Ultrasound-guided ethanol sclerotherapy for multifocal unilateral Warthin’s tumor after partial parotidectomy

Introduction Warthin’s tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for Warthin’s tumor is parotidectomy. However, surgical resection has the risk of complications including facial nerve weakness and Frey’s syndrome. Recently, ultrasound-guided ethanol sclerotherapy (UGES) has been found to be efficacious in the treatment of a variety of head and neck lesions. Case report We present a patient with multifocal Warthin’s tumor who was managed with partial parotidectomy and two cycles of ultrasound-guided ethanol sclerotherapy. Discussion Ethanol sclerotherapy has been used as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. To our knowledge, this is the first case presented in the literature where sclerotherapy was used in conjunction with a partial parotidectomy. Minimizing the extent of surgical resection can reduce the risk of facial nerve weakness and Frey’s syndrome and negate the need for fat grafting for defect reconstruction. Conclusion UGES may serve as a safe and reliable procedure that can be performed in conjunction with partial parotidectomy for patients who wish to achieve definitive diagnosis while also minimizing the risk of complications associated with extensive parotidectomy.

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Ultrasound-guided ethanol sclerotherapy for non-surgical treatment of Warthin's tumor

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2020.102813 ◽

2021 ◽

Vol 42 (1) ◽

pp. 102813

Author(s):

Ishwarya S. Mamidi ◽

Esther Lee ◽

Daniel A. Benito ◽

Lilun Li ◽

Joseph F. Goodman ◽

...

Keyword(s):

Surgical Treatment ◽

Warthin’S Tumor ◽

Ultrasound Guided ◽

Ethanol Sclerotherapy ◽

Warthin's Tumor ◽

Non Surgical Treatment

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Surgical treatment of benign parotid gland tumors in the years 2014–2018 at the ENT department of Hospital České Budějovice, a.s.

Otorinolaryngologie a foniatrie ◽

10.48095/ccorl202182 ◽

2021 ◽

Vol 70 (2) ◽

pp. 82-88

Author(s):

Hana Zapletalová ◽

Martin Kuchař ◽

Lubor Mrzena

Keyword(s):

Surgical Treatment ◽

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Benign Tumors ◽

Histological Structure ◽

Warthin’S Tumor ◽

Parotid Gland Tumors ◽

Warthin's Tumor ◽

Keywords Parotid Gland

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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Warthin's tumor with necrotizing tuberculous granulomatous inflammation causing severe facial nerve adhesion in parotid gland

Medicine ◽

10.1097/md.0000000000018763 ◽

2020 ◽

Vol 99 (7) ◽

pp. e18763

Author(s):

Shih-Lung Chen ◽

Cheng-Cheng Hwang ◽

Yu-Chih Liu ◽

Wei-Ting Chen ◽

Shih-Wei Yang

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Granulomatous Inflammation ◽

Warthin’S Tumor ◽

Warthin's Tumor

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Minimally Invasive Surgery for Parotid Pleomorphic Adenoma

Ear Nose & Throat Journal ◽

10.1177/014556130508400517 ◽

2005 ◽

Vol 84 (5) ◽

pp. 308-311 ◽

Cited By ~ 33

Author(s):

Robert L. Witt

Keyword(s):

Facial Nerve ◽

Pleomorphic Adenoma ◽

Operating Time ◽

Frey’S Syndrome ◽

Superficial Parotidectomy ◽

Facial Contour ◽

Great Auricular Nerve ◽

Objective Reduction ◽

Frey's Syndrome ◽

Nerve Dysfunction

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve—defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve—is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved. To test this hypothesis, the author conducted a retrospective study of 30 patients—15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms of morbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.

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Facial Nerve Palsy Associated With Warthin's Tumor

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1985.00800100096016 ◽

1985 ◽

Vol 111 (8) ◽

pp. 548-549 ◽

Cited By ~ 21

Author(s):

R. W. Lesser ◽

J. G. Spector

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Warthin’S Tumor ◽

Warthin's Tumor

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Local Excision Procedure for Warthin's Tumor of the Parotid Gland

Otolaryngology ◽

10.1016/j.otohns.2004.09.071 ◽

2005 ◽

Vol 132 (4) ◽

pp. 577-580 ◽

Cited By ~ 20

Author(s):

Hiroshi Iwai ◽

Toshio Yamashita

Keyword(s):

Facial Nerve ◽

Local Excision ◽

Operation Time ◽

Warthin’S Tumor ◽

Parotid Tumors ◽

Significant Difference ◽

Warthin's Tumor ◽

Group A ◽

Surgical Field ◽

Group B

The aim of this work is to establish a local excision procedure (LEP) and indications of this procedure for Warthin's tumor. Seventy-three patients (82 sides) with Warthin's tumor were studied. Point I was located 1 cm from the intertragal notch in the direction indicated by the notch. Point S was located 5 mm superior to the inferior end of the mandibular angle. The trunk of the facial nerve and the marginal mandibular branch run at the points I and S, respectively. In surgical maneuvers below the I-S line, the marginal mandibular and colli branches may exist within the surgical field, but the trunk and other peripheral branches of the facial nerve will not be encountered. For Warthin's tumor estimated to be below the I-S line (Group A), LEP was used, involving resection of the tumor after locating and dissecting the marginal mandibular and colli branches. For tumors not meeting these criteria (Group B), partial superficial parotidectomy was performed. Results indicated that mean volume of hemorrhage was significantly smaller, and that mean operation time was significantly shorter in Group A than in Group B. Conversely, no significant difference in tumor size or incidence of postoperative facial paresis was identified between the 2 groups. Recurrence has not yet been noted in either group. In conclusion, LEP is useful for Warthin's tumor below the I-S line. This procedure seems applicable not only to Warthin's tumors, but also to other benign parotid tumors in the surgical field below the I-S line, such as pleomorphic adenoma and lymphoepithelial cyst.

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Nonsurgical Treatment of Aggressive Fibromatosis in the Head and Neck

Otolaryngology ◽

10.1177/019459988910100307 ◽

1989 ◽

Vol 101 (3) ◽

pp. 338-343 ◽

Cited By ~ 28

Author(s):

Charles B. West ◽

Frank W. Shagets ◽

Michael J. Mansfield

Keyword(s):

Radiation Therapy ◽

Head And Neck ◽

Surgical Resection ◽

Aggressive Fibromatosis ◽

Wide Field ◽

Incisional Biopsy ◽

Anterior Maxilla ◽

Therapeutic Modalities ◽

First Case ◽

Extensive Lesion

Aggressive fibromatosis is a poorly defined, locally aggressive, yet histologically benign fibroblastic proliferative lesion that may occur in the head and neck. The lesion is highly cellular and locally infiltrative and has a propensity to invade and erode bone, compromising vital structures within the head and neck. However, it is not a true malignancy because it does not have malignant cytologic characteristics nor does it metastasize. We present two cases of aggressive fibromatosis occurring in young adult men. The first case involved a rapidly enlarging mass of the anterior maxilla that involved the upper lip, nasal alae, nasal septum, inferior turbinates, and hard palate. The patient underwent incisional biopsy to confirm the diagnosis. Because of difficulty in determining the actual margins of this extensive lesion and the significant morbidity that would have resulted from surgical resection, we elected to treat this patient with chemotherapy and radiation therapy. The second case was an extensive lesion involving the right temporal bone, pterygomaxillary space, and infratemporal, temporal, and middle cranial fossae. Incisional biopsy confirmed the diagnosis. Because of the lack of functional and cosmetic deficits and the unavoidable morbidity of a surgical resection, this patient was treated with radiation therapy. Although wide field resection is the most satisfactory form of treatment, in situations in which this modality would result in unacceptable morbidity or if surgical margins are positive, then radiation therapy and chemotherapy should be considered. Support for these therapeutic modalities is found in larger series of cases outside the head and neck.

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Positron emission tomography in Warthin’s tumor mimicking malignancy impacts the evaluation of head and neck patients

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2014.11.008 ◽

2015 ◽

Vol 36 (2) ◽

pp. 259-263 ◽

Cited By ~ 8

Author(s):

Christopher H. Rassekh ◽

Jamey L. Cost ◽

Jeffery P. Hogg ◽

Mike K. Hurst ◽

Gary D. Marano ◽

...

Keyword(s):

Positron Emission Tomography ◽

Head And Neck ◽

Emission Tomography ◽

Warthin’S Tumor ◽

Positron Emission ◽

Warthin's Tumor

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Patients’ perspectives on the short- and long-term outcomes following surgery for benign parotid neoplasms

The Journal of Laryngology & Otology ◽

10.1258/002221503768199960 ◽

2003 ◽

Vol 117 (8) ◽

pp. 624-629 ◽

Cited By ~ 47

Author(s):

Andrew H. Marshall ◽

Shahed M. Quraishi ◽

Patrick J. Bradley

Keyword(s):

Facial Nerve ◽

Facial Nerve Palsy ◽

Postal Questionnaire ◽

Frey’S Syndrome ◽

Long Term Outcomes ◽

Post Operative Period ◽

Frey's Syndrome ◽

Nerve Paresis ◽

Short And Long Term

Surgery for benign parotid gland salivary neoplasms is associated with sequelae: scar and divot defect and complications, facial nerve paresis/paralysis and Frey’s syndrome. These potential sequelae and complications are discussed with all patients prior to operation. We contacted 212 patients who had undergone surgery for benign parotid disease during1988–1997, by postal questionnaire. We enquired about their perception and recollection of the information they had received pre-operatively and to document and comment upon what problems they had experienced in the early and late post-operative period. The usable return rate was 75.5 per cent (173/212). Most patients (90 per cent) were satisfied with the information theyhad received pre-operatively. The complication and/or sequelae rates for facial nerve palsy (temporary 26.3 per cent, permanent 1.9 per cent), Frey’s syndrome (12.5 per cent) and sensory deficit about the cheek and ear (30.6 per cent), are comparable to other published studies.

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