Parotid gland is the most common location for salivary gland tumors, more commonly pleomorphic adenoma and Warthin's tumor. Types of parotid surgery include superficial parotidectomy (SP), partial ...superficial parotidectomy (PSP), total conservative parotidectomy (TCP), enucleation (E), extracapsular dissection (ECD), and are related to different incidence of complications. The choice depends on tumors localization, dimension and histology. The aim was to compare complications rate such as facial and great auricular nerve impairment and Frey syndrome according to type of surgery performed.
We retrospectively review the management of 116 benign tumors of the parotid gland treated between January 2004 and January 2020 at our Department.
Most frequent complication observed was a GAN deficiency (22.41%), permanent in 13% of cases. Post-operative facial nerve impairment was observed in 19 patients (persistent only in 1 case). Only Frey syndrome (4,31% of cases) seemed to be related to type of surgery (p<0.05) resulting more frequent in the group of patients that underwent "classical" parotidectomy, while facial nerve impairment, even if more frequent in this cases, did not statistically correlated with operative technique (p=0.054).
Once experience is gained, in order to reduce post-operative morbidity extracapsular dissection is a reliable technique in the management of these neoplasms, even if attention has to be paid particularly in the removal of superficial masses "emerging" from the parenchyma. PSP is an alternative to SP, while CTP has to be reserved to selected cases ot tumors arising in the deep lobe.
Benign tumor, Extracapsular dissection, Enucleation, Facial nerve Parotid gland, Parotidectomy, Superficial parotidectomy.
Abstract Only about 0.5% of all head and neck neoplasms occur in the parapharyngeal space (PPS) and approximately 80% of these tumours are benign lesions. Various surgical approaches some of which ...are associated with mandibulotomy to increase exposure have been described. This article describes our 16-years' experience in treating 60 PPS benign tumours with special focus on our surgical techniques intended to ensure adequate mass exposure and structure safety. On the basis of our experience we assert that mandibulotomy is currently not advocated in the surgical management of benign PPS tumours i.e. not even in very select cases. The transparotid approach is the treatment of choice for parotid gland lesions involving PPS and in cases of multinodular or uninodular pleomorphic adenoma relapse involving the PPS. The transcervical approach is suitable for the safe removal of even large PPS masses in most cases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
ABSTRACTSince the 1980s, bone free flaps have been used to reconstruct the maxilla and the mandible. The vascular pedicle, through the supply of nutritional substances and drugs from the bloodstream, ...ensures the vitality of the flap, rapid bone integration, and reduced risk of infection.However, due to many surgeons’ concerns about orocervical and orosinusal fistulas and infections, bone flaps are usually buried and protected by mucosal flaps or a second skin flap whenever it is not possible to harvest a skin paddle together with the bone flap.The authors, convinced that naked bone free flaps, if well vascularized, are capable of healing and repairing the osteomucosal deficit on their own, with no risk of infection or fistulas, began to harvest, for oral reconstructions, naked bone flaps, that is, bone flaps covered only by a muscle layer 5 to 20 mm thick.In this study, the authors present a review of their experience in oral cavity reconstructions by harvesting naked and covered bone free flaps, retrospectively evaluating the occurrence of major and minor, early and late complications, associated with the different reconstructive technique.
Abstract
Trigeminal nerve damage after mandibulectomy is a condition that may occur not infrequently when oncologic resections of the maxillo-facial district are performed. In the last decades ...microsurgery has made possible effective osteomuscular reconstructions using vascularised free flaps. Nevertheless, this procedure, if assuring satisfactory results, involved the sacrifice of the mandibular nerve. Nowadays, supramicrosurgical innovation has shifted the gold-standard to a higher level, allowing the complete sensitive recovery after mandibulectomy. The cross-face nerve transfer technique is an innovative procedure that provides excellent nerve regeneration in mini-invasive operations, avoiding visible scars and any deficiency in donor sites. We suggest that the cross-face nerve transfer is the surgical modality of choice to restore lower lip and chin sensibility after mandibulectomy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
In patient with facial paralysis, facial appearance and muscular ability are impaired, and the psychological integrity is affected. Botulinum toxin A may be used to improve facial symmetry in ...patients suffering with facial palsy reducing the progressive contralateral hyperkinesis and facial asymmetry after primary surgery for facial paralysis.
Six patients, whom have been suffering unilateral facial palsy with an House-Brackmann score grade from III to VI, were included in this study for a residual facial asymmetry and contralateral hyperkinesis after previous facial reanimation. They were treated with 50 units of botulinum toxin type A injected in muscles of the unaffected side of face to improve muscular ability and facial symmetry.
This study demonstrated reduction in contralateral hyperkinesis and facial asymmetry that lasted approximately 120 days. All patients reported satisfactory results with the treatment.
Botulinum toxin type A injections improved facial asymmetry and muscular function in all patients.
Botulinum toxin type A injections may be an indispensable technique as a nonsurgical treatment or as a complementary measure in postsurgical treatments and should be certainly considered for temporary or permanent asymmetries in patients who suffer from facial palsy.
Contralateral botulinum toxin type A injection was useful in reducing muscular hyperkinesis in patients with residual facial asymmetry after primary surgery for facial palsy, improving aesthetic and functional facial recovery with not widely common adverse events.
Abstract Free flap reconstruction is the treatment of choice after extensive head and neck tumour resection. When treating a patient with a previous disability, such as lower extremity paralysis ...secondary to poliomyelitis, it is important to offer the best reconstruction whilst preserving healthy extremities. We report the case of a 51-year-old man with a squamous cell carcinoma (SCC) of the right tongue and a left lower extremity paralysis secondary to an acute poliomyelitis during childhood in which reconstruction was successfully achieved with a left anterolateral thigh (ALT) free flap.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The goal of our study is investigate the frequency of metastasis to oro-maxillo-facial region to understand if they are really so rare.
In this eight year's retrospective study (2004-2012) we ...collected 15 cases of metastasis localized in the maxilla-facial region from distant primary tumor.
Our results show breast and kidney as the most frequent primary site (40% and 20% respectively), adenocarcinoma as most common histological type (60%). Bone involvement has found to be much frequent than the soft tissue one (53.3%). The mandible (5/15 cases) is more affected than the maxilla, and most common interested subsites are molar and retromolar region. In our study we found only one case of unknown primary tumor, it was a mandibular bone metastasis from a renal clear cell carcinoma.
Finally, according to our results and considering the increase of survival in cancer disease, even if metastases to oro- maxilla- facial region from distant sites are not frequent, it is important to suspect secondary lesions both in patients that was referred a tumor in their medical history and in those that present a head and neck lesion.
