scholarly journals Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S142-S149 ◽  
Author(s):  
S Sood ◽  
M McGurk ◽  
F Vaz
Keyword(s):  
Salivary Gland ◽  
Facial Nerve ◽  
Head And Neck ◽  
Needle Aspiration ◽  
Low Grade ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Complete Excision ◽  
Salivary Gland Tumours ◽  
Parotid Tumours

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Salivary gland tumours are rare and have very wide histological heterogeneity, thus making it difficult to generate high level evidence. This paper provides recommendations on the assessment and management of patients with cancer originating from the salivary glands in the head and neck.Recommendations• Ultrasound guided fine needle aspiration cytology is recommended for all salivary tumours and cytology should be reported by an expert histopathologist. (R)• Adjuvant radiotherapy (RT) following surgery is recommended for all malignant submandibular tumours except in cases of small, low-grade tumours that have been completely excised. (R)• For benign parotid tumours complete excision of the tumour should be performed and offers good cure rates. (R)• In the event of intra-operative tumour spillage, most cases need long-term follow-up for clinical observation only. These should be raised in the multidisciplinary team to discuss the merits of adjuvant RT. (G)• As a general principle, if the facial nerve function is normal pre-operatively then every attempt to preserve facial nerve function should be made during parotidectomy and if the facial nerve is divided intra-operatively then immediate microsurgical repair (with an interposition nerve graft if required) should be considered. (G)• Neck dissection is recommended in all cases of malignant parotid tumours except for low-grade small tumours. (R)• Where malignant parotid tumours lie in close proximity to the facial nerve there should be a low threshold for adjuvant RT. (G)• Adjuvant RT should be considered in high grade or large tumours or in cases where there is incomplete or close resection margin. (R)• Adjuvant RT should be prescribed on the basis of clinical factors in addition to histology and grade, e.g. stage, pre-operative facial weakness, positive margins, peri-neural invasion and extracapsular spread. (R)

scholarly journals Review of Salivary Gland Neoplasms

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Victor Shing Howe To ◽  
Jimmy Yu Wai Chan ◽  
Raymond K. Y. Tsang ◽  
William I. Wei
Keyword(s):  
Salivary Gland ◽  
Regional Lymph Node ◽  
Postoperative Radiotherapy ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Low Grade ◽  
Malignant Tumours ◽  
Parotid Glands ◽  
Salivary Gland Tumours ◽  
Mri Scans

Salivary gland tumours most often present as painless enlarging masses. Most are located in the parotid glands and most are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but most cases will require surgical excision as a means of coming to a definitive diagnosis. Benign tumours and early low-grade malignancies can be adequately treated with surgery alone, while more advanced and high-grade tumours with regional lymph node metastasis will require postoperative radiotherapy. The role of chemotherapy remains largely palliative. This paper highlights some of the more important aspects in the management of salivary gland tumours.

scholarly journals Investigation of Salivary Gland Pathology

2017 ◽  
pp. 29
Author(s):  
M. Zulfath Nihara ◽  
K. Udhaya Chandrika ◽  
R. Vijaya Sundari ◽  
Tan Shi Yi ◽  
Maya Ramesh
Keyword(s):  
Salivary Gland ◽  
Regional Lymph Node ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Low Grade ◽  
Malignant Tumours ◽  
Parotid Glands ◽  
Salivary Gland Tumours ◽  
Mri Scans ◽  
Salivary Gland Pathology

Salivary gland pathology is diverse in nature and mainly inflammatory or neoplastic. Salivary gland tumours present as painless enlarging masses. Most of the tumours are located in parotid glands and many of them are benign. The management of these tumours is difficult just like the diagnosis of benign and malignant tumours. Fine Needle Aspiration Cytology (FNAC) and Magnetic Resonance Imaging (MRI) scans provide some useful information in diagnosis, but most of the tumours will require surgical excision as a means of coming to a definitive diagnosis. Surgical approach is adequate for benign tumours and early low grade malignancies whereas post operative radiotherapy is needed for more advanced and high grade tumours with regional lymph node metastasis. The role of chemotherapy remains largely palliative. This article throws light on some of the more important aspects in the investigations of salivary gland pathologies.

Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland

2021 ◽  
Vol 14 (6) ◽  
pp. e238759
Author(s):  
Auric Bhattacharya ◽  
Madhumati Singh ◽  
Anjan Shah ◽  
Lynn Lilly Varghese
Keyword(s):  
Salivary Gland ◽  
Parotid Gland ◽  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Needle Aspiration ◽  
Superficial Parotidectomy ◽  
Salivary Gland Tumours ◽  
Patient Reported ◽  
The Face ◽  
Needle Aspiration Cytology

Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair’s incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.

Hearing preservation in the removal of intracanalicular acoustic neuromas via the retrosigmoid approach

1997 ◽  
Vol 86 (3) ◽  
pp. 456-461 ◽  
Author(s):  
David W. Rowed ◽  
Julian M. Nedzelski
Keyword(s):  
Facial Nerve ◽  
Binaural Hearing ◽  
Retrosigmoid Approach ◽  
Nerve Function ◽  
Success Rates ◽  
Facial Nerve Function ◽  
Complete Excision ◽  
Hearing Conservation ◽  
Content Type ◽  
Acoustic Neuromas

✓ In a series of 514 consecutive operations for complete excision of acoustic neuromas, 94 procedures were performed via a retrosigmoid approach to preserve the patient's hearing. Twenty-six of these procedures (5.1%) were performed in cases of intracanalicular tumor and 68 (13.2%) were for larger lesions in which most of the tumor was located medial to the porus acusticus within the cerebellopontine angle. Preservation of useful hearing was achieved in 13 (50%) of 26 patients with intracanalicular tumors and in 20 (29%) of 68 with larger tumors. A trend toward higher success rates in intracanalicular tumors appears to be present, although the difference is not statistically significant (p = 0.09). Normal or nearnormal facial function (House and Brackmann Grades I and II) was present postoperatively in 25 (96%) of 26 patients. Indications for treatment of intracanalicular acoustic neuromas are considered and treatment alternatives are reviewed. Results from other series reporting removal of intracanalicular acoustic neuromas are considered with respect to hearing conservation and postoperative facial nerve function. Surgical excision of intracanalicular acoustic neuromas in otherwise healthy patients appears to be warranted if preservation of useful binaural hearing is considered a worthwhile objective and if perioperative morbidity can be maintained at an acceptably low level. The retrosigmoid approach is familiar to all neurosurgeons and offers a comparable success rate for hearing conservation and probably a superior outcome in terms of facial nerve function when compared with the middle fossa approach.

Intraoperative facial motor evoked potential monitoring for pontine cavernous malformation resection

2020 ◽  
Vol 132 (1) ◽  
pp. 265-271
Author(s):  
Ridzky Firmansyah Hardian ◽  
Tetsuya Goto ◽  
Yu Fujii ◽  
Kohei Kanaya ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cavernous Malformation ◽  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Warning Signs ◽  
Constant Current ◽  
Karnofsky Performance Scale ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Cavernous Malformations

OBJECTIVEThe aim of this study was to predict postoperative facial nerve function during pontine cavernous malformation surgery by monitoring facial motor evoked potentials (FMEPs).METHODSFrom 2008 to 2017, 10 patients with pontine cavernous malformations underwent total resection via the trans–fourth ventricle floor approach with FMEP monitoring. House-Brackmann grades and Karnofsky Performance Scale (KPS) scores were obtained pre- and postoperatively. The surgeries were performed using one of 2 safe entry zones into the brainstem: the suprafacial triangle and infrafacial triangle approaches. Six patients underwent the suprafacial triangle approach, and 4 patients underwent the infrafacial triangle approach. A cranial peg screw electrode was used to deliver electrical stimulation for FMEP by a train of 4 or 5 pulse anodal constant current stimulation. FMEP was recorded from needle electrodes on the ipsilateral facial muscles and monitored throughout surgery by using a threshold-level stimulation method.RESULTSFMEPs were recorded and analyzed in 8 patients; they were not recorded in 2 patients who had severe preoperative facial palsy and underwent an infrafacial triangle approach. Warning signs appeared in all patients who underwent the suprafacial triangle approach. However, after temporarily stopping the procedures, FMEP findings during surgery showed recovery of the thresholds. FMEPs in patients who underwent the infrafacial triangle approach were stable during the surgery. House-Brackmann grades were unchanged postoperatively in all patients. Postoperative KPS scores improved in 3 patients, decreased in 1, and remained the same in 6 patients.CONCLUSIONSFMEPs can be used to monitor facial nerve function during surgery for pontine cavernous malformations, especially when the suprafacial triangle approach is performed.

Optimal access route for pontine cavernous malformation resection with preservation of abducens and facial nerve function

2020 ◽  
pp. 1-10
Author(s):  
Helmut Bertalanffy ◽  
Shinya Ichimura ◽  
Souvik Kar ◽  
Yoshihito Tsuji ◽  
Caiquan Huang
Keyword(s):  
Facial Nerve ◽  
Retrospective Analysis ◽  
Scale Score ◽  
Surgical Approach ◽  
Posterolateral Approach ◽  
Nerve Function ◽  
Modified Rankin Scale ◽  
Access Route ◽  
Facial Nerve Function ◽  
Patient Groups

OBJECTIVEThe aim of this study was to analyze the differences between posterolateral and posteromedial approaches to pontine cavernous malformations (PCMs) in order to verify the hypothesis that a posterolateral approach is more favorable with regard to preservation of abducens and facial nerve function.METHODSThe authors conducted a retrospective analysis of 135 consecutive patients who underwent microsurgical resection of a PCM. The vascular lesions were first classified in a blinded fashion into 4 categories according to the possible or only reasonable surgical access route. In a second step, the lesions were assessed according to which approach was performed and different patient groups and subgroups were determined. In a third step, the modified Rankin Scale score and the rates of permanent postoperative abducens and facial nerve palsies were assessed.RESULTSThe largest group in this series comprised 77 patients. Their pontine lesion was eligible for resection from either a posterolateral or posteromedial approach, in contrast to the remaining 3 patient groups in which the lesion location already had dictated a specific surgical approach. Fifty-four of these 77 individuals underwent surgery via a posterolateral approach and 23 via a posteromedial approach. When comparing these 2 patient subgroups, there was a statistically significant difference between postoperative rates of permanent abducens (3.7% vs 21.7%) and facial (1.9% vs 21.7%) nerve palsies. In the entire patient population, the abducens and facial nerve deficit rates were 5.9% and 5.2%, respectively, and the modified Rankin Scale score significantly decreased from 1.6 ± 1.1 preoperatively to 1.0 ± 1.1 at follow-up.CONCLUSIONSThe authors’ results suggest favoring a posterolateral over a posteromedial access route to PCMs in patients in whom a lesion is encountered that can be removed via either surgical approach. In the present series, the authors have found such a constellation in 57% of all patients. This retrospective analysis confirms their hypothesis in a large patient cohort. Additionally, the authors demonstrated that 4 types of PCMs can be distinguished by preoperatively evaluating whether only one reasonable or two alternative surgical approaches are available to access a specific lesion. The rates of postoperative sixth and seventh nerve palsies in this series are substantially lower than those in the majority of other published reports.

Parotid tumours

2021 ◽  
pp. 175573802110160
Author(s):  
Edward Balai ◽  
Navdeep Bhamra ◽  
Karan Jolly
Keyword(s):  
Salivary Gland ◽  
Parotid Gland ◽  
Head And Neck Neoplasms ◽  
Secondary Care ◽  
Care Management ◽  
Clinical Anatomy ◽  
Salivary Gland Tumours ◽  
The Common ◽  
Parotid Tumours ◽  
Key Aspects

Salivary gland tumours are uncommon and account for just 6% of all head and neck neoplasms. Worldwide incidence varies, from 0.4 to 13.5 cases per 100 000 population. The parotid gland is by far the most commonly affected site, accounting for 80% of cases. The vast majority of these tumours are benign; only approximately 20–25% being malignant. This article considers the relevant clinical anatomy of the parotid gland, key aspects of assessment with history and examination, and when to refer to secondary care for further investigation. It will touch on the common benign and malignant parotid neoplasms and give an overview of secondary care management.

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