Parotid Tumors Research Articles

Dosimetric investigation of radiation-induced trigeminal nerve toxicity in parotid tumor patients.

We aimed to describe the association between trigeminal nerve (TN) dose and toxicity and determine a threshold value that leads to TN toxicity in patients with parotid tumors treated with adjuvant conventional fractionated radiation therapy. Eighteen patients who underwent adjuvant radiotherapy (RT) between 2013 and 2018 were included in this retrospective study. TN and its branches were outlined subsequently on the planning CT scans. The doses received by TN were obtained based on the dose-volume histogram. The dose and toxicity relationship was investigated over the total prescribed dose. RT-related toxicity was graded according to Common Terminology Criteria for Adverse Events V4.0 (CTCAEv4.0). The median follow-up was 29.5 months. After RT, 61% of patients had Grade I-II late TN toxicity divided into Grade I in 4 (22%) and Grade II in 7 (39%) patients. TN injury symptoms were as follows: loss of sensation in the chin area in 3, difficulty in jaw movements in 3, and paresthesia in 5 patients. The total RT dose (p = 0.001), Dmax (p = 0.001), PTV-TN Dmax (p = 0.001), D1cc (p = 0.004), D0.5cc (p = 0.001), and D0.1cc (p = 0.01) had a significant effect on TN toxicity. Cut-off values leading to toxicity were determined as 66, 65.5, 65.25, 63.6, and 62.7 Gy for Dmax, PTV-TN Dmax, D0.1cc, D 0.5cc, and D1cc, respectively. Radiation-induced TN injury in head and neck cancer patients may further be investigated in clinically prospective trials by virtue of high toxicity rates with current RT doses in our retrospectively designed dosimetric study in parotid tumors.

Research trends and perspectives on immediate facial reanimation in radical parotidectomy (Review).

For patients diagnosed with advanced malignant parotid tumour, radical parotidectomy with facial nerve sacrifice is part of the treatment. Multiple surgical techniques have been developed to cure facial paralysis in order to restore the function and aesthetics of the face. Despite the large number of publications over time on facial nerve reanimation, a consensus on the timing of the procedure or the donor graft selection has remained to be established. Therefore, the aim of the present study was to conduct a bibliometric analysis to identify and analyse scientific publications on the reconstruction of the facial nerve of patients who underwent radical parotidectomy with facial nerve sacrifice. The analysis on the topic was conducted using the built-in tool of the Scopus database and VOSviewer software. The first 100 most cited articles were separately reviewed to address the aim of the study. No consensus was found regarding the recommended surgical techniques for facial nerve reanimation. The most used donor cranial nerves for transfer included the following: Masseteric branch of the V nerve, contralateral VII nerve with cross-face graft, the XI nerve and the XII nerve. The best timing of surgery is also controversial depending on pre-exiting pathology and degree of nerve degeneration. However, most of the clinical experience suggests facial nerve restoration immediately after the ablative procedure to reduce complications and improve patients' quality of life.

Evaluation of Quantitative Dual-Energy Computed Tomography Parameters for Differentiation of Parotid Gland Tumors

To assess the diagnostic performance of quantitative parameters from dual-energy CT (DECT) in differentiating parotid gland tumors (PGTs). 101 patients with 108 pathologically proved PGTs were enrolled and classified into four groups: pleomorphic adenomas (PAs), warthin tumors (WTs), other benign tumors (OBTs),and malignant tumors (MTs). Conventional CT attenuation and DECT quantitative parameters, including iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Zeff), electron density (Rho), double energy index (DEI),and the slope of the spectral Hounsfield unit curve (λHU), were obtained and compared between benign tumors (BTs) and MTs, and further compared among the four subgroups. Logistic regression analysis was used to assess the independent parameters and the receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance. Attenuation, Zeff, DEI, IC, NIC, and λHU in the arterial phase (AP) and venous phase (VP) were higher in MTs than in BTs (p<0.001-0.047). λHU in VP and Zeff in AP were independent predictors with an area under the curve (AUC) of 0.84 after the combination. Furthermore, attenuation, Zeff, DEI, IC, NIC, and λHU in the AP and VP of MTs were higher than those of PAs (p<0.001-0.047). Zeff and NIC in AP and λHU in VP were independent predictors with an AUC of 0.93 after the combination. Attenuation and Rho in the precontrast phase; attenuation, Rho, Zeff, DEI, IC, NIC, and λHU in AP; and the Rho in the VP of PAs were lower than those of WTs (p<0.001-0.03). Rho in the precontrast phase and attenuationin AP were independent predictors with an AUC of 0.89 after the combination. MTs demonstrated higher Zeff, DEI, IC, NIC, and λHU in VP and lower Rho in the precontrast phase compared with WTs (p<0.001-0.04); but no independent predictors werefound. DECT quantitative parameters can help to differentiate PGTs.

Surgical, histopathological, and clinical outcomes of parotid gland neoplasms: a 10-year tertiary single-center experience

Objectives: This study aims to contribute to the literature by presenting an overview of a 10-year experience by retrospectively examining the cases with a parotid mass from a tertiary referral center Methods: Two hundred fourteen patients were diagnosed with a parotid mass in the Otorhinolaryngology Clinic of HSU Izmir Bozyaka Training and Research Hospital between January 2009 and January 2019. Sociodemographic characteristics, diagnostic methods, surgical operations and complications, pathology results, and long-term follow-up results were retrospectively analyzed over the patients' files. SPSS Version 21.0 computer for data analysis. Results: Of 214 parotidectomies, 140 (75%) were male, 74 (35%) were female, mean age was 55 ±14 years (15-85 years). The most common diagnoses were 87 (40.7%) pleomorphic adenomas and 48 (22.4%) Wharton tumors. The most prevalent malignant tumors were reported as 18 (8.1%) mucoepidermoid carcinoma. The main type of surgery was superficial parotidectomy, performed in 192 (90%) patients. Facial paralysis was observed in 11 (5.1%) patients as the main postoperative complication. Conclusions: Considering the histopathological diagnosis of parotid tumors, the stage and grade of the tumor, surgery is generally preferred for treatment. More males are affected than women, especially in the middle ages.

Classification of benign and malignant parotid tumors based on CT images combined with stack generalization model.

Parotid tumors are among the most prevalent tumors in otolaryngology, and malignant parotid tumors are one of the main causes of facial paralysis in patients. Currently, the main diagnostic modality for parotid tumors is computed tomography, which relies mainly on the subjective judgment of clinicians and leads to practical problems such as high workloads. Therefore, to assist physicians in solving the preoperative classification problem, a stacked generalization model is proposed for the automated classification of parotid tumor images. A ResNet50 pretrained model is used for feature extraction. The first layer of the adopted stacked generalization model consists of multiple weak learners, and the results of the weak learners are integrated as input data in a meta-classifier in the second layer. The output results of the meta-classifier are the final classification results. The classification accuracy of the stacked generalization model reaches 91%. Comparing the classification results under different classifiers, the stacked generalization model used in this study can identify benign and malignant tumors in the parotid gland effectively, thus relieving physicians of tedious work pressure.

Characterization of parotid tumor surgeries and pathological findings at the IPS Central Hospital in the period 2016-2020

Introducción: Los tumores parotídeos son considerados una patología relativamente rara, constituyendo un grupo de tumores que afectan a la cabeza y el cuello. Dentro de la patología tumorales de las glándulas salivales, constituyen un 80%, y el 3% de todos los tumores de cabeza y cuello. De estos, un 80% corresponde a tumores benignos. Como objetivo es caracterizar las cirugías de tumor de parótida y hallazgos anatomopatólogicos en el Hospital Central del IPS en el periodo 2016-2020. Metodología: Estudio observacional, descriptivo y retrospectivo de la base de datos, con fichas clínicas de pacientes con antecedente de cirugía por tumor de parótida en el Hospital Central del IPS en el periodo 2016-2020. Resultados: Fueron analizadas un total de 44 cirugías de parótida. No hubo predominio de sexo. Los pacientes de 51 a 60 años fueron los más afectados. El adenoma pleomórfico fue el tumor benigno más frecuente, seguido del tumor de Warthin. Entre los tumores malignos, distintos tipos de carcinomas representaron el 9% de los casos. La parotidectomía superficial fue realizada en 64%. Conclusión: La mayoría de los tumores de parótida fueron benignos, con el adenoma pleomórfico como el más frecuente. En casi 2/3 de los casos se realizó parotidectomía superficial.

602 Bilateral Warthin's Tumour of the Parotid Gland: A 16-Year Retrospective Analysis and Systematic Review

Abstract Aim Warthin’s tumour (WT) is the second most common benign parotid tumour in the United Kingdom. The World Health Organisation (WHO) states that WTs are bilateral in 5-14% of patients. However, current medical literature varies significantly more. We aim to assess the frequency of bilateral WTs over the last 16 years at a large head and neck unit in Kent, England and to perform the first systematic review of literature on bilateral WTs. Method A single-centre retrospective analysis of patients who were diagnosed with WT on histology between January 1st, 2005, and December 31st, 2020 was conducted. A systematic review (PROSPERO Registration Number: CRD42022326846) of literature was performed using PubMed and the Cochrane Library. The inclusion criteria were full-text published studies in English describing patients, at any age, who were diagnosed with bilateral WTs. Results 290 patients (112 females) diagnosed with WTs were included in our retrospective analysis. 24.5% of our patients had bilateral WTs. WTs in female patients were bilateral in 28.6% of cases and 21.9% in male patients. Our systematic review identified 157 papers, of which 14 met our inclusion/exclusion criteria. These studies reported the prevalence of bilateral WTs to range from 0.65% to 40% and the mean was 12.5%. Conclusions Our study showed that 1 in 4 of our patients had bilateral WTs and nearly a third of WTs in females were bilateral. This varies significantly from the WHO guidelines (5-14% bilateral WTs). This will be of interest to surgeons who discuss this disease with future patients.

Reliability of Fine Needle Aspiration Cytology for Salivary Gland Tumours Meta-Analytical Study

Abstract Background Fine needle aspiration (FNA) cytology is a safe, reliable, minimally invasive and cost- effective technique for the diagnosis of salivary gland lesions. Aim and objectives to assess the accuracy, sensitivity and specificity of FNAC for diagnosis of salivary gland tumors in comparison with biopsy as definite diagnostic tool for these tumors. Subjects and methods This is a Retrospective and prospective studies, was carried out on Patients diagnosed with salivary gland tumors, treated with surgical management. Result FNA was associated with statistically significant fewer nondiagnostic results, Pooled analysis of all studies (n = 3605) revealed that rate of nondiagnostic results is 2.992% with 95% CI of rate 91.10–95.09 with absence of publication bias. Conclusion Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2 cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results Funding Sources This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

Amide proton transfer-weighted magnetic resonance imaging for the differentiation of parotid gland tumors.

To assess the usefulness of amide proton transfer-weighted (APTw) imaging in the differentiation of parotid gland tumors. Patients with parotid gland tumors who underwent APTw imaging were retrospectively enrolled and divided into groups according to pathology. Two radiologists evaluated the APTw image quality independently, and APTw images with quality score ≥3 were enrolled. The maximum and average values of APTw imaging for tumor lesions (APTmax and APTmean) were measured. The differences in APTmax and APTmean were compared between malignant tumors (MTs) and benign tumors (BTs), as well as between MTs and pleomorphic adenomas (PAs) and between MTs and Warthin tumors (WTs). Independent-samples t-test, Kruskal-Wallis H test, and receiver operating characteristic (ROC) curve analyses were used for statistical analysis. Seventy-three patients were included for image quality evaluation. In this study, 32/73 and 29/73 parotid tumors were scored as 4 and 3, respectively. After excluding lesions with quality score ≤2 (12/73), the APTmean and APTmax of MTs were 4.15% ± 1.33% and 7.43% ± 1.61%, higher than those of BTs 2.74% ± 1.04% and 5.25% ± 1.54%, respectively (p < 0.05). The areas under the ROC curve (AUCs) of the APTmean and APTmax for differentiation between MTs and BTs were 0.819 and 0.821, respectively. MTs indicated significantly higher APTmean and APTmax values than those of PAs (p < 0.05) and WTs (p < 0.05). The AUCs of the APTmean and APTmax for differentiation between MTs and PAs were 0.830 and 0.815 and between MTs and WTs were 0.847 and 0.920, respectively. Most APTw images for parotid tumors had acceptable image quality for APTw value evaluation. Both APTmax and APTmean can be used to differentiate MTs from BTs and to differentiate MTs from subtype parotid gland tumors.

Construction and Application of a Nomogram for Predicting Benign and Malignant Parotid Tumors.

A prediction model of benign and malignant differentiation was established by magnetic resonance signs of parotid gland tumors to provide an important basis for the preoperative diagnosis and treatment of parotid gland tumor patients. The data from 138 patients (modeling group) who were diagnosed based on a pathologic evaluation in the Department of Stomatology of Jilin University from June 2019 to August 2021 were retrospectively analyzed. The independent factors influencing benign and malignant differentiation of parotid tumors were selected by logistic regression analysis, and a mathematical prediction model for benign and malignant tumors was established. The data from 35 patients (validation group) who were diagnosed based on pathologic evaluation from September 2021 to February 2022 were collected for verification. Univariate and multivariate logistic regression analysis showed that tumor morphology, tumor boundary, tumor signal, and tumor apparent diffusion coefficient (ADC) were independent risk factors for predicting benign and malignant parotid gland tumors ( P < 0.05). Based on multivariate logistic regression analysis of the modeling group, a mathematical prediction model was established as follows: Y = the ex/(1 + ex) and X = 0.385 + (1.416 × tumor morphology) + (1.473 × tumor border) + (1.306 × tumor signal) + (2.312 × tumor ADC value). The results showed that the area under the receiver operating characteristic curve of the model was 0.832 (95% confidence interval, 0.75-0.91), the sensitivity was 82.6%, and the specificity was 70.65%. The validity of the model was verified using validation group data, for which the sensitivity was 85.71%, the specificity was 96.4%, and the correct rate was 94.3%. The results showed that the area under receiver operating characteristic curve was 0.936 (95% confidence interval, 0.83-0.98). Combined with tumor morphology, tumor ADC, tumor boundary, and tumor signal, the established prediction model provides an important reference for preoperative diagnosis of benign and malignant parotid gland tumors.

Basal cell adenoma and pleomorphic adenoma of the parotid gland: a single center experience.

Basal cell adenoma (BCA) and pleomorphic adenoma (PA) are among the most common benign neoplasms of the salivary glands. The aim of this study was to analyze and compare the diagnosis, treatment, and recurrence rate of these two different types of parotid benign tumors. A retrospective analysis of all cases of parotid gland BCA and PA surgically treated between January 1, 1990, and December 31, 2019, was performed at our university. A total of 349 patients were enrolled in the present study, 311 of which (89.1%) were affected by PA, and 38 patients (10.9%) by BCA. The most frequently performed surgery was partial parotidectomy for both groups (85.9% in PA and 65.8% in BCA). Perioperative complications - often transient and of short duration - occurred within 48 hours of surgery and were observed in 30.6% of PA patients and in 18.4% of BCA patients; furthermore, recurrences were noticed in 19 PA patients (6.2%) and in 3 BCA patients (7.9%) (rates in range with the available literature data). To the best of our knowledge, this study is one of the largest single-center series in the literature comparing diagnosis, treatment, recurrence rate and clinical-pathological features of two different types of benign parotid gland tumors, BCA, and PA.

Prioritizing parotid gland surgery: A call for the implementation of the MSRSGC classification.

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is developed to aid diagnosis and management of salivary gland tumors. This study evaluates the time-to-treatment initiation (TTI) for parotid gland tumors in the Netherlands and relates these to the MSRSGC classification. Subsequently, the use of the MSRSGC in the Netherlands is evaluated. Data regarding fine-needle aspiration cytology (FNAC) and histopathological resections of the parotid were gathered from the Dutch nationwide pathology data bank (PALGA). The TTI was calculated for each MSRSGC category and type of treating center. FNACs performed from 2018 to 2021 were gathered from PALGA to estimate how frequently the MSRSGC classification was applied. Median TTI in days were 86 for nondiagnostic (MSRSGC I), 75 for nonneoplastic (MSRSGC II), 65 for atypia of unknown significance (AUS) (MSRSGC III), 89 for benign (MSRSGC IVa), 52 for salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), 31 for suspected malignant (MSRSGC V), and 30 for malignant (MSRSGC VI) categories. Significant variation in the TTI between the types of treating centers was found for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. In the first 3 years after the introduction of the MSRSGC, the pathologist stated the MSRSGC classification in 6.4% of all reports. The median TTI for most categories is long, and there is significant interhospital variation in TTI. Preoperative risk stratification and treatment prioritization in parotid gland surgery in the Netherlands should be improved. The MSRSGC could contribute to this. Until 2021, the MSRSGS classification was implemented on a limited scale in the Netherlands.

Safety and Aesthetics of Autologous Dermis-Fat Graft after Parotidectomy: A Multidisciplinary Retrospective Study.

(1) Background: In surgical procedures for maxillofacial tumours, it is challenging to preserve functional and cosmetic properties in the affected patients. The use of fat grafting is considered as a valuable alternative to overcome postoperative aesthetic asymmetry problems. (2) Methods: In this study, we enrolled thirty patients with parotid gland tumours in which a partial or complete parotidectomy was performed with positioning in the parotid bed of autologous dermis-fat grafts. We evaluated the satisfaction rate of the patients and the objective efficacy in solving the deformity by comparing MRI data before and after surgery. (3) Results: Twenty-six patients showed a satisfying cosmetic result with proper facial symmetry between the affected side and the healthy one. Two patients presented mild postsurgical complications such as haematomas, and two patients reported temporary weakness of the facial nerve related to the parotidectomy. (4) Conclusions: Based on the imaging data obtained via MRI before and after surgery, we can assess that the employment of fat grafts in parotidectomy surgical procedures gives good cosmetic results and does not affect the post operative management and follow up of oncologic patients.

The parotid tumours-benign and malignant: our experience

Salivary gland tumors are uncommon and constitute a highly heterogeneous histopathological group of neoplasms. The present study aims to determine the correlation between the cytological and histopathological findings of parotid gland tumors, and preservation of the facial and posterior branch of the greater auricular nerve during parotid surgery. A study of 21 cases of parotid gland tumors was conducted at our hospital- GMERS Medical College and Civil Hospital, Valsad. All of them were clinically diagnosed and investigated. Hospital records of these patients including operative findings were analyzed concerning age, sex, indications for surgical management, and outcome. A total of 21 salivary gland tumors were diagnosed over 2 years representing pleomorphic adenoma was most commonly occurring in 15 (71%) cases followed by Warthin`s in 3 (14%) cases, mucoepidermoid carcinoma 2 (10%) and benign cystic lesion in 1 (5%) cases. Most of the parotid gland tumors occurred in the 20-60 years age group. Females were more commonly affected than males. The data discussed in this study was consistent with other hospital-based studies concerning age, sex, site, clinical presentation, diagnosis, complications, management, and outcome of these different types of parotid gland tumors.

Tumor localization is the important factor for recovery time of postoperative facial nerve paralysis in benign parotid surgery

ObjectiveFacial nerve paralysis is the most problematic complication of surgery for parotid tumors. This study aimed to examine the progress of recovery from postoperative transient facial nerve paralysis (POFNP). MethodsParticipants were 203 patients who developed POFNP after benign parotid surgery. A Kaplan-Meier showed the progress of recovery from paralysis. Factors involved in recovery were examined. For factors for which a significant difference was found, recovery from paralysis was examined over time. ResultsRates of recovery from paralysis were as follows: 28.6% of patients at 1 month, 58.3% at 3 months, 85.9% at 6 months, and 95.1% at 12 months after surgery. Deep lobe tumors were shown to be significantly associated with delayed recovery from paralysis. The relationship between tumor location and the time of recovery from was that deep lobe tumors had a significantly worse recovery from paralysis at 4 and 5 months after surgery. ConclusionPatients who develop POFNP must be informed about the progress of recovery and factors involved in recovery from paralysis. We believe that the results of the present study are a useful reference to that end.

Adding automated decision-tree models to multiparametric MRI for parotid tumours improves clinical performance

PurposeTherapeutic management of parotid gland tumours depends on their histological type. To aid its characterisation, we sought to develop automated decision-tree models based on multiparametric magnetic resonance imaging (MRI) parameters and to evaluate their added diagnostic value compared with morphological sequences. Methods206 MRIs from 206 patients with histologically proven parotid gland tumours were included from January 2009 to January 2018. Multiparametric MRI findings (including parameters derived from diffusion-weighted imaging [DWI] and dynamic contrast-enhanced [DCE]) were used to build predictive classification and regression tree (CART) models for each histological type. All MRIs were read twice: first, based on morphological sequence findings only, and second, with the addition of multiparametric sequences and CART findings. The diagnostic performance between these two readings was compared using ROC curves. ResultsCompared to morphological sequences alone, the addition of multiparametric analysis significantly increased the diagnostic performance for all histological types (p < 0.001 to p = 0.011), except for lymphomas, where the increase was not significant (AUC 1.00 vs. 0.99, p = 0.066). ADCmean was the best parameter to identify pleomorphic adenomas, carcinomas and lymphomas with respective cut-offs of 1.292 × 10–3 mm2/s, 1.181 × 10–3 mm2/s and 0.611 × 10–3 mm2/s, respectively. × 10–3 mm2/s. The mean extracellular-extravascular space coefficient was the best parameter to Warthin tumours from the others, with a cut-off of 0.07. ConclusionsThe addition of decision tree prediction models based on multiparametric sequences improves the non-invasive diagnostic performance of parotid gland tumours. ADC and extracellular-extravascular space coefficient are the two best parameters for decision making.

A rare case of nodular fasciitis presenting as a parotid tumor: Clues to cytodiagnosis

A 14-year-old boy presented with left preauricular painless swelling of 10 months’ duration. Local examination revealed a 3 × 2-cm, firm, nodular, nonmobile mass in the left preauricular area, just in front of tragus. Fine needle aspiration yielded paucicellular smears comprising singly scattered histiocyte/myofibroblast-like spindle cells and occasional giant cells. It was reported as benign mesenchymal lesion on cytology. Left superficial parotidectomy was performed. Histopathological and immunohistochemical analysis confirmed the diagnosis of nodular fasciitis (NF). It was an illcircumscribed cellular neoplasm, abutting and focally infiltrating into otherwise normal parotid gland. The tumor comprised spindle cells arranged in short bundles and storiform pattern with interspersed osteoclast-like giant cells, foam cells, extravasated red blood cells (RBCs), and focal areas of keloidal collagenization. The cells were positive for smooth muscle actin and negative for CD34, beta-catenin, S100, and pancytokeratin. Final diagnosis of NF was rendered. NF can rarely involve the parotid gland or present as parotid enlargement and pose diagnostic challenge, especially on cytology. However, in appropriate clinical context, subtle cytomorphological clues such as presence of myofibroblasts and fibrocollagenous stromal fragments can help in ruling out the commonly occurring salivary gland neoplasms and offering a definitive cytodiagnosis of NF which will be helpful in deciding the further course of management.

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort.

We characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses. A de-identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included. Among the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001). In one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3-4 months. 4 Laryngoscope, 134:911-918, 2024.

Cavernous hemangioma in adult parotid gland encroaching on the parapharyngeal space: A case report

Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland. With about 50 cases reported worldwide in adults, diagnosing a hemangioma in the parotid gland can be difficult. An accurate diagnosis of parotid hemangiomas in adults before excision is challenging. We report a case of a 54-year-old woman with a left parotid mass of five years duration, which was rapidly increasing in size over last one year. Magnetic resonance imaging (MRI) was suggestive of a left parotid pleomorphic adenoma invading the parapharyngeal space. Fine needle aspiration cytology was inconclusive. However, with a strong clinical suspicion of a pleomorphic adenoma, left total parotidectomy was performed. The histopathological findings were of a cavernous hemangioma. The rarity of such condition in head and neck region and misdiagnosis or failing to diagnose make this case more interesting to pathologists and clinicians alike. Nevertheless, hemangioma should be considered in the differential diagnosis of parotid tumors in adults.

The Role of Parotid Gland Invasion in Adenoid Cystic Carcinoma of the External Auditory Canal.

This study aimed to investigate the significance of parotid gland invasion in predicting distant metastasis of adenoid cystic carcinoma in the external auditory canal. Single-institution retrospective cohort study. A retrospective review of patients with adenoid cystic carcinoma of the external auditory canal who underwent surgery was performed. Information on patient demographics, parotid gland invasion, tumor stage, perineural invasion, lymphovascular invasion, and follow-up data were collected and analyzed. One hundred twenty-nine patients were identified for review. Parotid gland invasion was noted in 45 patients (34.9%). Parotid gland invasion was significantly associated with tumor stage, perineural invasion, distant metastasis, and postoperative adjuvant therapy. Distant metastasis was noted in 30 patients (23.3%). Multivariate Cox proportional hazards analysis identified parotid gland invasion as an independent risk factor for predicting distant metastasis. The 5-year distant metastasis-free survival rate was 83.6% for patients without parotid gland invasion and 61.8% for patients with parotid gland invasion (p = 0.010). The parotid gland invasion rate is relatively high in adenoid cystic carcinoma of the external auditory canal and is significantly related to tumor stage. Parotid gland invasion is associated with worse distant metastasis-free survival. 4 Laryngoscope, 134:419-425, 2024.