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Dosimetric Analysis and Feasibility.

Objective Parotid gland (PG) is a radiosensitive organ, and xerostomia (XS) is a key factor affecting patients' life quality after conventional radiotherapy for head and neck tumors. In this study, dosimetry analysis was performed on PG stem cell preservation in intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods All clinical data of 80 NPC patients diagnosed pathologically in the Radiotherapy Department of Taizhou Hospital of Zhejiang Province Affiliated with Wenzhou Medical University from August 2017 to September 2019 were retrospectively analyzed. Patients were assigned to a regular group and a restricted group according to different IMRT plans, in which a dose limitation for the parotid duct was added in the restricted group in addition to the conventional plan used in the regular group to minimize the parotid duct radiation dose. The differences in planning target volume (PTV) dose distribution, organ at risk (OAR) dose, and dose to the PG and its ducts were compared between the two groups. Results Significantly higher mean irradiation doses of the brainstem, mandible, and oral cavity were determined in the restricted group compared with the regular group (P > 0.05), but there was no significant difference in the mean dose of other OARs irradiated (P > 0.05). As compared to the irradiation of bilateral PGs, no statistical differences were found in the mean irradiation dose and V30 between regular and restricted groups (P > 0.05), but lower V20 and higher V45 were determined in the restricted group (P < 0.05). The mean irradiation dose, V15, V20, and V26 of bilateral parotid ducts were lower in the restricted group as compared to the regular group (P < 0.05). Conclusion IMRT for NPC can effectively reduce the mean irradiation dose and play a PG stem cell preservation role by giving specific dose limitation conditions to the parotid duct area without affecting PTV dose distribution and OAR irradiation dose, which has certain feasibility.

Symptoms: Unilateral Hearing Loss and Facial Paresis

Symptoms: Unilateral Hearing Loss and Facial Paresis

Reconstructive otoplasty in post-burn scar deformation of the parotid area

The result of using the temporal fascial flap in combination with autodermoplasty in the reconstruction of the total postburn auricle and parotid area defect is presented in this paper. The techniques of reconstructive otoplasty in conditions of cicatricial process of parotid zone are described.

Clinical validation of the 3-dimensional double-echo steady-state with water excitation sequence of MR neurography for preoperative facial and lingual nerve identification

PurposeThis study aimed to evaluate the clinical usefulness of magnetic resonance (MR) neurography using the 3-dimensional double-echo steady-state with water excitation (3D-DESS-WE) sequence for the preoperative delineation of the facial and lingual nerves.Materials and MethodsPatients underwent MR neurography for a tumor in the parotid gland area or lingual neuropathy from January 2020 to December 2021 were reviewed. Preoperative MR neurography using the 3D-DESS-WE sequence was evaluated. The visibility of the facial nerve and lingual nerve was scored on a 5-point scale, with poor visibility as 1 point and excellent as 5 points. The facial nerve course relative to the tumor was identified as superficial, deep, or encased. This was compared to the actual nerve course identified during surgery. The operative findings in lingual nerve surgery were also described.ResultsTen patients with parotid tumors and 3 patients with lingual neuropathy were included. Among 10 parotid tumor patients, 8 were diagnosed with benign tumors and 2 with malignant tumors. The median facial nerve visibility score was 4.5 points. The distribution of scores was as follows: 5 points in 5 cases, 4 points in 1 case, 3 points in 2 cases, and 2 points in 2 cases. The lingual nerve continuity score in the affected area was lower than in the unaffected area in all 3 patients. The average visibility score of the lingual nerve was 2.67 on the affected side and 4 on the unaffected side.ConclusionThis study confirmed that the preoperative localization of the facial and lingual nerves using MR neurography with the 3D-DESS-WE sequence was feasible and contributed to surgical planning for the parotid area and lingual nerve.

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.