Long‐term results of morbidity after parotid gland surgery in benign disease

Koch, Michael; Zenk, Johannes; Iro, Heinrich

doi:10.1002/lary.20822

Cited by 130 publications

(160 citation statements)

References 28 publications

(188 reference statements)

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“…Our results demonstrate that local capsular dissection of inferiorly located benign parotid lesions is safe and avoids many of the complications of facial nerve dissection [11][12][13]. It is imperative to emphasise that the capsular dissection technique is different to the enucleation of parotid lesions which involves a ''shelling out'' of the lesion.…”

Section: Discussionmentioning

confidence: 83%

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Riffat

Mahrous

Buchanan

et al. 2012

J. Maxillofac. Oral Surg.

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Introduction The current practice for removal of clinically benign superficial parotid lesions is an appropriate superficial parotidectomy with a cuff of normal parotid tissue for complete pathological clearance. This technique requires the identification of the facial nerve at the main trunk and dissection of the segment of the facial nerve deep to the lesion. The reported major complications of this procedure include temporary or permanent facial nerve weakness, Frey's syndrome and salivary leaks. In order to avoid these complications, a local extracapsular dissection technique can be utilised in the management of small inferiorly located benign lesions of the parotid gland. Methods A retrospective case note review was performed for all parotidectomies between 2004 and 2009 in Addenbrooke's Hospital, Cambridge by the senior authors. Results A total of 172 cases were identified out which 46 underwent an extracapsular dissection. The average size of these lesions was 1.9 cm (0.9-2.4 cm) with all universally located inferior or posterior to the angle of the mandible. The pathologies were 14 pleomorphic adenomas, 24 Warthin's tumours, 6 lymphangiomas and 2 simple cysts. There were no post-operative facial nerve weaknesses, Frey's syndrome or salivary leaks within the extracapsular dissection group. The median follow-up of these patients were 4.6 years (2-6 years) with 6 patients lost to followup. No recurrences have been noted in the cohort at followup.

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Section: Discussionmentioning

confidence: 83%

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Riffat

Mahrous

Buchanan

et al. 2012

J. Maxillofac. Oral Surg.

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“…Despite the high sensitivity of these radiological techniques, the accuracy of predicting histopathology of salivary gland masses is lower than expected as morphologic characteristics of benign and malignant lesions may overlap frequently (1)(2)(3)(4)(5)(6)(7). In addition, they have several limitations in daily practice.…”

Section: Introductionmentioning

confidence: 99%

Sonoelastographic Features of Major Salivary Gland Tumors and Pathology Correlation

Farasat¹,

Ovalı

Düzgün

et al. 2017

Iran J Radiol

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Objectives: To investigate the diagnostic efficiency of elastography in differentiation of malignant and benign tumors by evaluating salivary gland masses in means of their elastography scores and strain ratios. Patients and Methods: Twenty five patients with salivary gland mass lesions were detected through B-mode ultrasonography, Doppler ultrasonography, strain elastography and their strain ratios were calculated. The results were compared with histopathologic results. Results: Twenty five patients had 27 lesions consisting of seven malignant and 20 benign lesions. Mann Whitney U test, ROC analysis, Fisher test and Chi square tests were used statistically. Mean strain rates were calculated as 2.26 ± 0.29 in the benign group and 2.02 ± 0.59 in the malignant group. There was no statistically significant difference between the two groups (P = 0.698). Elastography score was calculated as mean 2.4 ± 0.94 in the benign group and mean 2.28 ± 0.38 in the malignant group. There was no statistically significant difference between the two groups (P = 0.708). Accepting the strain rate as 0.89; sensitivity of elastography in differentiating malignant from benign lesions is 71%, and the specificity is 50%. However, the area under the ROC curve is 0.55, which is not statistically significant (P = 0.699). Conclusion: Elastography is a supporting method for B-mode ultrasonography in the differentiation of benign and malignant salivary gland masses. However, the overlap of elastographic findings is evident in benign and malignant masses. Care should be taken to have tissues with similar stiffness under the reference tissue and the lesions in elastographic evaluation of the superficial mass. We have not met a study that has pointed out the importance of stiffness of the tissue located beneath the lesion that may affect the elastography results in the literature. In this respect our study is unique.

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“…From this point of view a systematisation in cystic tumors (mostly benign) and solid masses (multiple etiologies) may be considered appropriate. A consequent more thorough characterization of the solid tumors in order to discriminate the ethiopathogenetic type is also important given the fact that the therapeutic conduct is very different [2,16]. In parotid adenomas the treatment is purely surgical, without representing an emergency.…”

Section: Discussionmentioning

confidence: 99%

“…The detection and characterization of parotid masses is important considering the complex anatomical relationships with the vascular and nervous structures of the region and the morbidity associated with extensive surgery situations that can lead to disability [2].…”

Section: Introductionmentioning

confidence: 99%

Solid parotid tumors: an individual and integrative analysis of various ultrasonographic criteria. A prospective and observational study.

et al. 2013

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Objectives: The purpose of the study is to identify and validate ultrasound criteria for parotid tumors evaluation, as well as to elaborate a multimodal, multi-criteria and integrative ultrasound approach for allowing tumor discrimination in a noninvasive manner. Material and method: Twenty patients with solid parotid tumors (12 benign, 8 malignant) were examined by ultrasound: real-time "grey scale" ultrasound, Doppler ultrasound, elastography, harmonic ultrasound imaging with i.v. contrast (CEUS). The study focused on tumor morphology and circulation. The analysis of the results was observational, enhanced by statistical methods and artificial intelligence (decision trees). Results: All malignant tumors showed increased hypoechogenicity, tumoral cervical adenopathies, increased stiffness and "in block" mobility with the parotid gland upon palpation with the transducer, uneven distribution of the contrast material during the arterial phase (8/8). To varying degrees, they showed imprecise delineation (7/8), structural heterogeneity (6/8) and disorganized flow pattern (6/8). All cases of benign tumors showed heterogeneous echostructure, clear delineation and no capsule (12). They also showed moderate hypoechogenicity (9/12), no cervical lymph nodes (11/12) and variable rigidity (increased 6/12; low 3/12). A selection and ranking of relevant ultrasound parameters was also made. Some of them were included in a transparent and easy-to-use decision tree model with 100% data accuracy. Conclusions: The characterization and discrimination of solid parotid tumors require a multimodal and multicriteria approach. Ultrasound criteria can be divided into criteria of certainty and criteria of diagnosis probability. CEUS examination of parotid tumors did not reveal significant differences between benign and malignant circulatory bed. Decision trees discovered by artificial intelligence from the data may represent intelligent diagnosis support systems with very high accuracy, up to 100%.

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Long‐term results of morbidity after parotid gland surgery in benign disease

Cited by 130 publications

References 28 publications

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Sonoelastographic Features of Major Salivary Gland Tumors and Pathology Correlation

Solid parotid tumors: an individual and integrative analysis of various ultrasonographic criteria. A prospective and observational study.

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