Is the surgical treatment of benign tumors of the parotid gland possible without dissection of the facial nerve?

ntroduction: Salivary tumors represent a heterogeneous group of tumors of diverse location, histological structure and bio logical behavior. The purpose of this study was a retrospective evaluation of surgical treatment of a group of patients with newly dia gnosed benign tumors of the parotid salivary gland operated in the years 2014–2018 at the ENT department of Hospital České Budějovice, a.s. Material and methods: A type of surgery, defi nitive histology, postoperative complications and a number of recurrences were monitored. The data were evaluated by descriptive statistical methods. Results: A total of 190 surgeries with benign histological fi ndings in 182 patients were performed. The most common benign result was Warthin‘s tumor (90 cases, 47.4%), followed by pleomorphic adenoma (66 cases, 34.7%). Uncommon histological types of tumors were dia gnosed in 14 patients (7.4%). Non-tumorous fi ndings were found in 20 cases (10.5%). The most frequently performed procedure in 84 cases (44.2%) was extracapsular extirpation. Transient lesion in the area of innervation of the temporofacial and / or cervicofacial branch of the facial nerve was present in 34 (17.9%) patients. Permanent paresis of some of the branches of the facial nerve was reported in 2 (1.1%) patients. In 12 patients, the postoperative course was complicated by the development of salivary fi stula (6.3%). Pleomorphic adenoma relapsed after extracapsular extirpation in 5 cases (20.0%). After partial parotidectomy, one recurrence of pleomorphic adenoma (3.6%) was recorded. Warthin‘s tumor relapsed after simple extirpation in 4 cases (20.0%). Conclusion: Our evaluation results of the surgical treatment of benign parotid gland tumors lead us to make further eff orts improve the care of our patients. We see reserves mainly in the routine use of ultrasonographic examination with performance FNAC and thus planning a safe and suffi ciently radical operational solution. Keywords: parotid gland – pleomorphic adenoma – Warthin‘s tumor – parotidectomy – recurrence – facial nerve paresis – FNAC

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Surgical Treatment Outcome of Salivary Gland Tumors

Journal of Baghdad College of Dentistry ◽

10.26477/jbcd.v31i3.2698 ◽

2019 ◽

Vol 31 (3) ◽

pp. 34-38

Author(s):

Nibrass J. Kadhim ◽

Salwan Y. Bede

Keyword(s):

Salivary Gland ◽

Surgical Treatment ◽

Postoperative Complications ◽

Parotid Gland ◽

Facial Nerve ◽

Malignant Tumors ◽

Surgical Excision ◽

Salivary Gland Tumors ◽

Benign Tumors ◽

Common Complication

Background: Salivary gland neoplasms constitute a group of heterogeneous lesions with complex clinicopathologic characteristics and distinct biological behavior. Numerous studies have suggested geographical variation, therefore the aims of this study were to analyze the characteristics of salivary gland neoplasms in two Iraqi centers and to analyze the postoperative complications that are encountered after surgical treatment of these tumors. Materials and Methods: A retrospective study of the patients who were treated for major and minor epithelial salivary gland tumors was conducted. The analyzed data included; demographic information (age and gender), the site of the tumor, the clinical manifestations, the histological type of the tumor, the type of the treatment and the postoperative complications. Results: Fifty seven patients were included in this study. The parotid gland was involved in most patients (n=37, 64.9%). Thirty five patients (61.4%) had benign tumors while 22 patients (38.6%) had malignant tumors. The mean age of patients with malignant tumors was 52.05 (±17.3) while of patients diagnosed with benign tumors was 41.6 (±11.4) years, the difference was statistically significant (p= 0.008). Surgical treatment consisted of superficial parotidectomy, total parotidectomy, surgical excision of the submandibular gland, surgical excision of minor salivary glands and maxillectomy. The most common complication was weakness of one or multiple branches of the facial nerve, complications were significantly associated with patients’ age, whereas gender and type of tumor whether benign or malignant did not affect the complication rate Conclusions: benign salivary gland tumors are more common than malignant tumors with no gender predilection and that patients who are diagnosed with malignant tumors are significantly older that patients with benign tumors, parotid gland is the most commonly affected gland with pleomorphic adenoma as the most frequent diagnosis. Facial nerve dysfunction was the most common complication and the complication rate was significantly associated with the age of patients.

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Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management

Case Reports in Otolaryngology ◽

10.1155/2016/3939685 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Murat Damar ◽

Aykut Erdem Dinç ◽

Sultan Şevik Eliçora ◽

Sultan Bişkin ◽

Gül Erten ◽

...

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Benign Tumors ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Seventh Cranial Nerve ◽

Peripheral Facial Nerve Palsy ◽

Painless Mass ◽

Facial Nerve Schwannoma ◽

Left Parotid Gland

Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature.

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Artificial Neural Network as a Tool to Predict Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors

Medical Sciences ◽

10.3390/medsci8040042 ◽

2020 ◽

Vol 8 (4) ◽

pp. 42

Author(s):

Carlos M Chiesa-Estomba ◽

Jon A Sistiaga-Suarez ◽

José Ángel González-García ◽

Ekhiñe Larruscain ◽

Giovanni Cammaroto ◽

...

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Prediction Models ◽

Facial Nerve Palsy ◽

Benign Tumors ◽

Proof Of Concept ◽

Nerve Monitoring ◽

Facial Nerve Monitoring ◽

Artificial Neural ◽

And Performance

(1) Background: Despite the increasing use of intraoperative facial nerve monitoring during parotid gland surgery or the improvement in the preoperative radiological assessment, facial nerve injury (FNI) continues to be the most feared complication; (2) Methods: patients who underwent parotid gland surgery for benign tumors between June 2010 and June 2019 were included in this study aiming to make a proof of concept about the reliability of an artificial neural networks (AAN) algorithm for prediction of FNI and compared with a multivariate linear regression (MLR); (3) Results: Concerning prediction accuracy and performance, the ANN achieved the highest sensitivity (86.53% vs 46.23%), specificity (95.67% vs 92.59%), PPV (87.28% vs 66.94%), NPV (95.68% vs 83.37%), ROC–AUC (0.960 vs 0.769) and accuracy (93.42 vs 80.42) than MLR; and (4) Conclusions: ANN prediction models can be useful for otolaryngologists—head and neck surgeons—and patients to provide evidence-based predictions about the risk of FNI. As an advantage, the possibility to develop a calculator using clinical, radiological and histological or cytological information can improve our ability to generate patients counselling before surgery.

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Congenital facial nerve agenesis

The Journal of Laryngology & Otology ◽

10.1258/0022215011906795 ◽

2001 ◽

Vol 115 (1) ◽

pp. 53-54 ◽

Cited By ~ 6

Author(s):

P. N. Jervis ◽

P. D. Bull

Keyword(s):

Surgical Treatment ◽

Parotid Gland ◽

Facial Nerve ◽

Facial Paralysis ◽

Facial Palsy ◽

Surgical Procedure ◽

Nerve Function ◽

Facial Nerve Function ◽

Stylomastoid Foramen ◽

Unrelated Condition

We present a case of a seven-year-old child with a congenital facial palsy, diagnosed at birth, who subsequently developed a non-tuberculous mycobacterial (NTM) infection of the ipsilateral parotid gland. This required parotid exploration to treat the NTM disease with the intention of identifying and protecting the facial nerve to preserve any residual facial nerve function. At operation, thorough exploration revealed the complete absence of the nerve both at the stylomastoid foramen and more peripherally within the substance of the parotid gland. Exploration of the facial nerve for congenital facial paralysis is not normally indicated. Surgical treatment, if required, tends to involve the use of techniques such as cross facial nerve and free vascularized muscle grafting. To our knowledge this is the first reported case of complete congenital facial nerve agenesis, diagnosed incidentally during a surgical procedure for an unrelated condition.

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Machine Learning Models for Predicting Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors

Journal of Surgical Research ◽

10.1016/j.jss.2020.12.053 ◽

2021 ◽

Vol 262 ◽

pp. 57-64

Author(s):

Carlos Miguel Chiesa-Estomba ◽

Oier Echaniz ◽

Jon Alexander Sistiaga Suarez ◽

Jose Angel González-García ◽

Ekhiñe Larruscain ◽

...

Keyword(s):

Machine Learning ◽

Parotid Gland ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Benign Tumors ◽

Learning Models ◽

Machine Learning Models

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Oncocytoma of the Parotid Gland with Facial Nerve Paralysis

Case Reports in Otolaryngology ◽

10.1155/2018/7687951 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Seijiro Hamada ◽

Keishi Fujiwara ◽

Hiromitsu Hatakeyama ◽

Akihiro Homma

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Malignant Tumor ◽

Case Reports ◽

Benign Tumors ◽

Facial Nerve Paralysis ◽

Gland Tumor ◽

Nerve Paralysis ◽

Parotid Gland Tumor

Parotid gland tumor with facial nerve paralysis is strongly suggestive of a malignant tumor. However, several case reports have documented benign tumors of the parotid gland with facial nerve paralysis. Here, we report a case of oncocytoma of the parotid gland with facial nerve paralysis. A 61-year-old male presented with pain in his right parotid gland. Physical examination demonstrated the presence of a right parotid gland tumor and ipsilateral facial nerve paralysis of House–Brackmann (HB) grade III. Due to the facial nerve paralysis, a malignant tumor of the parotid gland was suspected and right parotidectomy was performed. Oncocytoma was confirmed histopathologically. The facial nerve paralysis was resolved 2 months after surgery. During the follow-up period (one and a half years), no recurrence was observed. As the tumor showed a distinctive dumbbell shape and increased somewhat due to inflammation (i.e., infection), the facial nerve was pinched by the enlarged tumor. Ischemia and strangulation of the nerve were considered to be the cause of the facial nerve paralysis associated with the benign tumor in this case.

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Retrograde Facial Nerve Dissection Using Zygomatic Branch as Landmark in Parotid Gland Surgery for Pleomorphic Adenoma: A 4 Year Prospective Study of 40 Cases

Annals of International medical and Dental Research ◽

10.21276/aimdr.2018.4.3.sg5 ◽

2018 ◽

Vol 4 (3) ◽

Author(s):

Jayanth Kumar Biswal ◽

Jino Sebastian

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Prospective Study ◽

Pleomorphic Adenoma

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Facial Nerve Schwannoma: The Rare/Great Mimicker of Vestibular Schwannoma/Neuroma

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1734356 ◽

2021 ◽

Author(s):

Deepthi Pathapati ◽

Kiran Barla ◽

Monal Dayal ◽

Rajitha Gati ◽

Praveen Kumar Lakota

Keyword(s):

Facial Nerve ◽

Schwann Cells ◽

Benign Tumors ◽

Facial Weakness ◽

Vestibulocochlear Nerve ◽

Seventh Nerve ◽

Clinical Presentations ◽

Topographical Anatomy ◽

Facial Nerve Schwannoma ◽

Early Surgical Intervention

AbstractSchwannomas are benign tumors arising from Schwann cells which are a protective casing of nerves, composing myelin sheath and can develop in any nerve where Schwann cells are present. Most common are vestibulocochlear nerve schwannomas. Facial nerve schwannomas (FNSs) are uncommon tumors involving seventh nerve of which geniculate ganglion involvement is most common. Clinical presentations and the imaging appearances of FNSs are influenced by the topographical anatomy of the facial nerve and vary according to the segments involved. We report a case of 73-year-old man presenting with right side facial weakness of lower motor neuron type involvement. Computed tomography and magnetic resonance imaging are clinching the diagnosis. An early diagnosis is important in containing the disease facilitating early surgical intervention.

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The diagnostic value of Superb Microvascular Imaging in identifying benign tumors of parotid gland

BMC Medical Imaging ◽

10.1186/s12880-020-00506-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lihui Zhao ◽

Yiran Mao ◽

Jie Mu ◽

Jing Zhao ◽

Fangxuan Li ◽

...

Keyword(s):

Differential Diagnosis ◽

Parotid Gland ◽

Color Doppler ◽

Benign Tumors ◽

Color Doppler Flow Imaging ◽

Cell Adenoma ◽

Mixed Distribution ◽

Superb Microvascular Imaging ◽

Grade 3 ◽

Microvascular Imaging

Abstract Background We compared the ultrasound features, superb microvascular imaging (SMI) and micro vessel density (MVD) of pleomorphic adenoma (PA), Warthin’s tumor (WT) and basal cell adenoma (BCA) to explore the clinic value of SMI in differential diagnosis of benign tumors of parotid gland. Methods The vascular distributions and grade by color doppler flow imaging (CDFI) and SMI, as well as vascular index (VI) of 249 parotid gland masses from 217 patients were analyzed. Results The internal echogenicity of BCA are more homogeneous in comparing with WT and PA(P < 0.05). By SMI, the vascular distribution and vascular grade in PA were mainly peripheral (33.1%) and avascular (25.7%), Grade 1 (27.8%) and Grade 0 (25.7%). WT were mainly central (31.3%) and mixed distribution (34.9%), in Grade 3 (37.3%) and Grade 2 (36.2%). BCA was mainly peripheral (33.3%) and mixed distribution (33.3%), in Grade 2 (33.3%) and Grade 3 (33.3%). The overall detection rate of SMI for vascular Grade 2 and 3 was significantly higher than that of CDFI (P < 0.05). Both VI and MVD were lowest in PA, highest in WT (P < 0.001). The VI by SMI was correlated with MVD (P < 0.001). The correlation index between vascular distribution and grade by SMI and MVD were significantly higher than CDFI. Conclusion SMI can provide low-velocity blood flow information, which is helpful for the differential diagnosis of common benign tumors of parotid gland, and is expected to be more widely used.

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