Mixed Tumours of the Parotid Gland

of the parotid gland warrant consideration because of the potential for facial nerve injury occurring with surgical treatment and the risk of malignant conversion. Forty-eight cases of recurrent pleomorphic adenoma treated at the University of Michigan, Ann Arbor, between 1935 and 1975 were retrospectively analyzed. The results of surgical procedures for recurrence were determined with respect to tumor control and resultant facial nerve function. Malignant conversion developed in three (6%) of 48 cases. The results of this study underscore the importance of adequate surgical excision of initial recurrences as well as primary tumors to prevent tumor recidivism. Tumor control rates and facial nerve preservation are enhanced with formal parotidectomy for recurrent tumor when feasible. In cases in which facial nerve identification and dissection is not possible, en bloc total parotidectomy offers effective, though not absolute, control of extensive recurrence.Advances in surgical techniques -¿A-have markedly diminished the recurrence rate previously associated with surgical excision of pleomorphic adenoma of the parotid gland. Factors responsible for the recurrence of pleo¬ morphic adenoma have received extensive review over the past 50 years. While intraoperative tumor rupture and seeding, tumor multicentricity, metachronous tumor develop¬ ment, and histologie evidence of cap¬ sular penetration or hypercellularity are mentioned as factors possibly related to the development of recur¬ rence, clinical behavior of pleomor¬ phic adenomas is most closely corre¬ lated with the adequacy of surgical treatment. Rates of recurrence follow¬ ing primary surgery for pleomorphic adenoma of the parotid gland have been reported to be as high as 44%, this being attributed to inadequate surgical excision.1 Subsequent reports suggested that formal parotidectomy was associated with lower rates of recurrence than was simple excision,2 and comparisons of large groups treated within the same institution revealed a fourfold greater rate of recurrence from simple excision as compared with formal parotidectomy, whether superficial or total, with facial nerve preservation.3 Recent reports have documented that a surgi¬ cal treatment policy of formal paroti¬ dectomy for primary pleomorphic adenoma leads to recurrence rates that approach zero,46 and many sur¬ geons have adopted this policy. None¬

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Die Morphologie der Speicheldr�senerkrankungen

Seifert

Donath

1976

Arch Otorhinolaryngol

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The human salivary glands represent a functional system with manifold responsibilities and interactions to the organism. The major and minor salivary glands show a common construction schedule consisting of an acinar functional system for the production of an enzyme- and mucin-containing primary saliva and a ductal functional system with manifold secretory, resorptive and regulatory responsibilities for the transport and the definitive composition of the saliva. The cyclic AMP and calcium iones localized in the glandular acini have an exceptional importance for the course of the secretory process. The neurohormonal control of the salivary secretion results by adrenergic and cholinergic transmitter substances. Moreover the secretory process shows a daily cycle combined with morphological alterations of the glandular cells (so called circadian structures). The fluid secretion of the salivary duct system (the output of sodium-, potassium- and chlorine-iones) represents an active energy-consumed transport process which will be regulated by several factors (autonomic nervous system, quantity of perfusion, hydrostatic pressure in the blood capillaries, transepithelial active transport by ATP-consumed pump systems). The striated ducts are the functional most important sector of the duct system for a rapid fluid- and electrolyte excretion. The terminal axons of the postganglionic sympathic and parasympathic neurits are characterized by spindle-shaped enlargements (varicosities) which contain neurosecretory granules. In the region of the acinar and intercalated duct cells a direct synaptic contact exists for the stimulation transmission, in the course of which the terminal axon contacts immediately with the effector cell by penetration of the basement membrane. The salivary glands form a part of the stabil tissues with reversible postmitotic cells in regard of the tissue regeneration. Under pathological conditions (inflammations, impediment of secretion fluid, radiation effects etc.) metaplasias and proliferations of the duct system arise with development of indifferent duct formations analogous to the type of an embryonal salivary gland. The terminal zone between intercalated and striated ducts represents an indifferent zone with large regeneratory potency. A special behaviour shows the myoepithelial cells which are developed as well to the outside of primitive embryonic duct buds as differentiated intercalated and striated ducts. Morphologically three types of diseases can be classified in the salivary glands: sialadenosis, sialadenitis and tumours.(ABSTRACT TRUNCATED AT 400 WORDS)

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Mixed Tumours of the Parotid Gland

Cited by 11 publications

References 15 publications

Recurrent Benign Mixed Tumor and the Facial Nerve

Recurrent Benign Mixed Tumor and the Facial Nerve

Surgical Treatment of Recurrent Pleomorphic Adenoma of the Parotid Gland

Die Morphologie der Speicheldr�senerkrankungen

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