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Evaluation of diagnostic and treatment modalities in accessory lobe tumors of the parotid gland
Oral P r e s e n t a t i o n s / O 3 1 . Tumor V the Singapore National Eye Centre for dental evaluation prior to OOKP surgery underwent careful dental examination and oral radiography. All patients underwent dental optimisation before surgery. Each patient's findings were recorded and compiled in a database. Eighteen patients with ocular blindness were evaluated. Ten patients (55.6%) were female, 8 (44.4%) were male. Their ages ranged from 16 to 65 years, with a mean of 37.1 years (SD 17.3 years). Eight patients (44.4%) were Chinese, 5 (27.8%) were Malay and 5 (27.8%) were Indian. Seven patients (38.9%) were from Malaysia, 6 (33.3%) were Singaporean, 2 (11.1%) were Indonesian, 2 (11.1%) were Sri Lankan and 1 (5.6%) was from Thailand. Eleven patients (61.1%) were blind from Stevens-Johnson's syndrome; 6 (33.3%) suffered chemical burns. Three patients (16.7%) had diseased cheek mucosa (Sjorgren's syndrome, submucous fibrosis, smoker's keratosis). Most (88.9%) had usable canine teeth; 1 patient had only a usable premolar and 1 patient had no usable teeth from severe peridontal bone loss. Two-thirds of patients (66.7%) were suitable for OOKP; 5 patients (27.8%) were graded as being at risk of complication or failure, due to mucosal disease or periodontal bone loss; 1 patient (5.6%) had no suitable teeth and submucous fibrosis. To date, 9 patients have undergone OOKP stage 1 surgery. Most patients evaluated to date have suitable dental conditions for OOKP surgery. The main reasons for unsuitability were periodontal disease or mucosal diseases.
61 in 62% whereas in 38% mostly low-grade malignancy was present. MRI was superior in preoperative planning. Extended parotidectomy with total facial nerve preservation was the most utilized surgical procedure. Multivariate analysis on the malignant lesions showed that histology grade (P<0.05), tumor size (P<0.1), and stage (P<0.01) were associated with decreased survival. Postoperative results are quite satisfactory with only 16.5% of transitory facial nerve palsy, only one case of recurrence and affirmative disease-free survival rate. Immunohistochemistry was effective in distinguishing type and grade. Tumors of the accessory lobe are uncommon and exact preoperative assessment and scrupulous choice of the operative procedure are necessary for achieving satisfactory postoperative results with optimally extended radicality and minimal functional morbidity.
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A RETROSPECTIVE STUDY ON THE COMPLICATIONS AFTER THE MODIFIED PAROTIDECTOMY IN THE BENIGN TUMORS OF PAROTID GLAND
H.-W. Zhao, L.-J. Li, B. Han. Department of Oral and Maxillofacial
Surgery, West China College of Stomatology, Sichuan University, China
O31. Tumor V
•03•
SALIVARY GLAND CANCER - CLINICAL REVIEW AND PROGNOSTIC FACTORS
H. Kokemueller, A. Eckardt. Department of Oral and Maxillofacial
Surgery, Hanover Medical School, Hanover, Germany In this retrospective study we give a clinical review of our experience with different subtypes of salivary gland cancer. During the past 20 years, a total of 155 patients with carcinomas of the salivary glands received initial treatment at the Department of Oral and Maxillofacial Surgery, Hanover Medical School. There were 79 (51.0%) adenoid cystic carcinomas, 42 (27.1%) mucoepidermoid carcinomas, 12 (7.7%) adenocarcinomas, 10 (6.5%) polymorphous adenocarcinomas and 12 (7.7%) other tumor entities of smaller number. Complete resection was reached for 63.5% of patients with high grade carcinomas and for 80.0% of patients with low grade carcinomas. 26.2% of patients with high grade carcinomas and 13.3% of patients with low grade carcinomas received postoperative radiation. Overall survival rates at 5, 10 and 15 years were 65.9%, 48.0% and 39.8% with significant difference for patients with high grade and low grade carcinomas. Histopathologic subtype, tumor stage and margin status significantly influenced prognosis. Statistically, we were not able to demonstrate a positive effect for postoperative radiation. In the future, patients with salivary gland carcinomas should be randomised for prospective multicentric clinical trials, which could provide reliable information about adjuvant treatment modalities and their results even for rare subtypes of salivary gland cancer. [-0-'3-'~ EVALUATION OF DIAGNOSTIC AND TREATMENT MODALITIES IN ACCESSORY LOBE TUMORS OF THE PAROTID GLAND
V. Popovski, A. Benedetti, G. Pantcevski. University Clinic forMaxillofacial
A retrospective clinic study is presented of surgical patients undergoing a modified parotidectomy with conserving the sub-superficial muscuIoaponeurotic system (sub-SMAS) and great auricular nerve and reconstructing by the sternocleidomastoid flap. The incidence of clinical complications were observed after the parotidectomy. 226 patients were operated on between 1997 and 2001. The surgical technique is described and the incidence of clinical Frey's syndrome as evaluated by minor test (starch-iodine test) and observe gustatory sweating syndrome. The feeling and concave of the region of auricular Iobule were followed up. After a minimal follow-up of 24 months, all patients were investigated for gustatory sweating and cosmetic appearance. The incidence of Frey's syndrome in parotidectomy with SMAS or with SMAS and the sternocleidomastoid flap (SF) is significantly lower than that of patients with a sub-cutaneous flap (sub-CF) (P <0.005 or <0.001) through by subjective observation and minor test. The significance between the SMAS and SMAS with the sternocleidomastoid flap existed (P <0.005) in protecting the concave of the region of auricular Iobule. So did that of the sub-cutaneous flap and sub-cutaneous flap with the sternocleidomastoid flap (P<0.05). On the contrary, there is no significance between the two groups without SF (P>0.05). The feeling of the region of auricular Iobule had no change by preserving the great auricular nerve. There has good effect to prevent gustatory sweating syndrome in parotidectomy of reserve parotid fascia. Combination of the two techniques provides excellent aesthetic results because the sternocleidomastoid flap can protect the concave of the region of auricular Iobule. The loss of sense of the region of auricular Iobule can be prevented by reserving the great auricular nerve.
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BILATERAL MIXED TUMOURS OF THE PAROTID GLAND WITH MALIGNANT TRANSFORMATION OF ONE SIDE CASE REPORT
N. Papadogeorgakis, S. Kyriakou, E. Parara, K. Papadimitriou, K. Alexandridis. University of Athens, Oral and Maxillofacial Surgery
Dept., Athens, Greece
Surgery, R. Macedonia, Skopje, Macedonia Wide spectrum of histopathological presentations, as well as the diversity of its morphological features in different parts of the gland pronounces the peculiarity of the parotid gland tumors. Tumors of the accessory lobe as a midcheek masses are relatively rare but still with intelligible interest about their clinicopathological, diagnostic and surgical modalities. The clinical course of 18 consecutive patients with accessory parotid gland tumor surgically treated on our clinic in ten year period was evaluated for the study. Comparison was created with relevant information concerning patient, disease, diagnostics and treatment distinctiveness. The efficiency of contemporary diagnostic algorithm and surgical treatment, were compared with histology, recurrence and facial nerve morbidity. Rank regression procedure was conducted for analysis of survival in the malignant group. Final histological findings included benign neoplasms
To present a female patient with bilateral pleiomorphic adenoma of the parotid, one of which presented malignant transformation in histopathological diagnosis Female patient 68 years old was refferred to our dept for evaluation and management of recurrent tumour of the left preauricular area. Clinical examination revealed a swelling of the left side as well as one on the right parotid. Computerized tomography verified the clinical findings. The patient underwent bilateral superficial parotidectomy with preservation of the facial nerve, with the provisional diagnosis of mixed tumours. Histopathological examination revealed malignancy on the reoperated on site and mixed tumour on the contralateral side Bilateral mixed tumours of the parotid are rare, with very few cases reported. Malignant transformation is even more so. Careful clinical and computerised tomography or MRI evaluation of such lesions is necessary, especially for patients with recurrencies.
61 in 62% whereas in 38% mostly low-grade malignancy was present. MRI was superior in preoperative planning. Extended parotidectomy with total facial nerve preservation was the most utilized surgical procedure. Multivariate analysis on the malignant lesions showed that histology grade (P<0.05), tumor size (P<0.1), and stage (P<0.01) were associated with decreased survival. Postoperative results are quite satisfactory with only 16.5% of transitory facial nerve palsy, only one case of recurrence and affirmative disease-free survival rate. Immunohistochemistry was effective in distinguishing type and grade. Tumors of the accessory lobe are uncommon and exact preoperative assessment and scrupulous choice of the operative procedure are necessary for achieving satisfactory postoperative results with optimally extended radicality and minimal functional morbidity.
•0-'•-]
A RETROSPECTIVE STUDY ON THE COMPLICATIONS AFTER THE MODIFIED PAROTIDECTOMY IN THE BENIGN TUMORS OF PAROTID GLAND
H.-W. Zhao, L.-J. Li, B. Han. Department of Oral and Maxillofacial
Surgery, West China College of Stomatology, Sichuan University, China
O31. Tumor V
•03•
SALIVARY GLAND CANCER - CLINICAL REVIEW AND PROGNOSTIC FACTORS
H. Kokemueller, A. Eckardt. Department of Oral and Maxillofacial
Surgery, Hanover Medical School, Hanover, Germany In this retrospective study we give a clinical review of our experience with different subtypes of salivary gland cancer. During the past 20 years, a total of 155 patients with carcinomas of the salivary glands received initial treatment at the Department of Oral and Maxillofacial Surgery, Hanover Medical School. There were 79 (51.0%) adenoid cystic carcinomas, 42 (27.1%) mucoepidermoid carcinomas, 12 (7.7%) adenocarcinomas, 10 (6.5%) polymorphous adenocarcinomas and 12 (7.7%) other tumor entities of smaller number. Complete resection was reached for 63.5% of patients with high grade carcinomas and for 80.0% of patients with low grade carcinomas. 26.2% of patients with high grade carcinomas and 13.3% of patients with low grade carcinomas received postoperative radiation. Overall survival rates at 5, 10 and 15 years were 65.9%, 48.0% and 39.8% with significant difference for patients with high grade and low grade carcinomas. Histopathologic subtype, tumor stage and margin status significantly influenced prognosis. Statistically, we were not able to demonstrate a positive effect for postoperative radiation. In the future, patients with salivary gland carcinomas should be randomised for prospective multicentric clinical trials, which could provide reliable information about adjuvant treatment modalities and their results even for rare subtypes of salivary gland cancer. [-0-'3-'~ EVALUATION OF DIAGNOSTIC AND TREATMENT MODALITIES IN ACCESSORY LOBE TUMORS OF THE PAROTID GLAND
V. Popovski, A. Benedetti, G. Pantcevski. University Clinic forMaxillofacial
A retrospective clinic study is presented of surgical patients undergoing a modified parotidectomy with conserving the sub-superficial muscuIoaponeurotic system (sub-SMAS) and great auricular nerve and reconstructing by the sternocleidomastoid flap. The incidence of clinical complications were observed after the parotidectomy. 226 patients were operated on between 1997 and 2001. The surgical technique is described and the incidence of clinical Frey's syndrome as evaluated by minor test (starch-iodine test) and observe gustatory sweating syndrome. The feeling and concave of the region of auricular Iobule were followed up. After a minimal follow-up of 24 months, all patients were investigated for gustatory sweating and cosmetic appearance. The incidence of Frey's syndrome in parotidectomy with SMAS or with SMAS and the sternocleidomastoid flap (SF) is significantly lower than that of patients with a sub-cutaneous flap (sub-CF) (P <0.005 or <0.001) through by subjective observation and minor test. The significance between the SMAS and SMAS with the sternocleidomastoid flap existed (P <0.005) in protecting the concave of the region of auricular Iobule. So did that of the sub-cutaneous flap and sub-cutaneous flap with the sternocleidomastoid flap (P<0.05). On the contrary, there is no significance between the two groups without SF (P>0.05). The feeling of the region of auricular Iobule had no change by preserving the great auricular nerve. There has good effect to prevent gustatory sweating syndrome in parotidectomy of reserve parotid fascia. Combination of the two techniques provides excellent aesthetic results because the sternocleidomastoid flap can protect the concave of the region of auricular Iobule. The loss of sense of the region of auricular Iobule can be prevented by reserving the great auricular nerve.
•0-•-•
BILATERAL MIXED TUMOURS OF THE PAROTID GLAND WITH MALIGNANT TRANSFORMATION OF ONE SIDE CASE REPORT
N. Papadogeorgakis, S. Kyriakou, E. Parara, K. Papadimitriou, K. Alexandridis. University of Athens, Oral and Maxillofacial Surgery
Dept., Athens, Greece
Surgery, R. Macedonia, Skopje, Macedonia Wide spectrum of histopathological presentations, as well as the diversity of its morphological features in different parts of the gland pronounces the peculiarity of the parotid gland tumors. Tumors of the accessory lobe as a midcheek masses are relatively rare but still with intelligible interest about their clinicopathological, diagnostic and surgical modalities. The clinical course of 18 consecutive patients with accessory parotid gland tumor surgically treated on our clinic in ten year period was evaluated for the study. Comparison was created with relevant information concerning patient, disease, diagnostics and treatment distinctiveness. The efficiency of contemporary diagnostic algorithm and surgical treatment, were compared with histology, recurrence and facial nerve morbidity. Rank regression procedure was conducted for analysis of survival in the malignant group. Final histological findings included benign neoplasms
To present a female patient with bilateral pleiomorphic adenoma of the parotid, one of which presented malignant transformation in histopathological diagnosis Female patient 68 years old was refferred to our dept for evaluation and management of recurrent tumour of the left preauricular area. Clinical examination revealed a swelling of the left side as well as one on the right parotid. Computerized tomography verified the clinical findings. The patient underwent bilateral superficial parotidectomy with preservation of the facial nerve, with the provisional diagnosis of mixed tumours. Histopathological examination revealed malignancy on the reoperated on site and mixed tumour on the contralateral side Bilateral mixed tumours of the parotid are rare, with very few cases reported. Malignant transformation is even more so. Careful clinical and computerised tomography or MRI evaluation of such lesions is necessary, especially for patients with recurrencies.