Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: A 25‐year experience with 229 patients

Laccourrèye, H; Laccourreye, O.; Cauchois, R.; Jouffre, Véronique; Ménard, M.; Brasnu, Daniel

doi:10.1288/00005537-199412000-00011

Cited by 221 publications

(248 citation statements)

References 47 publications

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“…Retrograde dissection of the facial nerve is more popular in china with encouraging results. 1 Function preserving parotid surgery has relatively low complication rate like the use of a modified facelift incision, preservation of the great auricular nerve and normal parotid parenchyma. Ear sensation returned more rapidly and more completely in patients in whom the posterior branch of the great auricular nerve is preserved than in those in whom the nerve is sacrificed.…”

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confidence: 99%

Study of the Nerve Injury in Parotid Gland Surgery

Rahman

Joarder

2012

Nepalese J ENT Head Neck Surg

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Tumors of the parotid glands are believed to represent approximately 2% of tumors of the head and neck. Parotid gland tumors also accounts for 70% to 80% of all tumors of the salivary glands. 1 Approximately, 80% of parotid tumors are benign and 80% of benign tumours are pleomorphic adenomas and 80% arise from the superficial lobe of the parotid gland. 2 Less commonly, tumours may arise from the accessory lobe of the gland and present as a persistent swelling in the cheek. Rarely, tumours may arise from the deep lobe of the parotid gland and present as parapharyngeal masses. 3 The facial nerve is a very important nerve which exits through the skull base, below the ear lobule and travels through the parotid gland, separating the gland into superficial and deep lobes. 4 The hazardous course of the facial nerve through the parotid has evoked considerable risk of nerve injury. 2 The incidence of facial nerve paralysis is higher in total than in superficial parotidectomy, which may be related to stretch injury or as a result of surgical interference with the vasa nervosum. Among the branches of facial nerve which is the most at risk for injury during parotidectomy, is the marginal mandibular branch. 5 Parotid duct ligation increases the risk of nerve palsy in the distribution of zygomatic and buccal branches. Operations for Warthins tumour were associated with the increased risk of dysfunction of the cervical branch of the facial nerve. 6 Advanced age, longer operation time and larger specimen will have the significant risk for transient facial palsy after conservative parotidectomy. 7 There are two basic techniques for the identification and dissection of the facial nerve. One is the forward or antegrade dissection, where the approach to the main trunk is taken as an early step of tracing it to the bifurcation and peripheral branches. Retrograde dissection of the facial nerve is more popular in china with encouraging results. 1 Function preserving parotid surgery has relatively low complication rate like the use of a modified facelift incision, preservation of the great auricular nerve and normal parotid parenchyma. Ear sensation returned more rapidly and more completely in patients in whom the posterior branch of the great auricular nerve is preserved than in those in whom the nerve is sacrificed. 8 The auriculotemporal nerve provides both parasympathetic innervations to the parotid gland and sympathetic innervations to sweat glands and subcutaneous blood vessels. Freys syndrome is due to regrowth of the secretomotor parasympathetic fibers into the distal cut ends of the sympathetic fibers into the skin. 9 The objective of this study is to find out the frequency of nerve injuries after parotid surgery. O b j e c t i v e :To find out the frequency of nerve injuries after parotid surgery M a t e r i a l a n d m e t h o d s :A Cross sectional study was done from January 2008 to December 2009, in the Department of Otolaryngology and Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) & Dhaka Medical ...

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confidence: 99%

Study of the Nerve Injury in Parotid Gland Surgery

Rahman

Joarder

2012

Nepalese J ENT Head Neck Surg

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“…[1][2][3][4] Pleomorphic adenoma is most common in middle age and in women, 5 and although rare in children, it remains the most common solid parotid mass in the pediatric population. [6][7][8][9] These tumors arise directly from salivary gland tissue and consist of epithelial and mesenchymal cells; the latter can give rise to osseous, cartilaginous, hyaline, and myxoid elements, hence the name "mixed tumor."…”

Section: Discussionmentioning

confidence: 99%

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2012

J Neurol Surg Rep

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A 53-year-old man presented to the emergency department with a 7-day history of right ear fullness, otalgia, and hearing loss. He had recently been treated with antibiotics for sinusitis at an outside hospital but his symptoms failed to resolve. He denied vertigo, dizziness, otorrhea, or tinnitus. Physical examination demonstrated a mass behind an intact right eardrum, and tuning fork evidence of a conductive hearing loss. The remainder of his cranial nerve examination was normal, with the exception of the long-standing HouseBrackmann Grade VI/VI right facial nerve paralysis. Audiogram demonstrated a right moderate conductive hearing loss with flat (Type B) tympanogram. The left side was normal.The patient had a right parotid pleomorphic adenoma 35 years ago, which was treated by enucleation. He presented with several subcutaneous nodules 7 years after the initial treatment, which were treated by total parotidectomy. During surgery the facial nerve was sacrificed due to tumor encasement. Pathology confirmed recurrent pleomorphic adenoma. Postoperatively the tumor bed was treated with external beam radiotherapy. After this he remained asymptomatic for nearly 30 years.Magnetic resonance imaging of the head confirmed a large, irregular, heterogeneous, and variably enhancing mass in the right mastoid with extension medially along the floor of the posterior fossa measuring $5 Â 5 Â 5 cm (►Fig. 1). The mass eroded through the mastoid laterally and inferiorly into the upper cervical soft tissues. The superior portions of the mastoid were opacified with enhancement, suggesting tumor infiltration. The mass extended inferiorly into the parapharyngeal space and extrinsically compressed the right sigmoid sinus displacing it medially. In addition, a 1 Â 1 cm enhancing nodule in the right cerebellum medial to the cystic lesion was observed. The differential diagnosis at this point included carcinoma ex AbstractPleomorphic adenoma, also known as benign mixed tumor, is the most common tumor affecting the parotid gland and can reach massive size; however, intracranial invasion is rare. Recurrence of pleomorphic adenoma after excision is a well-known phenomenon and can present decades after resection of the primary tumor. Here we present the case of a 53-year-old man who presented to our clinic with ear fullness, otalgia, and hearing loss 30 years after undergoing total parotidectomy and external beam radiotherapy for pleomorphic adenoma. Magnetic resonance imaging revealed a massive transcranial tumor invading the mastoid cavity, the dura of the posterior fossa, the fallopian and semicircular canals, the jugular foramen, the lateral infratemporal fossa skull base, the sigmoid and transverse sinuses, and the superior parapharyngeal region. Gross examination and histopathological studies confirmed that the mass was a recurrent pleomorphic adenoma. Here we discuss the features of recurrent pleomorphic adenoma and review the current literature.

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“…For pleomorphic adenoma it is known that local excision/enucleation are accompanied by 20-45% rate of local recurrence (LR) [1,3,5] and that this is due to seeding rather than multicentricity [1,7,8]. some authors have advocated TCP to reduce the incidence of LR while maintaining acceptable morbidity patterns [8,9]. However for most cases SP remains 'an adequate procedure for small tumours confined to superficial lobe [1,3,5,1 0].…”

Section: Discussionmentioning

confidence: 99%

Parotoid Tumours: A Study of 65 Cases

Vohra

Kumar

Rajagopal³

et al. 1999

Medical Journal Armed Forces India

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Sixty five patients who had undergone surgery for parotid tumours over a period of nine years were studied retrospectively. There were 45 males and 20 females. There were 49 benign and 16 malignant tumours. Age ranged 35-69 years; mean 47 years. Pain (6%) and facial palsy (3%) were unusual features. Size of tumour at presentation varied from 1.5 to 12 em. Superficial parotidectomy was the commonest operation performed and TotaURadicallEnended parotidectomy was done in selected cases. Postoperative radiotherapy,was used in six cases. No recurrences were noted following surgery for benign tumours. Howe"er a local recurrence rate of 37%, was found for malignancies (6/16 cases). This paper aims to review the experience of managing these tumours in the setting of service hospitals. MJAFI 1999; SS : 35-37.

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Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: A 25‐year experience with 229 patients

Cited by 221 publications

References 47 publications

Study of the Nerve Injury in Parotid Gland Surgery

Study of the Nerve Injury in Parotid Gland Surgery

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Parotoid Tumours: A Study of 65 Cases

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