Parotid Research Articles

3085: To curate or not to curate: simple auto-curation for deep learning-based parotid gland segmentation

3085: To curate or not to curate: simple auto-curation for deep learning-based parotid gland segmentation

PSMA PET improves characterization of dural-based intracranial lesions in patients with metastatic prostate cancer

PurposeTheranostic approaches combining prostate-specific membrane antigen (PSMA)-PET/CT or PET/MRI with PSMA-targeted radionuclide therapy have improved clinical outcomes in patients with prostate cancer (PCa) especially metastatic castrate resistant prostate cancer. Dural metastases in PCa are rare but can pose a diagnostic challenge, as meningiomas, a more common dural based lesions have been shown to express PSMA. The aim of this study is to compare PSMA PET parameters between brain lesions classified as dural metastases and meningiomas in prostate cancer patients. MethodsA retrospective analysis of PSMA PET/CT scans in patients with PCa and intracranial lesions was conducted. Brain lesions were categorized as dural metastases or meningiomas based on MRI characteristics, longitudinal follow-up, and histopathological characteristics. Standardized uptake values (SUVmax) of each brain lesion were measured, along with SUV ratio referencing parotid gland (SUVR). SUVs between lesions classified as metastases and meningiomas, respectively, were compared using Mann-Whitney-test. Diagnostic accuracy was evaluated using ROC analysis. Results26 male patients (median age: 76.5 years, range: 59–96 years) met inclusion criteria. A total of 44 lesions (7 meningiomas and 37 metastases) were analyzed. Median SUVmax and SUVR were significantly lower in meningiomas compared to metastases (SUVmax: 2.7 vs. 11.5, p = 0.001; SUVR: 0.26 vs. 1.05, p < 0.001). ROC analysis demonstrated AUC 0.903; the optimal cut-off value for SUVR was 0.81 with 81.1 % sensitivity and 100 % specificity. ConclusionPSMA PET has the potential to differentiate meningiomas from dural-based metastases in patients with PCa, which can optimize clinical management and thus improve patient outcomes.

Prognostic value of pretherapeutic 68Ga-PSMA-11-PET based imaging parameters in mCRPC patients treated with PSMA radioligands.

This study aims to evaluate the prognostic significance of various previously reported PSMA-PET parameters in patients undergoing 177Lu-PSMA radioligand therapy (RLT). While individual studies have investigated the prognostic value of one or few of these factors, comprehensive analyses are rare. Data of 82 patients undergoing 177Lu-PSMA-radiologand-therapy (RLT) were analyzed. Total tumor volume (tumor volume), average SUVmean of all tumor lesions (SUVmean) and the quotient of sum of SUVmean of all tumor lesions to SUVmean of the parotid glands (tumor-parotid-ratio; TPR) and of the kidneys (tumor-kidney-ratio; TKR) were included in analysis. This study showed that a tumor volume of <290.6 ml is associated with a better survival in patients undergoing PSMA-RLT (median PFS: 4.2, median OS: 13.2 months) compared to patients with higher tumor volume (median PFS: 3.4,median OS: 6.2 months; p-value = 0.01 for PFS and <0.001 for OS). The average SUVmean correlated inversely with survival. Patients with a SUVmean > 10.7 had a median PFS of 4.2 and OS of 11.4 months while patients with SUVmean <10.7 had a median PFS of 1.6 and OS of 5 months (p-value <0.001 for both). The assessment of TPR showed no significant difference regarding OS and PFS. TKR showed a better PFS in patients with ratio > 0.33 (p-value 0.009) but no significant difference regarding OS. The present study confirms that pretherapeutic PSMA-PET before RLT with 177Lu-PSMA has a prognostic value.

Heterotopic salivary duct inclusions in Warthin tumor – A cryptic histological finding involved in its pathogenesis

Warthin tumor (WT) is the second most common benign parotid gland tumor after pleomorphic adenoma. WT is characterized by cystic and papillary proliferation of a two-layered oncocytic epithelium supported by lymphoid tissue. Heterotopic salivary duct inclusions (SDIs) are frequently observed in lymph nodes (LNs) of WT (SDI/LNs), and are thought to be the origin of WT. If this is true, SDIs should also persist in the lymphoid tissue of WT itself (SDI/WT), as a missing link between SDIs and WTs, but studies of this issue are limited. From 2008–2023, 138 WT cases were surgically excised at our hospital. SDI/LNs and SDI/WTs were histologically examined. Of 100 WT cases with LNs, SDI/LNs were observed in 67 cases (67 %). SDI/WTs were detected in 114 of 138 cases (82.6 %), including 107 of 127 smokers (84.3 %) and 7 of 11 never-smokers (63.6 %). SDI/WTs were located mainly in the subcapsular lymphoid tissue and often surrounded by a fibrous coat resembling salivary excretory ducts. This study revealed a high incidence of SDIs in WT itself, strongly supporting the theory that WT develops from heterotopic salivary ducts.

Case Report: Methimazole-Induced Parotitis - An Unusual Presentation

A 56-year-old female with a medical history of unspecified hyperthyroidism and a recent thyroid storm presented to the ED with tachycardia, hypertension, and bilateral enlarged parotid glands. During a previous hospitalization, she was diagnosed with unspecified hyperthyroidism and started on methimazole. During hospitalization, laboratory findings suggested Graves’ disease with an acute thyroid storm. The patient also complained of enlarged parotid glands bilaterally. CT tomography of the neck revealed no calculi of the parotid glands but showed extensive fatty replacement, possibly related to methimazole use. Treatment with propranolol and IV hydrocortisone improved thyroid function. Due to the suspicion of methimazole-induced parotitis, she was transitioned to a reduced methimazole dosage for treatment of Graves’ disease, which subsequently improved her parotitis. Methimazole, the standard initial treatment for Graves’ disease, is generally well-tolerated. It can cause adverse reactions; however, parotitis is very rare and has been documented in only a few case reports. Owing to the limited number of reports, its incidence is currently unknown. Here, we present a case of methimazole-induced parotitis as an unusual presentation of thyroid storm. Drug-induced reactions can only be considered once common causes of parotitis such as viral infection, obstruction, and autoimmune diseases are ruled out. Treatment involves dosage adjustments and supportive care. Methimazole-induced parotitis is often misdiagnosed and overlooked because of the lack of reported cases. This necessitates future research into the reaction mechanisms and optimal treatment.

Stensen's Duct Dynamic Anatomy Assessed with Sialography.

Objectives: The presence of a catheter required for contrast infusion during sialography obscures imaging of the distal duct. Static imaging via cone beam computed tomography and magnetic resonance sialography fails to address changes that occur dynamically to the anatomy of the flexible salivary ductal system. We aim to identify dynamic changes to the parotid gland by introducing a novel approach to analyze the full extent of Stensen's duct based on dynamic infusion digital sialography. Methods: Retrospective chart review of a single-center consecutive series of 409 parotid sialograms performed between April 2008 and June 2023 permitted selection of a contemporary series including seven normal sialograms and seven sialograms with stricture(s). Dynamic (fluoroscopic) infusion (iopamidol/gadolinium) sialograms were assessed through blinded review by two radiologists employing the institution's picture archiving and communication (PACS) system (©2023 Koninklijke Philips N.V., Amsterdam, Netherlands). Measurements determined changes, in two dimensions, to the angle of the masseteric bend and duct length while the catheter was in place (repose), during catheter withdrawal (stretch), and during recoil after withdrawal. Differences in median lengths and angles of Stensen's duct between the three time points were compared using Wilcoxon matched-pairs signed rank and Mann-Whitney tests. Results: Fourteen patients [median age (IQR), 55 years (24.7); 10 women] were evaluated. The median angle of the masseteric bend was 117.7° in repose versus 155.4° during catheter withdrawal (P < .001, n = 14). The median distance measured from the Stensen's duct orifice to the first major ductal bifurcation was 81.5 mm (IQR = 12.3) in repose. The median percent increase in length from repose to stretch was 6.3% (P < .001, n = 14). Conclusions: Dynamic infusion digital sialography with fluoroscopic recording during catheter removal permits assessment of the distal duct unobstructed by the presence of a catheter. The technique also identifies the dynamic nature and varying length and angulation of Stensen's duct.

Areal differences in the rate of operative care for cancer of the head and neck within one hospital district in Northern Finland

Abstract Aim The relationship between socioeconomic status (SES) and cancers of the head and neck has been described previously. The present study investigated areal differences in the rate of operative care of cancers of the head and neck in terms of SES and rural–urban areas. Methods This retrospective cohort study included operations performed in Northern Finland between 1 January 2014 and 31 December 2019. SES and the rurality of the residence was determined using postal codes. Results Patients from the low-income areas were older and had higher American Society of Anesthesiologists classification than patients from middle- and high-income areas. The number of operated thyroid and parotid gland tumours was higher in the high-income areas (n = 36 [33.0%] vs n = 21 [18.8%] and n = 330 [28.6%], p = 0.049). Patients living in low- or median-income areas were more likely to live in rural areas than patients living in high-income areas (n = 55 [49.1%] and n = 62 [59.0%] vs n = 44 [40.4%], p = 0.024). The age-weighted rate of operations was higher in low-income areas than in high-income areas (29.3 [23.9–29.3] vs 17.9 [14.5–21.2]), and the age-weighted rate of free-flap surgery was highest in the low-income areas (16.8 [12.4–21.2] vs 8.2 [5.7–10.6] and 9.6 [7.0–12.1] /100,000 inhabitants/year). Conclusion There are significant areal differences in the rate of ablative head and neck surgery. Significantly higher rates were found in low-income areas and in rural areas.

Warthin tumor concomitant with mantle cell lymphoma: a case report and review of literature

RationaleWarthin tumor (WT) is the second most common benign tumor in salivary gland. It has a slow growth rate and most frequently occurs in the parotid gland. Most patients present with an incidental finding of a painless mass inferior/anterior to the ear. Besides the epithelial component of the tumor, WT is characteristically associated with lymphoid stroma that is considered benign. While there have been a few reports of malignant transformation of the lymphoid components in WT, cases of WT concomitant with mantle cell lymphoma (MCL) are extremely rare. To the best of our knowledge, two cases have been described in the English literature. Herein, we report a case of WT concomitant with MCL in a 70-year-old female patient, and emphasize the importance of careful examination of lymphoid stroma in WT so that concurrent lymphoma is not missed.Patient concernsA 70-year-old Chinese woman with a 40-year history of cigarette smoking presented with a one year history of a right submaxillary mass with recent enlargement.DiagnosisCervical ultrasound (US) and computed tomography (CT) scans of the neck revealed a well-circumscribed mass in the right parotid with a maximum diameter of 3.1 cm. Surgical resection of the mass was performed. Histopathological examination revealed a characteristic double-layer of neoplastic epithelium with prominent lymphoid stroma, suggesting WT. In addition, morphology and immunohistochemistry studies confirmed the coexistence of MCL. Thereafter, the final diagnosis of this case was WT concomitant with MCL.InterventionsThe patient was staged as stage I after clinical assessment. Due to the slow growth of parotid lesions, close observation was decided with periodic clinical and radiological monitoring.OutcomesCurrently, the patient demonstrates a stable disease by clinical evaluation.LessonsTo the best of our knowledge, reported cases of WT concomitant with MCL are very rare. This case highlights the importance of a comprehensive assessment of the lymphoid stroma of WT to avoid missed diagnosis of a lymphoma component in a collision tumor.

A comprehensive analysis of the tubarial glands.

The tubarial glands (TGs) are a collection of salivary glands (SGs) located within the nasopharynx, proximal to the eustachian tube. Currently, there is no quantitative characterization of the TGs. We investigated the histological architecture of the TGs and compared it with the major and minor SGs for categorization. Tubarial, parotid, submandibular, sublingual, buccal, labial, and lingual glands were excised from human donors (8 male and 3 female). Hematoxylin and eosin-stained tissue sections were analyzed to measure the area of the largest lobule, number of ducts, number of mucinous acini, and mean mucinous acini area. Based on our observation, the TGs' histology resembles the minor SGs, while having some unique characteristics that distinguish them from both major and minor SGs. The area of the largest lobule in the TGs and minor SGs was smaller than the major SGs. TGs have a lower number of ducts than the major and minor SGs. TGs contain densely packed clusters of predominantly mucinous acini surrounded by loose connective tissue resembling minor SGs. This density may explain their previously observed high prostate-specific membrane antigen uptake. In our cohort of donors, sex-based differences were observed in the mean mucinous acini area between male and female TGs, submandibular and sublingual glands. Taken together, our findings suggest the histological characteristics of all SGs are better organized on a spectrum rather than discrete groups (major vs. minor) and provide information to open new avenues for research into the TGs' role in head and neck pathologies and sexual dimorphism of the SGs.

Diagnostic performance of MRI-based radiomics models using machine learning approaches for the triple classification of parotid tumors

Rationale and objectivesPreoperative differentiation of malignant tumors (MT), pleomorphic adenomas (PA), and other benign tumors of the parotid gland is critical to clinical strategy, this study aimed to develop and validate a T2-weighted image (T2WI) based radiomics model through machine learning approaches for the triple classification of parotid gland tumors. Materials and methodsWe retrospectively enrolled 147 patients from January 2010 to July 2022. T2WIs were used to extract radiomics features. Max-Relevance and Min-Redundancy (mRMR) and Extreme Gradient Boosting (XGBoost) algorithms were used to select features. Using a 5-fold cross-validation strategy, radiomics models were constructed using a Support Vector Machine (SVM), Logistic Regression (LR), and k-Nearest Neighbor (KNN) for the triple classification of parotid tumors. The three models were evaluated and compared using the receiver operator characteristic (ROC) curve, sensitivity, specificity, and accuracy. ResultsA total of 1057 radiomics features were extracted, and 8 features were selected to developed the radiomics model, including First-order Median, First-order Skewness, First-order Minimum, Original_shape_Flatness, Glcm Inverse Variance, Glcm Inverse Variance, Glszm Low Gray Level Zone Emphasis, and Glszm Small Area Low Gray Level Emphasis. The mean area under the curves (AUCs) for the radiomics models in training and validation sets through LR, SVM and KNN were 0.85 and 0.80, 0.85 and 0.80 and 0.83 and 0.79, respectively. ConclusionThe T2WI-based radiomics models through LR, SVM and KNN demonstrated good performance in the triple classification of parotid tumors.

Effects of Glucose Intolerance on Physiological Accumulation in Salivary Glands and Palatine Tonsils During 18F-Fluorodeoxyglucose Positron Emission Tomography.

We evaluated the effects of chronic hyperglycemia on physiological accumulation in salivary glands and tonsils during18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT). 12,738 patients underwent whole-body FDG-PET/CT in our institute during the study period. Of these, the case group comprised 777 patients with a blood glucose (BG) level >140 mg/dL; the control group comprised an equal number of randomly selected age- and sex-matched individuals with a BG level <110 mg/dL. Within the case group, the diabetic subgroup was defined as individuals with a BG level >200 mg/dL. Visual assessment and accumulation intensity among tissues were compared between the case and control groups, including (1) the mean difference in maximum standardized uptake value (SUVmax), (2) the difference in the proportion of patients with visible tissues on maximum intensity projection images, and (3) differences between the diabetic subgroup and the control group. Parotid, submandibular, sublingual, and tonsillar tissues all showed significantly lower SUVmax in the case group than in the control group. The proportions of individuals with visible uptake in the parotid and tonsillar tissues and in the sublingual gland were significantly smaller in the case group than in the control group. Tonsillar uptake was observed in more than 90% of individuals in the control group but in two-thirds of patients in the diabetic subgroup. Accumulation in the parotid and submandibular glands was visible in approximately 80% of individuals in the control groupbut only half of patients in the diabetic subgroup. Physiological accumulation in salivary glands and tonsils is significantly reduced among individuals with hyperglycemia or diabetes.

Could Obesity Be Related to the Increasing Incidence of Warthin Tumors?

Background: The number of patients diagnosed with Warthin tumors (WTs) has increased significantly in recent years. The association of obesity as measured by body mass index (BMI) with the incidence of WTs remains unclear. This retrospective study aims to compare the BMI and other clinical factors of patients diagnosed with WTs to those with other benign epithelial parotid gland tumors. Methods: Over a 24-year period, 465 cases of benign epithelial parotid gland tumors were treated in our department. Of these, 155 (33.3%) were diagnosed as WTs. The results of the WT group were compared with those of another benign epithelial parotid gland tumor. Results: The mean BMI of WT patients was 27.3, which was significantly higher than in other benign tumors (25.52; p < 0.001). Furthermore, statistically significant correlations were observed, including a higher incidence of WT in males (p < 0.001), in the elderly (p < 0.001), and in cigarette smokers (p < 0.001). Additionally, a higher prevalence of other head and neck cancers was confirmed in patients with WTs (p = 0.004); Conclusions: This study supports the multifactorial etiology of WT development. Among these factors, smoking, advanced age, and obesity have been identified as factors associated with the development of WT, which might be due to chronic inflammation linked to obesity.

THE USE OF NERVE MONITORIZATION IN PAROTID, SUBMANDIBULAR GLAND AND FACIAL SURGERY AND ITS EFFECT ON PROGNOSIS

Objective: The facial nerve and its branches are at risk during facial surgery. The surgery with the highest risk is parotid and submandibular gland surgery. An attempt was made to determine threshold values in terms of paralysis in nerve monitoring parameters. These determined values could not be used to predict facial nerve function after surgery. The aim of this study is to investigate the relationship between the parameters detected by nerve stimulation during surgery and postoperative facial nerve dysfunction in patients who underwent parotid and submandibular gland surgery. Material and Methods: A total of 29 facial nerve branches of 13 patients who underwent superficial parotidectomy or submandibular gland resection were examined. Patients were examined in two groups: those who did not develop paralysis after surgery and those who developed paralysis or sequelae. The relationship between the patient's pre- and postoperative House-Brackmann staging and potential changes detected during surgery was investigated. Results: Paralysis was detected in 8 of 29 nerves that were stimulated, and the affected branches were the cervicofacial branch and the marginal mandibular branch. No difference was observed in the mean threshold stimulation values and responses determined before, during and at the end of dissection between patients who developed paralysis and those who did not. Conclusion: Unlike the literature, it is determined that no electrophysiological measurement result can predict the postoperative phase as a result of ROC-curve analysis and logistic regression analysis. It is thought that these results are caused by the fact that the developing paralysis is at low stages and heal within one month.

Disparities in pediatric parotid cancer treatment and presentation: A National study

ObjectivesAlthough parotid gland malignancies are uncommon, they nevertheless represent a cause of morbidity and mortality in the pediatric population. Few studies have sought to identify disparities related to their presentation, treatment, and survival. There is a need to understand these variations to improve care for historically underrepresented groups. Study designRetrospective Cohort Study. SettingSurveillance, Epidemiology, and End Results (SEER) Program Database. MethodsAnalysis of pediatric patients with parotid gland malignancies between 2000 and 2019. Race and ethnicity were classified as Non-Hispanic White, Non-Hispanic Black, Asian, and Hispanic for multivariable analysis. Outcomes included tumor size and stage at diagnosis, survival, and need for facial nerve sacrifice. Kaplan-Meier analysis was used to analyze survival. Multivariable logistic regression was conducted to identify predictors of outcomes. Results149 patients met the criteria for inclusion. Stratified by race/ethnicity, Non-Hispanic Black (Median 23 mm, IQR 15–33), Asian (30 mm, 14–32), and Hispanic (23 mm, 20–28) patients had larger tumors at presentation than Non-Hispanic White patients (18 mm, 12–25, p = 0.017). Disease-specific survival differed by time-to-treatment (log-rank, p = 0.01) and overall survival differed by income (p < 0.001). On multivariable analysis, Hispanic patients were more likely to experience facial nerve sacrifice (OR 3.71, 95%CI 1.25–11.6, p = 0.020), and Non-Hispanic Black (OR 3.37, 0.95–11.6, = 0.053) and Asian (OR 5.67, 1.46–22.2, p = 0.011) patients presented with larger tumors compared to Non-Hispanic White patients. ConclusionsVariations in presentation and treatment exist across race and ethnicity in pediatric parotid cancer. Identifying these disparities may help improve access and outcomes for underserved patient populations. Level of evidenceIII.

Metastatic Renal-Cell Carcinoma of the Oro-Facial Tissues: A Comprehensive Review of the Literature with a Focus on Clinico–Pathological Findings

Background: Metastatic tumors of the oro-facial tissuesare rare, with an incidence ranging between 1% and 8% of all oral malignant tumors. Generally reported with a peak of incidence in the 5–7th decades but possibly occurring at any age, metastases may represent the first sign of an occult cancer or manifest in patients with an already known history of a primary carcinoma, mostly from the lungs, kidney, prostate, and colon/rectum in males, and the uterus, breast, lung, and ovary in females. In the oro-facial tissues, the most involved sites are the oral mucosa, gingiva/jawbones, tongue, and salivary glands. Methods: A broad and deep literature review with a comprehensive analysis of the existing research on oro-facial metastases from renal-cell carcinoma (RCC) was conducted by searching the most used databases, with attention also paid to the clear-cell histological variant, which is the most frequent one. Results: Among the 156 analyzed studies, 206 cases of oro-facial metastases of renal cancer were found in patients with an average age of 60.9 years (145 males, 70.3%; 61 females, 29.6%). In almost 40% of the cases, metastasis represented the first clinical manifestation of the primary tumor, and 122 were histologically diagnosed as clear-cell renal-cell carcinoma (ccRCC) (59.2%). The tongue was involved in most of the cases (55 cases, 26.7%), followed by the gingiva (39 cases, 18.9%), mandible (35 cases, 16.9%), maxilla (23 cases, 11.1%), parotid gland (22 cases, 10.6%), buccal mucosa (11 cases, 5.3%), lips (7 cases, 3.3%), hard palate (6 cases, 2.8%), soft palate, masticatory space, and submandibular gland (2 cases, 0.9%), and lymph nodes, tonsils, and floor of the mouth (1 case, 0.4%). Among the 122 ccRCCs (84 males, 68.8%; 38 females, 31.1%), with an average age of 60.8 years and representing in 33.6% the first clinical manifestation, the tongue remained the most frequent site (31 cases, 25.4%), followed by the gingiva (21 cases, 17.2%), parotid gland (16 cases, 13.1%), mandibular bone (15 cases, 12.2%), maxillary bone (14 cases, 11.4%), buccal mucosa and lips (6 cases, 4.9%), hard palate (5 cases, 4%), submandibular gland and soft palate (2 cases, 1.6%), and lymph nodes, tonsils, oral floor, and masticatory space (1 case, 0.8%). The clinical presentation in soft tissues was mainly represented by a fast-growing exophytic mass, sometimes accompanied by pain, while in bone, it generally presented as radiolucent lesions with ill-defined borders and cortical erosion. Conclusions: The current comprehensive review collected data from the literature about the incidence, site of occurrence, age, sex, and survival of patients affected by oro-facial metastases from renal-cell carcinoma, with particular attention paid to the cases diagnosed as metastases from clear-cell renal-cell carcinoma, which is the most frequent histological variant. Clinical differential diagnosis is widely discussed to provide clinicians with all the useful information for an early diagnosis despite the effective difficulties in recognizing such rare and easily misdiagnosed lesionsTheir early identification represents a diagnostic challenge, especially when the clinical work-up is limited to the cervico–facial region. Nevertheless, early diagnosis and recently introduced adjuvant therapies may represent the key to better outcomes in such patients. Therefore, general guidelines about the clinical and radiological identification of oro-facial potentially malignant lesions should be part of the cultural background of any dentist.

Papulonodular Lesions in Photo Exposed Areas as First Manifestation of IgG4-Related Disease

IgG4-related disease (IgG4-RD) or IgG4 syndrome is a chronic inflammatory condition of presumed autoimmune etiology, affecting mainly men in their sixth decade of life. It has a good prognosis following instituted treatment and is characterized by infiltration of IgG4 + plasma cells, predominantly in the pancreas, bile duct, lymph nodes, kidneys, retroperitoneum, lungs and salivary, parotid, submandibular and lacrimal glands. Skin manifestations of IgG4 syndrome are uncommon but should be known to the dermatologist. This report details arare case of IgG4 syndrome involving cutaneous and lymph nodes. A 53-year-old woman described a 15-year history of erythematous and pruritic papulo-nodular lesions, mostly in photoexposed areas of the face, neck and upper limbs. She explained that the lesions evolved with ulceration, healing and residual dyschromia. Furthermore, she reported relapsing lymphadenomegaly 2 years ago, primarily in the cervical, axillary and inguinal chains.

Examining timing of periorbital interventions in patients with upper division facial paralysis.

Facial paralysis is a life-altering condition that may arise from various etiologies, ranging from trauma to malignancy. Permanent facial paralysis may occur secondary to facial nerve sacrifice or irreversible damage to the nerve. In these particularly devastating cases, protection and maintaining function of the eye is paramount. There are many effective lagophthalmos corrective surgical procedures available for these patients. While placement of eyelid weights and lid tightening surgeries are the cornerstone of eyelid rehabilitation, limited information exists on whether the timing of eyelid interventions in the setting of permanent facial paralysis impact outcomes, including need for revision surgery. A single-center retrospective chart review was performed for patients with irreversible facial paralysis treated with an upper eyelid weight between 2013 to 2022. Electronic health records were acquired to obtain facial paralysis etiology, associated clinical characteristics, the type of intervention, and the timing of intervention. Patients were classified as immediate if the eyelid weight operation occurred within 29 days of the initial facial paralysis and delayed if the surgery occurred 30 days or more after initial presentation. Outcomes were assessed in terms of revision procedures and surgical complications. There were 70 patients in total, with 35 patients in the immediate category and 35 patients in the delayed category. The most common etiology related to parotid gland pathology, and 58.6% of patients had facial paralysis from cancer-related surgeries. There were no significant differences in revision rates (p < 0.208) or in the types of procedures (p = 0.077) between the two groups. The complication rates also did not differ significantly between groups; however, there were only complications in the delayed intervention group. These findings suggest there is no difference in postoperative complications between groups, including the need for revision surgeries when comparing groups with immediate or delayed intervention. Thus, treatment plans should be customized based on patient and provider preferences.

MRI findings of preauricular sinus: a case report

BackgroundThe preauricular sinus (PS) is a benign congenital abnormality affecting the soft tissues in the preauricular region. Diagnosis is typically clinical and routine imaging is usually unnecessary in symptomatic cases, but individuals with recurrent sinuses or previous unsuccessful surgeries may benefit from pre-operative imaging. Furthermore, PS may be detected incidentally during head and neck magnetic resonance imaging (MRI), emphasizing the need for radiologists and ear, nose, and throat specialists to be familiar with its characteristics. Notably, there is a gap in the existing literature regarding the MRI description of PS.Case presentationWe present the case of a 19 year-old man complaining of pain in the right external auditory canal. During the physical examination, a small depression was observed at the front edge of the ascending limb of the helix with the discharge of particulate material. Suspecting a PS, further investigation through an MRI examination was requested. The contrast-enhanced MRI documented a PS characterized by a small superficial subcutaneous cyst located in front of the right external auditory canal at the front edge of the ascending limb of the helix, behind the superficial temporal artery, and behind and above the parotid gland. The cyst showed restricted diffusivity (due to purulent content) and was surrounded by inhomogeneous adipose tissue with contrast-enhancement (due to inflammatory phenomena).ConclusionsTo the best of our knowledge, there is a lack of clear description of MRI semeiotics of PS in the literature and this case helps to fill that gap. MRI could play a role in the pre-surgical planning of complex PS cases. Additionally, a comprehensive understanding of the MRI appearance is essential for distinguishing PS from other diseases, such as branchial fistulas, epidermal inclusion cysts, and trichilemmal cysts.

A Clinicopathological Study of Parotid Gland Tumours

Abstract Background: The parotid gland is the largest salivary gland. Pleomorphic adenoma (PA) is the most common tumour found in the parotid gland. Most of the parotid tumours are painless and slow-growing. Ultrasound, computed tomography and magnetic resonance imaging are modalities of diagnosis. Fine-needle aspiration cytology (FNAC) is done in some cases, and its use is controversial. Aim: This clinicopathological study mainly aims at the demographic profile of the patient and clinical implications. Investigations were done and also evaluating the efficacy of FNAC in diagnosing parotid gland tumours. Materials and Methods: We conducted a prospective, hospital-based, observational study at our institution from December 2020 to June 2022. Forty patients who satisfied the inclusion and exclusion criteria were enrolled in the study. The study was analysed using SPSS version 25 developed by IBM. The categorical variables were presented as frequency and continuous data as mean, standard deviation (SD) and range with confidence interval. Categorical variables were compared using the Chi-square test; P &lt;0.05 is considered significant. The sensitivity, specificity positive predictive value (PPV) and diagnostic accuracy of FNAC against the gold-standard histopathological examination (HPE) were worked out. The results are shown in tabular and graphical format. Results: The incidence of swelling was higher in males than females. Swelling was the most common clinical feature of the parotid gland. The duration of the disease ranges from ½to 48 months with an SD of 8.26 and a 95% confidence interval. One patient presented with facial nerve involvement and one patient presented with lymph node involvement. Five patients gave a history of surgery done in the past, which indicates recurrence, 10 (25%) patients were smokers and 1 (3%) patient had a history of previous radiation. Amongst the population of smokers, Warthin’s tumours were the most common (50%), PA (20%), oncocytic lipoadenoma, mucoepidermoid (MEP) carcinoma and myoepithelial (MyoEP) tumours having 10% incidence. The radiological findings were evaluated showing PA in 72.5% of cases, Warthin’s in 7.5%, neoplasm in 7.5% and non-specific cyst parotitis in 2.5% each. One patient image shows features of malignancy. FNAC says that 67.5% were PA, 20% were Warthin’s cyst and non-specific cyst, MEP and inflammation, but in one patient, FNAC was inconclusive. Most of the study population underwent superficial parotidectomy (32.5%); 30% of the study group underwent superficial conservative parotidectomy, but 27.5% of patients underwent total conservative parotidectomy. About 2.5% of the study group underwent extracapsular excision and enucleation. However, 2 (5%) patients were done with simple excision only. After surgery, out of 40, 38 patients had neuropraxia which recovered on follow-up. The most common tumour was PA (67.5%), and Warthin’s (22.5%) malignant tumours like MEP and MyoEP were 5% and 2.5%, respectively. Rare benign tumours like oncocytic lipoadenoma were the finding of HPE in FNAC that was inconclusive in this case. The incidence of malignant tumours was more common in males than in females, and it was more common in the age group of 21–40 years. MEP carcinoma was the most common malignant tumour. The efficacy of FNAC was identified in terms of sensitivity, specificity, negative predictive value (NPV), PPV and diagnostic accuracy. The sensitivity for benign tumours was 91.89% and that for malignant tumours was 33.33%. The specificity was 33.33% for benign tumours and 100% for malignant tumours respectively. The PPV was 94.44% for benign and 100% for malignant tumours. NPV was 25% and 94.87%, respectively. The diagnostic accuracy was 87.5% and 95%. Conclusion: Although FNAC has some pitfalls, the high sensitivity, specificity and accuracy in diagnosing malignant lesions as evident from this study indicate that FNAC is a reliable diagnostic method when correctly performed and interpreted by an experienced cytopathologist. Not all parotid lesions are lumps are malignant. Most of the masses are benign in nature. FNAC is a simple, safe, painless and cost-effective method for easy diagnosis.

Pleomorphic adenoma in an adolescent, about a clinical case

Introduction: salivary gland tumors in children represent a low percentage of pediatric head and neck tumors; most of them are diagnosed in association with the Parotid salivary gland and present a higher proportion of malignancy than in adults. Objective: to present a case with a diagnosis of Pleomorphic Adenoma: clinical symptoms, complementary examinations, treatment and evolution. Case presentation: female patient, 13 years old, from a rural background and white race, attended the Maxillofacial Surgery consultation, in good general condition, accompanied by her parents, due to an increase in volume of a hard consistency, not fixed to deep planes ( mobile), asymptomatic, of 7 months of evolution and 3 cm in length located in the left parotid region. Ultrasound of soft tissues and neck was indicated, as well as contrast-enhanced facial mass tomography, which showed a mass in relation to the left parotid gland that captured contrast. In addition, complementary examinations and a fine needle aspiration biopsy (FNAB) were performed, resulting in a benign parotid gland tumor (Pleomorphic Adenoma). Superficial parotidectomy was performed with preservation of the facial nerve. The patient progressed satisfactorily and continues to be followed up by consultation. Conclusions: pleomorphic adenomas are discovered in practice as slowly growing asymptomatic masses; the size is variable and will always depend on the stage at which it is detected.