Treatment Of Parotid Gland Tumors Research Articles

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.

Comparative analysis of benign and malignant parotid gland tumors: A retrospective study of 992 patients

ObjectiveWe analyzed and compared the clinical characteristics of benign and malignant parotid gland tumors. Patients and methodsA total of 992 patients who underwent surgical treatment for parotid gland tumors from January 2010 to December 2020 were included in this study. This study population was subdivided into benign (n = 812, 81.9 %) and malignant parotid gland tumors (n = 180, 18.1 %). ResultsPleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma is the most common malignant tumor. The patients with malignant parotid gland tumors were older than the patients with benign lesions. The duration of symptoms was longer in patients with benign parotid gland tumors compared to those with malignant lesions. The size of the malignant tumors was larger than that of the benign lesions. Preoperative fine-needle aspiration cytology had a diagnostic sensitivity of 50.3 %, diagnostic specificity of 98.7 %, a positive predictive value of 89.5 %, a negative predictive value of 89.9 %, and accuracy of 89.9 % for diagnosing malignant parotid gland tumors. For benign parotid gland tumors, superficial parotidectomy was most frequently performed, and for malignant parotid gland tumors, total parotidectomy was most frequently performed. Facial palsy was observed in 19.4 % of the patients with malignant parotid gland tumors compared to 5.4 % of those with benign tumors. ConclusionThe clinical features of benign and malignant parotid gland tumors showed differences in age, symptoms, duration of symptoms, size and site of the parotid tumors, surgical procedures, and postoperative facial nerve palsy.

Two-Lines-Four-Regions: A New Concept in Endoscopic-Assisted Surgery of Parotid Gland Tumors

Endoscopic-assisted surgery of parotid gland tumor is challenging due to the complex anatomic structures. This study compared an innovative endoscopic-assisted operation called the two-lines-four-regions method to a traditional endoscopic-assisted surgery in the treatment of parotid gland tumors. In this retrospective cohort study, patients were assigned to the traditional endoscopic group (Trad-En group) and the two-lines-four-regions endoscopic group (Tlfr-En group) according to whether two-lines-four-regions concept was used before the surgery. The primary outcomes are operation time (minutes) and postoperative complications present or absent. Other outcomes including intraoperative blood loss (milliliter), whether to increase auxiliary incision (yes/no), postoperative drainage (milliliter), and retention time (day) are the secondary outcomes. χ2 analysis or Fisher exact test was used to compare the statistical differences of those variables in 2 groups, and a P value of less than .05 was considered to indicate statistical significance. A total of 121 patients with parotid gland tumors underwent endoscopic-assisted surgery; 59 patients were assigned to the Trad-En group, and 62 patients were assigned to the Tlfr-En group. The mean operation times (65.24±14.82min), blood loss (9.85±3.38mL), and the amount of drainage (10.52±3.17mL) in the Tlfr-En group were shorter than the values in the Trad-En group (75.75±14.16min, 10.52±3.17mL, and 16.54±3.21mL, respectively; P<.05). The median follow-up time was 34months (range 4 to 70months). No tumor recurrence was found in all patients. This study demonstrated that the new concept of two-lines-four-regions of parotid gland makes the endoscopic-assisted surgery of parotid gland tumors more simplified, efficient, and minimally invasive.

An overview of cases of parotid gland tumors managed in a teaching hospital, North-west, Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; Objective: Salivary gland tumors are mostly slow growing and painless. Majorities are located in the parotid glands and are benign. Treatment of these parotid tumors may endanger the facial nerve. This study evaluated the clinical presentation and management of parotid gland tumors in Kaduna, North-west, Nigeria.&#x0D; Methods: This was a retrospective study of patients that were treated for parotid gland tumors at the Maxillofacial Unit of Barau Dikko Teaching Hospital, Kaduna, North-west, Nigeria over a period of 13years (January 2008 to December, 2020). Patients’ records were analyzed for age, sex, clinical presentation, investigations, surgical management, histological diagnosis and outcome of treatment.&#x0D; Results: A total of 55 patients with parotid gland tumors were seen. Age range was 12 - 75 years with a mean of 45.5 (SD± 0.7) years. The male: female ratio was found to be 1.1: 1. Pleomorphic adenoma was the commonest tumour (n=28, 50.9%). Four (7.3%) patients who had been on antiretroviral medications were seen with massive tumors. Superficial parotidectomy was the commonest surgical procedure carried out in these patients. Patients with malignancies were referred for post-surgical radiotherapy. High early recurrences were noticed in patients who were retroviral positive.&#x0D; Conclusion: Pleomorphic adenoma was commonest tumors treated and superficial parotidectomy was the commonest surgical procedure performed for the treatment of parotid gland tumors. Post-operative radiotherapy as an adjunct was carried out in cases with diagnosis of malignant lesions.&#x0D; &#x0D; &#x0D; &#x0D;

Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study

BackgroundHigh-definition, three-dimensional (3D) exoscopes are being used to perform a growing number of head and neck surgeries. However, the use of the 3D exoscope in parotid gland surgery has not been previously described. Our initial experience with the VITOM 3D exoscope in the surgical treatment of parotid gland tumors is detailed here.MethodsWe made a prospective study of patients with benign parotid gland tumors indicated for surgical resection. Between January and December 2018, patients were randomly assigned to undergo surgery assisted with the VITOM 3D system (n = 31) or an operating microscope (n = 40). Visualization quality (greater auricular nerve, digastric muscle, tragal pointer), operating time, conversion rates, and surgical outcomes were compared.ResultsA total of 71 patients underwent superficial (n = 18) or total parotidectomy (n = 53). No exoscope-related complications were observed. Five patients undergoing exoscope-guided deep lobe surgery required intraoperative conversion to a microscope. No differences were observed in the subjective quality of intraoperative visualization of key anatomical structures. However, a significantly higher percentage of patients in the exoscope group developed transient facial nerve paralysis (n = 9; 29% vs. n = 4, 10%).ConclusionsThese findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. However, the high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation.

Effect of human acellular dermal matrix (Megaderm™) on infra-auricular depressed deformities, Frey's syndrome, and first bite syndrome following parotidectomy: a multi-center prospective study.

Parotidectomy is the primary treatment for parotid gland tumors. However, complications may include a prominent facial scar or infra-auricular depressed deformity, Frey's syndrome, first bite syndrome, or other facial pain, numbness, and paralysis. Acellular dermal matrix (ADM) has been widely used to prevent these complications in parotid surgery, but there have been no prospective, multi-center trials documenting its efficacy. This study evaluates the effectiveness of ADM implantation in preventing infra-auricular depressed deformity, Frey's syndrome and first bite syndrome after parotidectomy. We analyzed 51 cases of standard parotidectomy and 58 cases of parotidectomy with implantation of Megaderm™ ADM through prospective multicenter trial. Acute complications including infection, seroma, hematoma, skin necrosis, and acute parotid area pain were evaluated 1 week postoperatively. Clinician grading of Frey's syndrome and blinded clinician evaluation of infra-auricular depressed deformities were conducted at 3, 6, and 12 months. Patients evaluated subjective satisfaction with neck appearance, Frey's syndrome quality, and acute parotid area pain at 3, 6, and 12 months. There was a higher incidence of seroma in the Megaderm™ group than in the control group at week 1. The incidence and total clinician-evaluated Frey's syndrome scores were significantly lower in the Megaderm™ group than in the control group at 3, 6, and 12 months. Both the objective and subjective evaluations of the facial contour showed a better outcome in the Megaderm™ group compared to the control group at 3, 6, and 12 months. There were no significant differences between the groups in the patient-reported Frey's syndrome quality scores at 3, 6, and 12 months, but the Megaderm™ group reported significantly less acute pain than the control group. ADM implantation can effectively reduce the occurrence of Frey's syndrome, infra-auricular depressed deformity, and first bite syndrome after parotidectomy. ADM may be especially advantageous in complex parotidectomy cases when significant complications are expected.

Pediatric parotid gland tumors: Evaluation of 33 cases

Aim: Diagnosis and treatment of parotid gland tumors is a problem for clinicians and pathologists because these tumors are rare in children. We aimed to contribute to the literature by retrospectively evaluating 33 patients that we operated for a parotid tumor in our clinic.Materials and Methods: Thirty-three pediatric patients operated from parotid gland tumor in the otolaryngology department between 2000-2019 were included in the study. All patients in the study were under the age of 18. Clinicopathologic data of pediatric parotid gland tumors were reviewed including age, sex, results of histopathologic tumor examination and surgical procedures.Results: Patient group consists of 25 (76%) males and 8 females (24%). The age range of the patients is between 1-18 and the average age is 10,6. Benign tumors were observed in 28 patients (85%) and malignant tumors in 5 patients (15%). The most common benign parotid gland tumor was Pleomorphic Adenoma. Among malignant tumors, adenoid cystic carcinoma was observed in 2 patients, mucoepidermoid carcinoma in 2 patients, and acinic cell tumor in 1 patient.Conclusions: Parotid gland tumors are rare in the pediatric age group, so it is difficult to manage. It should be aimed to apply the appropriate treatment in which every patient has the least risk of complications. Studies with much more patients about pediatric parotid tumors need to be done to further contribute to the literature.

Extracapsular dissection in the parapharyngeal space: benefits and potential pitfalls

The aim of this study was to investigate the benefits and potential pitfalls of transcervical extracapsular dissection in the treatment of parotid gland tumours in the parapharyngeal space. We retrospectively evaluated the records of all patients with parapharyngeal parotid gland lesions treated between 2000 and 2015 by transcervical extracapsular dissection. Patients having revision operations and patients whose records were not complete were excluded, leaving 49 patients in the study. We found acceptable oncological and functional outcomes throughout. Special attention should be paid in cases with multilobular growth of the tumour on magnetic resonance imaging, satellite tumours of pleomorphic adenomas, tumours in broad contact with the inner surface of the deep lobe, and lesions suspected of malignancy. Extracapsular dissection in the parapharyngeal region is associated with acceptable oncological and functional outcomes. These outcomes can be expected only after a thorough assessment of patient’s history and preoperative imaging.

The sternocleidomastoid muscle flap for the prevention of Frey syndrome and cosmetic deformity following parotidectomy: A systematic review and meta-analysis

Approximately 34–86% of neoplasms of the salivary glands are located in the parotid gland and parotidectomy is the first-line treatment for parotid gland tumors. Frey syndrome and cosmetic deformity are common complications experienced by patients following parotidectomy and the sternocleidomastoid muscle flap (SCMF) is used to prevent them. Numerous studies have been performed to examine the effectiveness of the SCMF for the prevention of cosmetic deformity and Frey syndrome, however, they provide contradictory results and possess small sample sizes with consequently low statistical power. In order to evaluate the effectiveness of the SCMF for the prevention of Frey syndrome and cosmetic deformity following parotidectomy, we performed a systematic review and meta-analysis based on published randomized controlled trials (RCTs), which were identified using PubMed and CNKI databases, and references of studies up to August 2012 were included. Using these criteria, we yielded 11 RCTs. Following an independent assessment of the methodological quality of these studies and the extraction of data, a systematic review and meta-analysis was conducted. The results of the meta-analysis demonstrated that there was a significant trend towards a lower risk of objective incidence [67%; risk ratio (RR), 0.33; 95% confidence interval (CI), 0.16–0.67; P<0.01] and subjective incidence (66%; RR, 0.34; 95% CI, 0.16–0.75; P= 0.01) of Frey syndrome in the SCMF group. The sensitivity analysis also indicated that this result was significant. Due to the considerable variation between the included studies, a meta-analysis was not applicable to assess cosmetic deformity. Two RCTs demonstrated that the difference between the SCMF and no SCMF group was not statistically significant, while the other seven RCTs detected a statistically significant difference between the two groups. Publication bias was detected. In conclusion, based on currently available evidence, the use of the SCMF is benefical for the prevention of Frey syndrome, however, whether it is also benefical for cosmetic deformity remains inconclusive.

Guzy ślinianek przyusznych w materiale Kliniki Otolaryngologii WIM w latach 2004–2008

The parotid gland is the place where benign and malignant tumours may occur. They mostly grow in larger parotid glands. The aim of this work is to analyze operative treatment of parotid gland tumours performed in the years 2004-2008. Between 2004-2008, 128 patients underwent surgical procedure caused by parotid gland tumour, including 72 women (56%) and 56 men (44%) aged between 12-80 (the average age was 49.1); the procedures were performed in the Otolaryngology Department of the Medical Military Institute. The initial diagnosis was based on history and physical examination as well as additional examinations including standard ultrasound examination and BAC. The extent of operative treatment was based on medical examination, results of additional examinations and, finally, in special cases, on intraoperative histopathological examination. Our material includes benign tumours diagnosed in 113 patients (88.3%) and malignant ones in 15 patients (11.7%). The most frequent parotid gland tumour is polymorphic adenoma (50%), the second most frequent one is lympho-adenoma (33.6%). The results of fine-needle aspiration biopsy were confirmed in histopathological examination conducted on 101 patients (79%). It was discovered that parotid gland tumours were predominantly benign tumours. The most frequent type of parotid gland tumour was the polymorphic adenoma. The operative method was selected depending on the clinical picture supplemented by the results of additional examinations: BAC, ultrasound examination, computer tomography, MRI. In the event of suspected malignant parotid gland tumour, it is necessary to conduct intraoperative histopathological examination.

SU-FF-T-122: Comparison of Helical Tomotherapy to SMLC IMRT for Treatment of Parotid Gland Tumors

Purpose: To investigate the quality of helical tomotherapy intensity modulated radiotherapy treatment plans for parotid gland tumors by comparing them to step-and-shoot MLC (SMLC) IMRT plans Method and Materials: Helical tomotherapy (TomoTherapy Hi⋅Art System) plans were generated for five patients previously planned using Pinnacle3 and treated using SMLC IMRT with bolus. One primary and two elective planning target volumes (PTVs) and anatomic structures that had been outlined in Pinnacle3 were imported into Hi⋅Art. Hi⋅Art plans were generated without bolus. Doses from the Hi⋅Art plans were transferred to Pinnacle3 for analysis and plan comparisons. All dose-volume histogram (DVH) calculations were done in Pinnacle3. PTV doses were compared using cumulative DVH, conformity index (CI), and tumor control probability (TCP). Doses to the critical structures were compared using maximum dose, mean dose, and normal tissue complication probability (NTCP). Results: PTV doses were generally higher for the Hi⋅Art plans. Hi⋅Art plans also had steeper dose gradients at the edges of PTVs, leading to greater minimum doses. In addition, the maximum target doses were generally smaller, suggesting greater PTV dose homogeneity for the Hi⋅Art plans. The conformity index was generally higher for the Hi⋅Art plans. TCPs were 100% for both techniques, except for one case. Hi⋅Art surface doses without bolus were comparable to SMLC IMRT ones with bolus. Mean contralateral parotid dose was lower for all of the Hi⋅Art plans, substantially so in three of the cases. Doses to eyes, optic nerve, and spinal cord were similar or lower for Hi⋅Art plans. Similar or decreased NTCPs were found for all the OARs. Conclusion: Hi⋅Art plans generally gave higher and more uniform target doses. Both SMLC IMRT and Hi⋅Art plans were excellent for sparing critical structures, except for the contralateral parotid, where Hi⋅Art plans were better. Supported in part by a research agreement with TomoTherapy, Inc.

Treatment of parotid gland tumours by conservative parotidectomy.

Etude retrospective de 118 observations. Les tumeurs parotidiennes meme de petite taille peuvent etre malignes et le traitement conservateur (parotidectomie superficielle ou enucleation) ne garantit pas la prevention des recidives

Management of the Recurrent, Benign Tumor of the Parotid Gland

On occasion, the salivary gland surgeon is faced with clinical management questions related to the treatment of parotid gland tumors. Some of these are intraoperative and include margin of resection, management of the facial nerve when tumor abuts its branches, judicious use of lymphadenectomy, and the appropriateness of nerve grafting. Other questions concern postoperative care-such as the use of radiation therapy, reoperation when a malignancy is reported after surgery, timing of follow-up, and management of a recurrent, benign tumor. Although all of these issues cannot be addressed in one review article, the author has attempted to offer a rational approach to one of the most perplexing-the recurrent, benign tumor. The recommendations offered are based on the literature and a clinical experience of two decades of salivary gland surgery. Within this review a number of other management issues noted above are also addressed.

Parotid Gland Tumors: A Comparison of Postoperative Radiotherapy Techniques Using Three Dimensional (3D) Dose Distributions and Dose-Volume Histograms (DVHs)

Purpose: To compare different treatment techniques for unilateral treatment of parotid gland tumors. Methods and Materials: The CT-scans of a representative parotid patient were used. The field size was 9 × 11 cm, the separation was 15.5 cm, and the prescription depth was 4.5 cm. Using 3D dose distributions, tissue inhomogeneity corrections, scatter integration (for photons) and pencil beam (for electrons) algorithms and dose-volume histogram (DVH), nine treatment techniques were compared. [1] unilateral 6 MV photons [2] unilateral 12 MeV electrons [3] unilateral 16 MeV electrons [4] an ipsilateral wedge pair technique using 6 MV photons [5] a 3-field AP (wedged), PA (wedged) and lateral portal technique using 6 MV photons [6] a mixed beam technique using 6 MV photons and 12 MeV electrons (1:4 weighting) [7] a mixed beam technique using 6 MV photons and 16 MeV electrons (1:4 weighting) [8] a mixed beam technique using 18 MV photons and 20 MeV electrons (2:3 weighting) [9] a mixed beam technique using 18 MV photons and 20 MeV electrons (1:1 weighting). Results: Using dose-volume histograms to evaluate the dose to the contralateral parotid gland, the percentage of contralateral parotid volume receiving ≥ 30% of the prescribed dose was 100% for techniques [1], [8] and [9], and < 5% for techniques [2] through [7]. Evaluating the “hottest” 5 cc of the ipsilateral mandible and temporal lobes, the hot spots were: 152% and 150% for technique [2], 132% and 130% for technique [6]. Comparing the exit doses, techniques [1], [8] and [9] contributed to ≥ 50% of the prescribed dose to the contralateral mandible and the temporal lobes. Only techniques [2] and [6] kept the highest point doses to both the brain stem and the spinal cord below 50% of the prescribed dose. Conclusion: The single photon lateral field [1] and the mixed electron-photon beams [8] and [9] are not recommended treatment techniques for unilateral parotid irradiation because of high doses delivered to the contralateral parotid gland and high exit doses which are associated with Xerostomia. The en face electron beam technique [2] and the mixed electron-photon beam technique [6] are unacceptable due to the excessive dose heterogeneity to the contiguous normal structures. In spite of optimal dose fall-off achieved using the en face technique [3], most patients cannot tolerate the resulting high skin doses. We conclude that the ipsilateral wedge pair [4], the 3-field [5], and the mixed electron-photon beam [7] techniques are optimal techniques in providing relatively homogeneous dose distributions within the target area and for minimizing dose to the relevant normal structures.

Dosimetric control of conformal treatment of parotid gland tumours

The purpose of this study was to determine the dosimetric accuracy of the treatment of parotid gland tumours using 8 MV X-ray beams. These tumours are generally situated near the patient's skin. Entrance in vivo dose measurements with diodes were obtained for 20 patients during 5 sessions per patient, in the anterior-oblique and posterior-oblique wedged fields, on the central beam axis as well as in points situated in a cranial plane 2 or 3 cm off- axis. Phantom measurements were performed in order to determine the actual position of the 95% isodose surface. The measurements were compared with calculations performed with our three-dimensional treatment planning system. The reproducibility of the diode measurements on patients was found to be 1.4% (1 SD). The total accuracy in the entrance dose determination for the average of 2 measurements was 1.8% (1 SD). The central axis entrance dose for the anterior field was on average 1.5% ± 3.2% (1 SD) higher than the calculated value. For the posterior field, the difference was 0.9% ± 3.1% (1 SD). The deviations for the off-axis points were somewhat smaller, mainly due to overestimation of the block effect in the calculations. The value of the dose at the isocentre, obtained by extrapolation of the measured entrance dose values, differed 0.3% ± 2.1% from the calculations. The accuracy in dose determination at the isocentre was 2% (1 SD). After correction for the difference in prescribed and actual source-to-skin distance, the results showed good agreement with phantom measurements on a polystyrene phantom without inhomogeneities, performed both with diodes and an ionization chamber. The measured 95% isodose surface was situated 10.6 mm under the phantom surface, which meant a shift of 0.5 mm towards the surface compared with calculations. A 1–1.5 mm shift towards the block edges was observed. These results formed the basis of a dosimetric quality assurance protocol. The entrance dose on the central beam axis is measured twice at the beginning of the treatment. The total dose at the isocentre is calculated using the percentage depth dose values. If the difference between the average measured and calculated dose at the isocentre is larger than 4% (2 SD of the measurement accuracy at the isocentre), the reason for the discrepancy will be investigated and, if necessary, the number of monitor units will be adjusted.

Facial nerve grafting in treatment of parotid gland tumors; new technique.

Tumors of the parotid gland have been of particular interest to the clinician and the pathologist for the past 100 years. Their varied cellular arrangements have made their complete pathological classification a perplexing one. In the past, this situation was exaggerated by lack of an adequate correlation between the pathological classification and the appropriate therapy, thus causing the end-result analysis of the curative efforts directed against these tumors to be, in many instances, confusing. Recent efforts to clarify the microscopic classification of these tumors have been noteworthy. These classifications serve to emphasize the importance of the segregation of the various tumors of the parotid gland into their specific, microscopic categories, thus permitting the clinician to establish not only a more thorough and effective method of treatment, but a more accurate prognosis. Tumors of the parotid gland are divided into benign and malignant groups. Benign tumors of the parotid gland consist