Extracapsular dissection for warthin tumors despite the risk of ipsilateral metachronous occurrence

Mantsopoulos, Konstantinos; Goncalves, Miguel; Koch, Michael; Iro, Heinrich

doi:10.1002/lary.27166

Cited by 20 publications

(12 citation statements)

References 29 publications

(59 reference statements)

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“…Our analysis demonstrated that facial nerve‐dissecting modalities, in absolute numbers, remained relatively stable over the 19 years of our study: the number of PSPs increased from six to 16 cases, LP cases decreased slightly (from 15 to 10), and the number of CPs remained mostly the same (from 40 to 44). This observation points to the fact that dissection of the facial nerve retains its position and is strongly indicated in parotid surgery (diffuse unilateral multilocular cystadenolymphomas, lesions of the deep lobe, parapharyngeal lesions with broad contact to the facial nerve). It could also be seen that the rapid increase in the total number of parotidectomies (from 70 to 252) could be almost directly attributed to the increase in the number of extracapsular dissections (from 9 to 182).…”

Section: Discussionmentioning

confidence: 91%

“…Nevertheless, careful dissection of the facial nerve long remained the standard surgical method for treating benign lesions of the parotid gland, so that many working groups claimed that parotid surgery was the same as surgery of the facial nerve . It has been suggested that extracapsular dissection, in the form of removal of a tumor with a cuff of healthy gland parenchyma where possible, without intending to pre‐identify the main trunk or branches of the facial nerve, as a minimally invasive procedure reduces postoperative morbidity and offers early recovery with an even better preservation of salivary function . According to the philosophy of our department, minimal invasive surgery in the form of an extracapsular dissection (ECD) was indicated in cases of a single and mobile lesion with preoperative clinical and imaging signs of a benign tumor and located within the lateral lobe of the parotid gland as well as in cases of conglomerates of cystadenolymphomas in the caudal pole of the parotid gland.…”

Section: Introductionmentioning

confidence: 99%

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Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

2019

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Objectives The aim of this study was to explore the changes in philosophy in the surgical therapy of benign parotid tumors over a period of 19 years. Methods The records of all patients treated for benign parotid tumors between 2000 and 2018 were evaluated. Data were analyzed with respect to the number of procedures carried out per year of the study according to each of the different surgical modalities and the incidence of postoperative complications. Statistical analysis was performed using the x2 test. A P value of <.05 was considered statistically significant. Results A total of 2988 patients were included in this study. Our analysis showed that the increasing performance of extracapsular dissection was associated with a progressive reduction in the incidence of temporary facial nerve palsy and Frey's syndrome, while the rate of permanent facial nerve palsy remained consistently low. Conclusion One of the most controversial issues in head and neck surgery is which therapeutic approach is best in patients with benign parotid tumors. Our analysis demonstrated that a change of strategy towards reducing invasiveness was possible, with exceptional functional results. Avoidance of facial nerve dissection is feasible in more than two‐thirds of cases with benign tumors. Level of Evidence 4b Laryngoscope, 130: 1941–1946, 2020

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

2019

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“…Patients with cystadenolymphomas are often smokers. Malignant transformation is extremely rare (4) .…”

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confidence: 99%

Two case reports of synchronous unilateral pleomorphic adenoma and cystadenolymphoma of the parotid gland with literature review

2018

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Background: Synchronous unilateral tumors in the parotid glands account for less than 5–10% of all salivary gland neoplasms. Mostly these are cystadenolymphomas, but tumors of different histological types can be found as well. In these cases it is often pleomorphic adenoma in combination with cystadenolymphoma. Ultrasound is the first choice imaging modality. Case report: We present two patients with two simultaneous tumors in a unilateral parotid gland. In each case, B-mode ultrasound showed two hypoechoic masses, one of which was predominantly cystic. The subsequent use of Virtual Touch Imaging Quantification (VTIQ) showed tumors of elastic tissue. After a parotidectomy, both cases were diagnosed with pleomorphic adenoma combined with cystadenolymphoma. Conclusion: The combination of B-mode ultrasound and VTIQ is an important diagnostic modality and may improve diagnostic accuracy to differentiate between benign and malignant lesions. Every clinician should be aware of the co-existence of different histological types of tumors in unilateral salivary glands.

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“…Different authors [38,39] have also reported satisfactory results with ECD. Mantsopoulos et al [40] analyzed 327 WTs treated with ECD, observing an overall occurrence rate of 3.1% for ipsilateral second metachronous tumors. They concluded that ECD is extremely useful in the management of solitary as well as carefully selected multicentric WTs with acceptable surgical outcomes.…”

Section: Extracapsular Dissection (Ecd)mentioning

confidence: 99%

Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

et al. 2021

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Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.

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Extracapsular dissection for warthin tumors despite the risk of ipsilateral metachronous occurrence

Abstract: 4. Laryngoscope, 2521-2524, 2018.

Cited by 20 publications

References 29 publications

Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

Two case reports of synchronous unilateral pleomorphic adenoma and cystadenolymphoma of the parotid gland with literature review

Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

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