To report the standard of care, interesting new findings and controversies about the treatment of parotid tumors.Relevant and actual studies were searched in PubMed and reviewed for diagnostics, treatment and outcome of both benign and malignant tumors.Prospective trials are lacking due to rarity of the disease and high variety of tumor subtypes.The establishment of reliable non-invasive diagnostics tools for the differentiation between benign and malignant tumors is desirable. Prospective studies clarifying the association between different surgical techniques for benign parotid tumors and morbidity are needed. The role of adjuvant or definitive radiotherapy in securing loco-regional control and improving survival in malignant disease is established. Prospective clinical trials addressing the role of chemotherapy/molecular targeted therapy for parotid cancer are needed. An international consensus on the classification of parotid surgery techniques would facilitate the comparison of different trials. Such efforts should lead into a clinical guideline.
Background: To evaluate the face-specific quality of life after hypoglossal-facial jump nerve suture for patients with long-term facial paralysis. Methods: A single-center retrospective cohort study was performed. Forty-one adults (46% women; median age: 55 years) received a hypoglossal-facial jump nerve suture. Sunnybrook and eFACE grading was performed before surgery and at a median time of 42 months after surgery. The Facial Clinimetric Evaluation (FaCE) survey and the Facial Disability Index (FDI) were used to quantify face-specific quality of life after surgery. Results: Hypoglossal-facial jump nerve suture was successful in all cases without tongue dysfunction. After surgery, the median FaCE Total score was 60 and the median FDI Total score was 76.3. Most Sunnybrook and eFACE grading subscores improved significantly after surgery. Younger age was the only consistent independent predictor for better FaCE outcome. Additional upper eyelid weight loading further improved the FaCE Eye comfort subscore. Sunnybrook grading showed a better correlation to FaCE assessment than the eFACE. Neither Sunnybrook nor eFACE grading correlated to the FDI assessment. Conclusion: The hypoglossal-facial jump nerve suture is a good option for nerve transfer to reanimate the facial muscles to improve facial motor function and face-specific quality of life.
Objectives There is a lack of data on patients' and diagnostic factors for prognostication of complete recovery in patients with Bell's palsy. Design and setting Cohort register‐based study of 368 patients with Bell's palsy and uniform diagnostics and standardised treatment in a university hospital from 2007 to 2017 (49% female, median age: 51 years). Main outcome measures Clinical data, facial grading, electrodiagnostics, motor function tests, non‐motor function tests and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics. Results Median onset of treatment was 1.5 days. 46% of patients had a House‐Brackmann scale at baseline of ≥ III. The median recovery time was 2.6 months (95% confidence interval [CI] = 2.1‐3.0). 54.9% achieved a complete recovery. If prednisolone therapy started later than 96 hours after onset, the recovery rate decreased significantly. Beyond less severe palsy, no abnormal electroneurography side difference, no pathological spontaneous activity in electromyography and normal stapedius reflex testing were the most powerful tool for prognostication of recovery after Bell's palsy. Conclusion Beyond severity of the palsy, facial electrodiagnostics and stapedius reflex testing are the most powerful tool for prognostication of recovery time after Bell's palsy. Prednisolone therapy should have started at best within a time window of 96 hours after onset to reach the highest probability of complete recovery.
Background The prognostic importance of intraparotid lymph node metastasis (P+) in patients with primary parotid gland carcinoma is unclear. Methods Nineteen retrospective and noncomparative cohort studies, published between 1992 and 2020, met the inclusion criteria and included 2202 patients for this systematic review. Results The pooled prevalence of the P in adult patients in the unselected studies was 24.10% (95% confidence interval = 17.95‐30.25). The number of P+ lymph nodes per patient was counted in only three studies and ranged from 1 to 11. The 5‐year recurrence‐free survival rate based on Kaplan‐Meier analysis varied from 83% to 88% in P− patients compared to 36% to 54% in P+ patients. The average hazard ratio for tumor recurrence in patients with P+ compared to P− was 2.67 ± 0.58. Conclusions P+ is an independent negative prognostic factor in primary parotid gland cancer and should be included into the treatment planning.
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