Kimura Disease of the Parotid Gland: Management Approach

Here we present a 43-years old Malay man with Kimura’s disease of the right parotid gland. Asian men have a predisposition for this chronic inflammatory disorder of unknown etiology mostly presenting at the head and neck region. The management in dealing with this patient is not straight forward as the presentation mimics a subcutaneous tumor-like mass in which main differential diagnosis includes lymphoproliferative disorders and parotid neoplasm. Moreover, cytological investigation is inadequate, and this necessitates the use intra-operative frozen section prior to tumor debulking. Without proper investigation, misdiagnosis can occur and potentially expose the patient to unnecessary extensive surgical procedures. Here we discuss step by step approach in managing this patient.

Diagnostic Accuracy and Post-Procedural Complications Associated with Ultrasound-Guided Core Needle Biopsy in the Preoperative Evaluation of Parotid Tumors

Correct diagnosis of a parotid neoplasm based on histology preoperatively is of utmost importance in order to guide patient management. The aim of this study was to evaluate the diagnostic accuracy of an ultrasound-guided core needle biopsy of a parotid lesion and to describe associated post-procedural complications. A retrospective study was conducted between January 2015 and March 2021 of all patients who were referred to a tertiary care center for evaluation of a parotid lesion and who underwent core needle biopsy due to high-risk features or when malignancy was suspected on clinical examination or ultrasonography. Patient characteristics, histological findings, and post-procedural complications were recorded and evaluated. Among 890 patients referred for evaluation of a parotid lesion, in 138 patients a core needle biopsy was undertaken. On the basis of core needle biopsy findings, 11 lymphomas and 82 non-lymphoma malignancies were diagnosed in the parotid gland. The sensitivity of the core needle biopsy predicting the accurate tumor type was 97.56% (95% CI 91.47–99.70%) and the specificity 94.64% (95% CI 85.13–98.88%). The accuracy for the correct histopathological diagnosis was 93.48% (95% CI 87.98–96.97%). Post-procedural minor complications occurred in 19 patients (13.8%). In conclusion, a core needle biopsy can identify malignancy in the parotid gland with high sensitivity and specificity in a safe manner and therefore guide surgical treatment.

Case Series-An Overview of Extracapsular Dissection of Parotid Tumours

Extra Capsular Dissection (ECD) differs markedly from classic surgical approaches to the parotid neoplasm because facial nerve dissection is not performed. Factors noted to favor this approach include mobility of the tumor within the gland, a thin covering of capsule and glandular tissue, and a tumor large enough to allow digital manipulation during dissection. Imaging, fine needle aspiration cytology, and neuron-monitoring play a heightened role in ECD [1]. The AIM of this article is to report case series on surgical management of few types of parotid tumors by extra capsular dissection and to assess longterm results after the treatment of Parotid tumors using surgical technique ECD. This case series includes five different parotid tumors such as Warthin’s tumor, Pleomorphic adenoma, Sialadenoma papilliferum of parotid, chronic sialoadenitis, Parotid cystadenoma, out of 30 cases operated in our hospital. All the patients in this study received appropriate surgical treatment (ECD) and done a follow up evaluation every month. Extra capsular dissection is a safe, reliable and recommended technique to manage the small benign superficial parotid tumors if the case is selected properly.

Case series-an overview of extracapsular dissection of parotid tumours

<p>Extra capsular dissection (ECD) differs markedly from classic surgical approaches to the parotid neoplasm because facial nerve dissection is not performed. Factors noted to favor this approach include mobility of the tumor within the gland, a thin covering of capsule and glandular tissue, and a tumor large enough to allow digital manipulation during dissection. Imaging, fine needle aspiration cytology, and neuron-monitoring play a heightened role in ECD. The aim of this article is to report case series on surgical management of few types of parotid tumors by extra capsular dissection and to assess long-term results after the treatment of parotid tumors using surgical technique ECD.This case series includes five different parotid tumors such as Warthin’s tumor, Pleomorphic adenoma, Sialadenoma papilliferum of parotid, chronic sialoadenitis, parotid cystadenoma, out of 30 cases operated in our hospital. All the patients in this study received appropriate surgical treatment (ECD)<strong> </strong>and done a follow up evaluation every month.</p>

Intraparotid Facial Nerve Schwannoma Mimicking Primary Parotid Neoplasm

The following report is of a 36-year-old male who presented with a growing mass in the region of the parotid gland. Initial fine needle aspiration biopsy suggested a primary neoplasm of the parotid gland, but subsequent frozen section analysis intraoperatively demonstrated a schwannoma of the facial nerve. An intracapsular enucleation of the schwannoma was performed in order to preserve the fibers of the motor nerve.

Cervico-facial flap: a versatile option among various reconstructive options for skin defects in parotid surgery-our experience in a tertiary care center

<p class="abstract"><strong>Background:</strong> Cutaneous defects of the cheek and external ear present a reconstructive challenge. Even when free flap reconstructions and tissue transfer are commonly proposed, fewer patients with these malignancies are candidates for lengthy reconstructive surgery. The cost effectiveness, time consumption, long waiting period of head and neck malignancy patients and less availability of reconstruction teams in developing countries like India, are challenging factors.</p><p class="abstract"><strong>Methods:</strong> In our study, retrospectively 46 cases operated for parotid neoplasm were identified and the operative reports were reviewed from September 2018 to April 2021. Data on patient demographics, pathological diagnosis, defect type, type of flap used, co-morbid disease, and smoking history was collected. </p><p class="abstract"><strong>Results:</strong> The mean defect size was 4×5 cm, however for defects larger than 4×4 cm and lesser than 7 cm a cervico-facial flap was used for reconstruction. The average time for surgery was 2 and a half hours extra for the free flap reconstruction. Post-operative wound complications were higher in free flap reconstruction. Partial/DTN was observed in 16% patients and necrosis that needed intervention- 6% of all patients. Patients with cervico-facial flap reconstruction had an excellent final functional and cosmetic result, with good skin color and texture match.</p><p class="abstract"><strong>Conclusions:</strong> The cervico-facial flap is a versatile technique with excellent vascularity and good esthetic outcome, which should be utilized liberally in the reconstruction of facial defects, slight modifications in the flap harvesting and careful selection of patient can give excellent results in moderate defects after parotid surgeries, especially in a resource limited country like India.</p>

Parotid gland tuberculosis-presentation of 4 case variants

Pulmonary tuberculosis is a necrotizing granulomatous disease with diverse presentation. Nevertheless, extra pulmonary involvement although rare even in endemic regions, is associated with diagnostic dilemma for confirmation and treatment modalities. Contextually, parotid gland tuberculosis is a rare surgical presentation because of nonspecific signs, symptoms and allegedly low incidence; it is often misdiagnosed as parotid neoplasm, and therefore remains a diagnostic paradox. However, clinical suspicion alongside pathological evidence and imaging helps in diagnosing indecisive questionable cases. We present 4 cases of parotid tuberculosis each with different clinical presentation along with clinical suspicion and pathological diagnosis. Parotid tuberculosis is a rare clinical entity and completely curable by category-I anti-tubercular therapy. It has no residual deformity if diagnosed timely followed by conservative treatment management.

Long-Term Recurrence-Free Survival After Salivary Duct Carcinoma of the Parotid: A 10-Year Follow-Up Case Report

Salivary duct carcinoma (SDC) represents a very rare and aggressive parotid neoplasm. A 70-year-old male was admitted to the hospital with a swelling of the right parotid region, persisting for twelve weeks. Based on sonography and contrast-enhanced computed tomography, a suspicious lesion showing mass expansion and invasion of surrounding tissues was seen. Intraoperative biopsy brought evidence of SDC. In accordance, surgical treatment included parotidectomy with preservation of the facial nerve as well as ipsilateral neck dissection due to suspicious lymphatic nodes. Afterwards, an adjuvant radiation therapy was undertaken. At 10 years of follow-up, the patient was alive and free of recurrence with full function of the facial nerve. In conclusion, keeping in mind its poor prognosis, the rare parotid salivary duct carcinoma needs aggressive therapy consisting of a surgical as well as a radiation therapy approach.

A Modified Mini Incision for The Surgery of Parotid Benign Tumor: A Retrospective Analysis of 48 Cases

Background: Parotid neoplasm is a result of inadequate surgical incision during the treatment of head and neck cancers, and most of them are benign tumors. Hence, to explore a new surgical incision for parotid benign tumor in order to minimize the scar size on the premise of guaranteeing the safety of operation.Methods: We conducted a retrospective study of 48 patients who had undergone parotid surgeries from Jan. 01 2008 to Dec. 30 2014 at the department of otolaryngology, Jinshan Hospital of Fudan University. Histopathological examination confirmed benign parotid tumor (Warthin's tumor, pleomorphic adenoma, cysts, and monomorphic adenomas.) in all cases. All patients underwent a mini incision (cutting the skin directly on the surface of the tumor, and the incision was slightly longer than the diameter of the tumor). Results: Among the 48 cases, no recurrence and facial nerve injury were reported during the follow-up period of more than 4 years. Two cases of saliva fistula and one case of temporary facial nerve dysfunction were reported; however, they recovered quickly after symptomatic treatment.Conclusion: Extracapsular dissection is a safe and effective surgical procedure for the treatment of parotid benign tumor, and the postoperative scar is very small.