Ultrasound-guided ethanol sclerotherapy for multifocal unilateral Warthin’s tumor after partial parotidectomy

Abstract

Introduction Warthin’s tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for Warthin’s tumor is parotidectomy. However, surgical resection has the risk of complications including facial nerve weakness and Frey’s syndrome. Recently, ultrasound-guided ethanol sclerotherapy (UGES) has been found to be efficacious in the treatment of a variety of head and neck lesions. Case report We present a patient with multifocal Warthin’s tumor who was managed with partial parotidectomy and two cycles of ultrasound-guided ethanol sclerotherapy. Discussion Ethanol sclerotherapy has been used as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. To our knowledge, this is the first case presented in the literature where sclerotherapy was used in conjunction with a partial parotidectomy. Minimizing the extent of surgical resection can reduce the risk of facial nerve weakness and Frey’s syndrome and negate the need for fat grafting for defect reconstruction. Conclusion UGES may serve as a safe and reliable procedure that can be performed in conjunction with partial parotidectomy for patients who wish to achieve definitive diagnosis while also minimizing the risk of complications associated with extensive parotidectomy.

Ultrasound-guided bleomycin sclerotherapy for Warthin’s tumor: preliminary results of a prospective study

“…(12,13) Sclerotherapy is considered less painful than RFA or MWA, which use thermal energy, and potential thermal damage to the facial nerve should also be considered. (12)(13)(14)(15) One post-procedural infection occurred in the present series, which most likely was more due to the puncture itself. To date, we have not observed other relevant complications.…”

“…Two case reports on ultrasound-guided ethanol sclerotherapy exist with positive results. (12,13) Ultrasound-guided microwave ablation (MWA) and radiofrequency ablation (RFA) have also been utilized in small sets of patient with promising results. (14,15) We opted for bleomycin, as it has been widely used with good results for low-flow vascular malformations with minimal complications and minimal nerve damage.…”

“…Previous case reports on ultrasound-guided ethanol sclerotherapy showed similar results in two patients: the tumor volume shrank by 55-98%, but follow-up time was only 2-5 months. (12,13) Sclerotherapy is considered less painful than RFA or MWA, which use thermal energy, and potential thermal damage to the facial nerve should also be considered. (12-15) One post-procedural infection occurred in the present series, which most likely was more due to the puncture itself.…”

“…(10,11) Currently, reports on non-surgical interventions for WT are limited. (12)(13)(14)(15) This is the first study that prospectively evaluates the efficacy and safety of UGBS in the management of WTs.…”