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

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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Facial nerve monitoring in giant malignant tumor ex pleomorphic adenoma of parotid gland

JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY ◽

10.5106/jjshns.27.351 ◽

2018 ◽

Vol 27 (3) ◽

pp. 351-356

Author(s):

Munehito Moriyama ◽

Takashi Hirano ◽

Keigo Fujita ◽

Masashi Suzuki

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Malignant Tumor ◽

Nerve Monitoring ◽

Facial Nerve Monitoring

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Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195591 ◽

2019 ◽

Vol 6 (1) ◽

pp. 60

Author(s):

Dheer S. Kalwaniya ◽

Goutam Kothathi Chowdegowda ◽

Monish Raj ◽

Jaspreet S. Bajwa ◽

Satya V. Arya ◽

...

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Surgical Approaches ◽

Depth Of Invasion ◽

Tumor Depth ◽

Facial Paresis ◽

Superficial Parotidectomy ◽

Parotid Surgery ◽

Nerve Paresis

Background: The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.Methods: This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system. Results: Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size <4 cm), 2 suffered facial paresis and out of 11 patients (size >4 cm), 5 suffered same. Out of 59 patients with depth of tumor <2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth >2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).Conclusions: Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.

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Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland

BMJ Case Reports ◽

10.1136/bcr-2020-238759 ◽

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.

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Recurrent Pleomorphic Adenoma of the Parotid Gland

Otolaryngology ◽

10.1016/j.otohns.2005.04.008 ◽

2005 ◽

Vol 133 (3) ◽

pp. 319-322 ◽

Cited By ~ 34

Author(s):

John P. Leonetti ◽

Sam J. Marzo ◽

Guy J. Petruzzelli ◽

Brian Herr

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Surgical Procedures ◽

Recurrent Disease ◽

Long Term Results ◽

Subtotal Petrosectomy ◽

Total Parotidectomy ◽

Recurrent Pleomorphic Adenoma

OBJECTIVES: To assess the long-term results in the management of 42 patients with recurrent pleomorphic adenoma of the parotid gland. STUDY DESIGN: A retrospective analysis of 42 patients who underwent parotidectomy for recurrent pleomorphic adenoma was performed to study presenting clinicoradiographic features, surgical technique, facial nerve management, and the long-term risk of recurrence. RESULTS: All 42 patients had multi-focal, nontender recurrent nodules following one to four prior surgical procedures and 6 patients underwent prior radiotherapy. Surgical procedures included subtotal parotidectomy in 12 patients, total parotidectomy in 18 patients, parotidectomy with facial nerve resection in 7 cases, and subtotal petrosectomy with facial nerve resection in 5 individuals. The 2 patients with malignant transformation died of disseminated lung and bone metastasis. Twenty-nine of the remaining 40 patients had no recurrent disease. Seven patients developed local parotid bed or cutaneous recurrent disease, 2 patients died of unrelated causes, and 2 patients were lost to follow-up. CONCLUSIONS: All 7 patients with recurrent disease underwent subtotal parotidectomy with “negative” surgical margins. Total parotidectomy or subtotal petrosectomy with facial nerve resection in selected cases may reduce the risk of multiple episodes of pleomorphic adenoma recurrence. Two of 42 patients were found to have carcinoma ex-pleomorphic adenoma, both of these patients underwent prior radiotherapy, and both died of metastatic disease.

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Parotid gland surgery: a retrospective review of 108 cases

The Journal of Laryngology & Otology ◽

10.1258/0022215021910762 ◽

2002 ◽

Vol 116 (4) ◽

pp. 285-287 ◽

Cited By ~ 10

Author(s):

M. Harney ◽

P. Walsh ◽

B. Conlon ◽

S. Hone ◽

C. Timon

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Metastatic Disease ◽

Retrospective Review ◽

Poor Prognosis ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Histological Diagnosis

One hundred and eight parotidectomies performed by a single consultant were reviewed. Eighty-five patients had primary parotid disease, 23 patients had extra-parotid primaries. Pleomorphic adenoma was the most common histological diagnosis. In patients with primary parotid disease, a post-operative temporary facial nerve palsy was noted in 15 patients, with a further four developing a permanent palsy. Patients with metastatic disease to the parotid had a poor prognosis.

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Recurrent benign pleomorphic adenoma of the parotid gland: Facial nerve identification and risk factors for facial nerve paralysis at re-operation

Auris Nasus Larynx ◽

10.1016/j.anl.2019.02.010 ◽

2019 ◽

Vol 46 (5) ◽

pp. 779-784 ◽

Cited By ~ 2

Author(s):

Tatsuro Kuriyama ◽

Ryo Kawata ◽

Masaaki Higashino ◽

Shuji Nishikawa ◽

Takaki Inui ◽

...

Keyword(s):

Risk Factors ◽

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Nerve Identification

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Clinicopathologic and Surgical Study of Pleomorphic Adenoma of the Parotid Gland: Analysis of Risk Factors for Recurrence and Facial Nerve Dysfunction

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2017.07.171 ◽

2018 ◽

Vol 76 (2) ◽

pp. 347-354 ◽

Cited By ~ 4

Author(s):

Carlos A. Espinosa ◽

Álvaro Fernández-Valle ◽

Paloma Lequerica-Fernández ◽

Lucas de Villalaín ◽

Juan Carlos de Vicente

Keyword(s):

Risk Factors ◽

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Risk Factors For Recurrence ◽

Nerve Dysfunction

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Recurrent Multinodular Pleomorphic Adenoma of Parotid Gland- A Case Report

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49465:14907 ◽

2021 ◽

Author(s):

Priya Kanagamuthu ◽

Swetha Thirumurthi ◽

S Rajasekaran ◽

S Prabakaran ◽

RB Namasivaya Navin

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Previous History ◽

Significant Risk ◽

Superficial Parotidectomy ◽

Parotid Region ◽

Superficial Lobe ◽

History Of ◽

The Right

Pleomorphic adenoma or benign salivary gland tumours predominantly affects the superficial lobe of parotid gland. It is a slow growing swelling with or without facial nerve involvement with female predilection in third and fifth decade of life. The origin of the tumour is both epithelial and connective tissue and hence it is of pleomorphic nature. After surgery, its recurrence rate varies considerably and seems to depend more on the surgical technique used. A 49-year-old male patient, presented with complaints of swelling in front of right ear and right parotid region for past eight years. He gave previous history of similar swelling in the right parotid region and history of previous surgery done elsewhere in 2009. Right superficial parotidectomy was done following which he was asymptomatic for two years. On examination of right parotid- a multilobulated irregular swelling was present in right parotid region and the swelling extended till the right ear lobule. The swelling hid previous surgical scar. Facial nerve was clinically intact. Fine Needle Aspiration Cytology (FNAC) was suggestive of Pleomorphic Adenoma. Magnetic Resonance Imaging (MRI) with contrast revealed that the lesions were arising from superficial lobe of the parotid gland. Right superficial parotidectomy was planned. Mass was excised and sent for histopathological examination and was reported to be Pleomorphic Adenoma. Patient is still on follow-up and no recurrence has been noted. The rate of recurrence depends on tumour spillage, intra-surgical rupture, or any histopathological feature. There is significant risk for local recurrence if the microscopic finger like formation (pseudopodia) of tumour tissue extends beyond the main mass.

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Parotid Tumour Surgery- Personal Experience of 30 Cases

TAJ Journal of Teachers Association ◽

10.3329/taj.v26i0.37590 ◽

2018 ◽

Vol 26 ◽

pp. 57-60

Author(s):

MB Islam ◽

I Ahmed ◽

MG Mortuza ◽

MA Sayeed ◽

K Khanam ◽

...

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Residual Effect ◽

Low Grade ◽

Malignant Tumours ◽

College Hospital ◽

Medical College ◽

Parotid Tumour ◽

Parotid Tumours

Parotid gland is the most common site for salivery gland neoplasm. Most of the parotid tumours are benign and are commonly pleomorphic adenoma. Parotid tumours usually present with painless slow growing lobulated masses but may be associated with pain and paresis of the facial nerve if it is malignant. However it is difficult to differentiate clinically between benign and low grade malignant tumours. We studied thirty (30) patients with parotid gland tumours during Jan/2012 to April/2016 in dept. of surgery, Rajshahi Medical College Hospital. Twenty eight (28) were pleomorphic adenoma and two (2) were mucoepidermoid carcinoma. Superficial parotidectomy done in twenty five (25) patients and total parotidectomy done in five (5) patients. In all patients facial nerve dissection and preservation were performed safely without the facilities of nerve stimulator. Two years post operative follow up was satisfactory with no residual effect. This study highlights some of the important aspects in the management of the parotid gland tumours.TAJ 2013; 26: 57-60

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