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O.531 Advantages vs tradition – partial superflcial parotidectomy
Oral Presentations imaging revealed a very large mass occupying the whole of the parotid gland, and involving left the mandible from the premolar area to the condylar neck. Open biopsy from the mass (both extraorally and intraorally) showed low-grade mucoepidermoid cell carcinoma of ductal epithelium origin. Results: The patient underwent a major surgery involving a total parotidectomy with preservation of the facial nerve and hemimandibulectomy. Reconstruction of the mandible was obtained with a titanium reconstruction plate. The patient made an uneventful recovery and referred for further radiotherapy. Conclusions: Although cases of intraosseous mucoepidermoid cell carcinoma of the mandible have been reported, to our knowledge this is the first case of a mucoepidermoid cell carcinoma arising from the parotid and destroying in such extent the mandible
O.530 A giant pleomorphic adenoma of minor buccal salivary gland A. Benedetti, V. Popovski, A. Iliev, B. Ilievski. Clinic for Maxillofacial Surgery, Skopje, Fyrom Objectives: The purpose of the stady is presentation of diagnosis and operative treatment of buccal giant pleomorphic adenoma in 16 years old boy. Introduction: Salivary gland neoplasms are relatively uncommon with an incidence between 0.4 and 13.5 cases per 100,000 and represent between 1 and 5 percent of all head and neck tumors. Tumors of the salivary glands comprise 3% of all neoplasms (Grewal). The majority of salivary gland neoplasms are benign with pleomorphic adenomas the most common, but the majority of minor salivary gland tumors are malignant (Spiro). The incidence of salivary gland neoplasms in minor salivary glands varies from 9 to 22% (Magliulo, Spiro) and according to Grewal approximately 8% of pleomorphic adenomas involve minor salivary glands. Tumors rising in minor salivary glands accounts for 22% of all salivary gland neoplasms and majority of them are malignant with only 18% benign, with most pleomorphic adenoma. Joshihara and Suzuki found that the majority of pleomorphic adenoma of minor salivary gland involve the palate followed by lip. The next common sites are the buccal mucose, tongue, tonsil, pharynx, retromolar area and nasal cavity. Waldron et al. report 57.5% incidence of benign tumor in 426 cases of intraoral minor salivary gland tumor with most common pleomorphic adenoma. The palate was the most common site followed by the upper lip and buccal mucosa. The majority of salivary gland neoplasms occur in the third to fifth decade with slight female predominance. According to Waldron there is a a slight female to male preponderence at 1.59 to 1 and the mean age of patients is 49.8 years versus 55.2 years for patients with malignant tumors. The palate is the most common site followed by the upper lip, and buccal mucosa. Lesions at these three sites account for 76.1% of oral minor salivary gland tumors. Case: A 16-year-old boy sought medical attention for a large growth on the left side of the face in November 2007. The painless swelling had gradually increased in size over a period in excess of 3 years. Examination showed the swelling to be related to the left buccal side and was oval in shape. The growth measured 6.0×5.5×3.5 cm in dimensions and was firm in consistency. It was attached to the deeper structures in maxillary and nasal bone, but movable. The lesion was clinically diagnosed as a benign tumor arising in the parotid gland and fine needle aspiration cytology diagnosed the lesion as a pleomorphic adenoma (PA). Computerised tomography shows benign tumor with contact of mandibular body involving sphenoidal bone and sinus maxillaris, mandibular body, pterygoid lateral and temporal muscle with subbuccal and
Pathology and surgery of the salivary glands I
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submasseterical position. X-ray pictures with laboratory tests have been also performed. The tumor was subsequently excised under general anaesthesia along with total extirpation with intraoral approach and preservation of nearby bone structures. One week post-operatively patient recover fully. Very good aesthetic and functional results were performed. Macroscopically, the excised specimen was ovoid in shape and 6×5.5×3.5 cm in dimensions and weighed 42 g. Microscopically, the tumor was composed of strands and islands of epithelial and myoepithelial cells with many chondrocites sometimes in a myxomatous components. Some areas showed solid sheets of epithelial cells with squamous methaplasia. There was no evidence of malignancy and the tumour was diagnosed as a PA. Conclusion: Patient has been followed ambulatory. Very successful esthetic result with intraoral approach was performed. Neither reccurence or functional disorder has been observed. Future follow up is necessary. O.531 Advantages vs tradition – partial superficial parotidectomy M.P. Ilic, A. Kiralj, S. Dedic, B. Pejakovic, B. Markov. Clinical Center Vojvodina, Clinic for Maxillofacial Surgery, Novi Sad, Serbia Parotidectomy is the most common approach for benign salivary neoplasms (such as pleomorphic adenoma and Warthin’s tumor). The standard surgical method for pleomorphic adenoma is conservative superficial parotidectomy or total parotidectomy, although local excisions and enucleations are still reported. Recently, certain authors use modified technique including subtotal parotidectomy or partial parotidectomy, by preserving intact parotid tissue. The reasons are: reducing postoperative functional and cosmetic disturbance. Aim: The purpose of this study was to evaluate the advantages and complications of partial superficial parotidectomy in the surgical management of patients with benign parotid tumors. Material and Methods: In 2001–2006 period at Clinic for Maxillofacial Surgery 77 benign parotid gland tumor patients were operatively treated by the same surgeon. The operative techniques included: partial superficial parotidectomy (65), superficial parotidectomy (10) and total parotidectomy (2). Histological analysis showed 58 pleomorphic adenoma, 15 Warthin’ tumor and 4 other benign tumors. We have checked complications in short and long postoperative period. Results: This article shows some characteristics after partial parotidectomy. Postoperative pain and recovery are reduced. Numbness of the earlobe and outer edge of the ear was the most frequent disturbance (61 cases) during 2−7 postoperative months. 5 patients had temporary facial palsy of some branches. No patient had permanent facial nerve damage. Frey’s syndrome was present in 3 cases, temporary parotid fistula in 1. Partial skin flap necrosis have been detected in 4 patients, infection in 2, postoperative bleeding in 1 and postoperative swelling in 5 cases. The main benefits of partial superficial parotidectomy are: absence of recurrences and very good cosmetic effect – small depression in parotid region. Conclusion: Partial superficial parotidectomy minimize the risk of complication during and after parotidectomy. Absence of permanent facial palsy, no evidence of recurrence and excellent cosmetic effect are reasons for more frequent use of this kind of parotidectomy. But, the necessity for this operation is to be performed by experienced surgeon.
O.530 A giant pleomorphic adenoma of minor buccal salivary gland A. Benedetti, V. Popovski, A. Iliev, B. Ilievski. Clinic for Maxillofacial Surgery, Skopje, Fyrom Objectives: The purpose of the stady is presentation of diagnosis and operative treatment of buccal giant pleomorphic adenoma in 16 years old boy. Introduction: Salivary gland neoplasms are relatively uncommon with an incidence between 0.4 and 13.5 cases per 100,000 and represent between 1 and 5 percent of all head and neck tumors. Tumors of the salivary glands comprise 3% of all neoplasms (Grewal). The majority of salivary gland neoplasms are benign with pleomorphic adenomas the most common, but the majority of minor salivary gland tumors are malignant (Spiro). The incidence of salivary gland neoplasms in minor salivary glands varies from 9 to 22% (Magliulo, Spiro) and according to Grewal approximately 8% of pleomorphic adenomas involve minor salivary glands. Tumors rising in minor salivary glands accounts for 22% of all salivary gland neoplasms and majority of them are malignant with only 18% benign, with most pleomorphic adenoma. Joshihara and Suzuki found that the majority of pleomorphic adenoma of minor salivary gland involve the palate followed by lip. The next common sites are the buccal mucose, tongue, tonsil, pharynx, retromolar area and nasal cavity. Waldron et al. report 57.5% incidence of benign tumor in 426 cases of intraoral minor salivary gland tumor with most common pleomorphic adenoma. The palate was the most common site followed by the upper lip and buccal mucosa. The majority of salivary gland neoplasms occur in the third to fifth decade with slight female predominance. According to Waldron there is a a slight female to male preponderence at 1.59 to 1 and the mean age of patients is 49.8 years versus 55.2 years for patients with malignant tumors. The palate is the most common site followed by the upper lip, and buccal mucosa. Lesions at these three sites account for 76.1% of oral minor salivary gland tumors. Case: A 16-year-old boy sought medical attention for a large growth on the left side of the face in November 2007. The painless swelling had gradually increased in size over a period in excess of 3 years. Examination showed the swelling to be related to the left buccal side and was oval in shape. The growth measured 6.0×5.5×3.5 cm in dimensions and was firm in consistency. It was attached to the deeper structures in maxillary and nasal bone, but movable. The lesion was clinically diagnosed as a benign tumor arising in the parotid gland and fine needle aspiration cytology diagnosed the lesion as a pleomorphic adenoma (PA). Computerised tomography shows benign tumor with contact of mandibular body involving sphenoidal bone and sinus maxillaris, mandibular body, pterygoid lateral and temporal muscle with subbuccal and
Pathology and surgery of the salivary glands I
S133
submasseterical position. X-ray pictures with laboratory tests have been also performed. The tumor was subsequently excised under general anaesthesia along with total extirpation with intraoral approach and preservation of nearby bone structures. One week post-operatively patient recover fully. Very good aesthetic and functional results were performed. Macroscopically, the excised specimen was ovoid in shape and 6×5.5×3.5 cm in dimensions and weighed 42 g. Microscopically, the tumor was composed of strands and islands of epithelial and myoepithelial cells with many chondrocites sometimes in a myxomatous components. Some areas showed solid sheets of epithelial cells with squamous methaplasia. There was no evidence of malignancy and the tumour was diagnosed as a PA. Conclusion: Patient has been followed ambulatory. Very successful esthetic result with intraoral approach was performed. Neither reccurence or functional disorder has been observed. Future follow up is necessary. O.531 Advantages vs tradition – partial superficial parotidectomy M.P. Ilic, A. Kiralj, S. Dedic, B. Pejakovic, B. Markov. Clinical Center Vojvodina, Clinic for Maxillofacial Surgery, Novi Sad, Serbia Parotidectomy is the most common approach for benign salivary neoplasms (such as pleomorphic adenoma and Warthin’s tumor). The standard surgical method for pleomorphic adenoma is conservative superficial parotidectomy or total parotidectomy, although local excisions and enucleations are still reported. Recently, certain authors use modified technique including subtotal parotidectomy or partial parotidectomy, by preserving intact parotid tissue. The reasons are: reducing postoperative functional and cosmetic disturbance. Aim: The purpose of this study was to evaluate the advantages and complications of partial superficial parotidectomy in the surgical management of patients with benign parotid tumors. Material and Methods: In 2001–2006 period at Clinic for Maxillofacial Surgery 77 benign parotid gland tumor patients were operatively treated by the same surgeon. The operative techniques included: partial superficial parotidectomy (65), superficial parotidectomy (10) and total parotidectomy (2). Histological analysis showed 58 pleomorphic adenoma, 15 Warthin’ tumor and 4 other benign tumors. We have checked complications in short and long postoperative period. Results: This article shows some characteristics after partial parotidectomy. Postoperative pain and recovery are reduced. Numbness of the earlobe and outer edge of the ear was the most frequent disturbance (61 cases) during 2−7 postoperative months. 5 patients had temporary facial palsy of some branches. No patient had permanent facial nerve damage. Frey’s syndrome was present in 3 cases, temporary parotid fistula in 1. Partial skin flap necrosis have been detected in 4 patients, infection in 2, postoperative bleeding in 1 and postoperative swelling in 5 cases. The main benefits of partial superficial parotidectomy are: absence of recurrences and very good cosmetic effect – small depression in parotid region. Conclusion: Partial superficial parotidectomy minimize the risk of complication during and after parotidectomy. Absence of permanent facial palsy, no evidence of recurrence and excellent cosmetic effect are reasons for more frequent use of this kind of parotidectomy. But, the necessity for this operation is to be performed by experienced surgeon.