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Extracapsular Dissection for Benign Parotid Tumours: A Meta-Analysis
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The aim of this study was to investigate the complication rates and surgical effectiveness (measured as recurrence rate) of extracapsular dissection (ECD) versus superficial parotidectomy (SP) for the treatment of primary benign parotid neoplasms. ECD was defined as the dissection of the tumour with a thin margin of surrounding gland tissue without the intention for identification of the main trunk or branches of the facial nerve. Both complete and partial superficial parotidectomy were defined as superficial parotidectomy, where a portion of or the whole superficial lobe was removed with the tumour after planned identification and dissection of the main trunk and branches of the facial nerve.
The salivary glands
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
The key features for parotidectomy are: Complete excision with an adequate margin to avoid local recurrence.Type of resection (i.e. partial, superficial, total) depends on tumour size.Typically a modified Blair or rhytidectomy incision is used for lower or mid-gland regions of the parotid. The rhytidectomy incision can be extended in the hairline for further exposure.
The Head and Neck
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Mixed tumors (pleomorphic adenoma) are usually benign (less than 10% are malignant) and are mostly found in the superficial lobe of the parotid gland. Superficial parotidectomy with preservation of the facial nerve is the ideal surgical approach. Because of the anatomic relations of the parotid gland, the pharyngeal wall on the affected side must be inspected and palpated prior to surgery to rule out deep lobe involvement of the parotid. If mixed tumors are encountered at other salivary glands, excision of the affected gland or the area is sufficient. Occasionally, mixed tumors can develop in an accessory salivary gland, located near the posterior lower border of the parotid gland. They present as slow growing, freely mobile, and nontender nodules. They can be locally excised in toto without sacrificing the superficial lobe of the parotid, as long as they are separated from the parotid gland. Recurrent benign mixed tumor of the parotid is rare and, if it occurs, the surgical procedure should be tailored to the individual case. If a patient is seen after freshly excised or biopsied tumor, parotidectomy with excision of the skin at the biospy site is recommended. If the patient is seen after an old excision of such a tumor, it is preferred to wait and in case of recurrence, re-resection is in order.13 Radiation therapy is not to be used as the primary treatment in benign mixed tumors.
Metastatic salivary gland mammary analogue secretory carcinoma (MASC) of parotid gland – A rare case report in the literature review
Published in Acta Oto-Laryngologica Case Reports, 2023
Aynur Aliyeva, Ziya Karimov, Togay Muderris
There is no standard treatment protocol according to the rareness of the disease [4–8,12]. Nearly all patients performed surgical excision of the mass and superficial or total parotidectomy in the literature. Commonly accepted clinical indications for neck dissection in patients diagnosed with MASC are not standardized [1–8]. Suzuki et al. reported a rare MASC, which featured a metastatic lymph node without a primary source. The patient performed radical neck dissection without adjuvant treatment and showed no symptoms within nine months of follow-up [31]. The currently accepted management for MASC is in 2 ways:In local and less aggressive, low-grade malignant tumor diseases: complete surgical resection and close follow-up.In cases with invasive metastasis or positive surgical margins: complete resection, neck dissection, and chemo- and radiotherapy.
Survival after lymphadenectomy of nodal metastases from melanoma of unknown primary site
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Hans Petter Gullestad, Truls Ryder, Mariusz Goscinski
Surgery for all patients with clinical nodal disease has been consistent throughout the whole period.Neck: Selective nodal dissection as a standard and modified radical dissection with extensive disease. Superficial parotidectomy when the parotid gland or level II was affected.Axilla: Full en bloc dissection (level I-II-III). This involved complete clearance of the axillary content up to the apex of the axilla defined by the musculus subclavious tendon [15].Groin/Pelvis: Radical groin dissection with identification of Clocquet’s node. Whenever suspicious or confirmed metastatic nodes were present in the pelvic area, an ilioinguinal dissection was performed.
Misdiagnosis of sebaceous carcinoma
Published in Acta Chirurgica Belgica, 2022
Gino Vissers, Jérôme Corthouts, Carole Van Haverbeke, Sabine Declercq, Marianne Mertens
When diagnosis is made in an early stage, surgical treatment by wide excision and primary reconstruction is sufficient. In case of lymph node and/or parotid invasion, a lymphadenectomy and/or parotidectomy should be performed, respectively. Recurrence rates are lower when more parotid gland tissue has been resected [9]. Other studies could not confirm this but report worse quality of life after a total parotidectomy. In our opinion, a lymphadenectomy of neck zones 2 and 3 should always be performed when tumour spread into the parotid gland has been confirmed, as lymph node invasion is in all probability. For advanced cases, excision with primary reconstruction is not suitable and more aggressive treatments such as conjunctiva resection or orbital exenteration might be necessary. Advanced cases are more likely to have complications after surgery and have worse prognosis in general. When metastatic disease has been confirmed, systemic treatment will be necessary. Therefore, to prevent mutilating surgery and to improve patient outcome, early diagnosis is essential.