Thank You Joe Curry, MD David Cognetti, MD Ryan Heffelfinger, MD
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1 Thank You Joe Curry, MD David Cognetti, MD Ryan Heffelfinger, MD
2
3 Anatomy Epidemiology Pathology Treatment Controversies Current Research
4 Largest Salivary Gland 80% is superficial lobe Encased in Superficial Layer Deep Cervical Fascia
5 Secretory Function
6 Secretory Function
7 Facial Nerve
8 Risk Factors Radiation exposure Genetic predisposition Tobacco use Warthin s tumor Microorganism EBV linked to lymphoepithelial carcinoma
9 Histogenesis Multicellular Theory Bicellular Reserve Cell Theory
10 Table Distribution of 2807 Salivary Neoplasms Histology Number of Patients Percent Pleomorphic adenoma Warthin's tumor Benign cyst 29 1 Lymphoepithelial lesion Oncocytoma Monomorphic adenoma Mucoepidermoid carcinoma Adenoid cystic carcinoma Adenocarcinoma Malignant mixed tumor Acinic cell carcinoma 84 3
11 Benign Neoplasms
12 Pleomorphic Adenoma Most common salivary gland neoplasm 65-75% of all benign tumors of major salivary glands Painless Slow Growing Mass 90% Superficial to CN VII in parotid Presents in 3-6 th decade F:M = 3:1
13 Pleomorphic Adenoma Histology
14 Warthin s Tumor Second most common 6-12% of parotid neoplasms M>F 5-7 th decades 10% Bilateral Painless Slow Growing Mass Etiology Smoking Radiation
15 Warthin s Tumor Histology
16 Oncocytoma 1% of salivary neoplasms Most commonly arises in Parotid M=F 6 th decade Enlarging painless mass
17 Oncocytoma Histology
18 Basal Cell Adenoma Variant of monomorphic adenoma Mobile, Asymptomatic Mass 2% of all Salivary Gland Tumors 70% Occur in Parotid M:F = 1:1 4-9 th Decade
19 Basal Cell Adenoma Histology
20
21 Malignant Neoplasms
22 Mucoepidermoid Carcinoma Most common malignant salivary gland neoplasm 10-15% of all salivary gland neoplasms 45% of all malignant parotid tumors F>M 3-7 th decade
23 Mucoepidermoid Carcinoma Histology
24 Adenoid Cystic Carcinoma 10-12% of malignant salivary gland neoplasm 5% of parotid gland neoplasms M=F 6 th decade Slow-growing mass Pain, Facial paresis/paralysis
25 Adenoid Cystic Carcinoma Histology
26 Acinic Cell Carcinoma 5-11% of all malignant salivary gland neoplasms >80% of cases arise in parotid F>M 3-6 th decade Solitary, slow growing, mobile mass
27 Acinic Cell Carcinoma Histology
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29 Parotidectomy Superficial/Lateral Total Limited Parotidectomy Enucleation Extracapsular Dissection Partial Superficial Parotidectomy Approaches Rhytidectomy Blair Reconstruction
30 Gold Standard Superficial/Lateral Lesions of Superficial lobe Total Lesions of Deep Lobe
31 Complications Facial Nerve Injury Temporary: 5-25% (Superficial Parotidectomy), 20-50% (Total) Permanent: 5-8% (Superficial Parotidectomy), 5-10% (Total) Hematoma/Seroma 3-7% cases Sialocele 5-10% Salivary Fistula 5% Frey Syndrome
32 Enucleation Opening capsule and removing tumor within Extracapsular dissection Meticulous dissection outside tumor capsule 1-2mm cuff of loose areolar tissue around mass Partial Superficial Parotidectomy Dissection of main trunk of VII and Branch adjacent to mass 1-2cm cuff of normal tissue around mass
33 Tumor capsule opened Tumor removed from capsule Performed in US prior to 1950 s High Recurrence Rate 20-45%
34 - Mixed tumors of salivary glands. Long-term follow-up. Krolls SO, Boyers RC. Cancer Jul;30(1):
35 Tumor removal w meticulous dissection Minute cuff of surrounding tissue No Exposure of CN VII
36 Outcome, general, and symptom-specific quality of life after various types of parotid resection. Ciuman RR, Oels W, Jaussi R, Dost P. Laryngoscope Jun;122(6):
37 Long-term results of morbidity after parotid gland surgery in benign disease. Koch M, Zenk J, Iro H. Laryngoscope Apr;120(4):
38 Follow-up of parotid pleomorphic adenomas treated by extracapsular dissection. Iro H, Zenk J, Koch M, Klintworth N. Head Neck Jun;35(6):
39 Pleomorphic adenoma: extracapsular dissection versus partial superficial parotidectomy with facial nerve dissection Witt RL, Rejto L ECD PSP Recurrence 36/1183 (3.0%) 1/340 (0.3%) Transient paresis 112/1036 (11.8%) 142/793 (17.9%) Permanent paresis 22/1202 (1.8%) 2/924 (0.2%) Pleomorphic adenoma: extracapsular dissection versus partial superficial parotidectomy with facial nerve dissection. Witt RL, Rejto L. Del Med J Mar;81(3):
40 Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Zbären P et al. Am J Surg Jan;205(1):109-18
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43 The extended indication of parotidectomy using the modified facelift incision in benign lesions: retrospective analysis of a single institution. Lee SY, Koh YW, Kim BG, Hong HJ, Jeong JH, Choi EC. World J Surg Oct;35(10):
44 The extended indication of parotidectomy using the modified facelift incision in benign lesions: retrospective analysis of a single institution. Lee SY, Koh YW, Kim BG, Hong HJ, Jeong JH, Choi EC.
45 Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison. Wasson J, et al. Ann R Coll Surg Engl Jan;92(1):40-3.
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50 Frey's syndrome: a preventable phenomenon. Bonanno PC, Casson PR. Plast Reconstr Surg Mar;89(3):452-6
51 p = p = 0.42 p = Impact of the SMAS on Frey's syndrome after parotid surgery: a prospective, long-term study. Wille- Bischofberger A, Rajan GP, Linder TE, Schmid S. Plast Reconstr Surg Nov;120(6):
52 Aesthetic parotid surgery: evolution of a technique. Arden RL, Miguel GS. Laryngoscope Dec;121(12):
53 Sternocleidomastoid Muscle Flap
54 Meta-analysis of Surgical Techniques for Preventing Parotidectomy Sequelae. Curry J, King N, Reiter D, Fisher K, Heffelfinger R, Pribitkin E. Arch Facial Plast Surg. 2009;11(5):
55 Meta-analysis of Surgical Techniques for Preventing Parotidectomy Sequelae. Curry J, King N, Reiter D, Fisher K, Heffelfinger R, Pribitkin E. Arch Facial Plast Surg. 2009;11(5):
56 Meta-analysis of Surgical Techniques for Preventing Parotidectomy Sequelae. Curry J, King N, Reiter D, Fisher K, Heffelfinger R, Pribitkin E. Arch Facial Plast Surg. 2009;11(5):
57
58 - Free abdominal fat transfer for reconstruction of the total parotidectomy defect. onger BT, Gourin CG. Laryngoscope Jul;118(7):
59 Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Curry JM, Fisher KW, Heffelfinger RN, Rosen MR, Keane WM, Pribitkin EA. Laryngoscope Feb;118(2):210-5.
60 Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Curry JM, Fisher KW, Heffelfinger RN, Rosen MR, Keane WM, Pribitkin EA. Laryngoscope. 2008
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67 Revisiting our Parotid Series 2006-present 361 patients Modified Blair & Facelift No Recon, SMAS, Fat, SCM WLE and Free Flap
68 Retrospective Chart Review Demographic information Surgical Data Pathologic Data Postop outcomes Phone Survey Symptoms of Frey s Syndrome FACE-Q Questionnaire
69 Evaluate incidence of Frey s Syndrome Evaluation overall outcome Collaborative Research
70 Patient Related Outcomes Scale Validated/Reliable Questionnaire - Measuring Patient-Reported Outcomes in Facial Aesthetic Patients: Development of the FACE-Q. Klassen, Cano, Scott, Snell, Pusic. Facial plast Surg 2010; 26(4): Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale: a new patient-reported outcome instrument for facial aesthetics patients. Pusic AL Klassen AF, Scott AM, Cano SJ. Clin Plast Surg Apr;40(2): Measuring health-related quality of life outcomes in head and neck reconstruction. Pusic et al. Clin Plast Surg Apr;40(2):341-9.
71
72 Parotid Tumor Operations; the case against enucleation. Perzik SL. Calif Med Jul;85(1):26-9. Recurrent pleomorphic adenomas of the parotid gland: clinical evaluation and long-term follow-up. Laskawi R, Schott T, Schroder M. Br J Oral Maxillofac Surg Feb;36(1): Mixed tumors of salivary glands. Long-term follow-up. Krolls SO, Boyers RC. Cancer Jul;30(1): Recurrent pleomorphic adenoma of the parotid gland: analysis of 108 consecutive patients. Wittekindt C, Streubel K, Arnold G, Stennert E, Guntinas-Lichius O. Head Neck Sep;29(9): Outcome, general, and symptom-specific quality of life after various types of parotid resection. Ciuman RR, Oels W, Jaussi R, Dost P. Laryngoscope Jun;122(6): Long-term results of morbidity after parotid gland surgery in benign disease. Koch M, Zenk J, Iro H. Laryngoscope Apr;120(4): Follow-up of parotid pleomorphic adenomas treated by extracapsular dissection. Iro H, Zenk J, Koch M, Klintworth N. Head Neck Jun;35(6): Extra-capsular dissection in benign parotid tumors. Barzan L, Pin M. Oral Oncol Oct;48(10): Surgical management of benign tumors of the parotid gland: extracapsular dissection versus superficial parotidectomy--our experience in 232 cases. Dell'Aversana Orabona G et al. J Oral Maxillofac Surg Feb;71(2): Pleomorphic adenoma: extracapsular dissection versus partial superficial parotidectomy with facial nerve dissection. Witt RL, Rejto L. Del Med J Mar;81(3): Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Zbären P et al. Am J Surg Jan;205(1): Improving esthetic results in benign parotid surgery: statistical evaluation of facelift approach, sternocleidomastoid flap, and superficial musculoaponeurotic system flap application. Bianchi B, et al. J Oral Maxillofac Surg Apr;69(4):
73 Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison. Wasson J, et al. Ann R Coll Surg Engl Jan;92(1):40-3. Frey's syndrome: a preventable phenomenon. Bonanno PC, Casson PR. Plast Reconstr Surg Mar;89(3):452-6 Aesthetic parotid surgery: evolution of a technique. Arden RL, Miguel GS. Laryngoscope Dec;121(12): Impact of the SMAS on Frey's syndrome after parotid surgery: a prospective, long-term study. Wille- Bischofberger A, Rajan GP, Linder TE, Schmid S. Plast Reconstr Surg Nov;120(6): Meta-analysis of Surgical Techniques for Preventing Parotidectomy Sequelae. Curry J, King N, Reiter D, Fisher K, Heffelfinger R, Pribitkin E. Arch Facial Plast Surg. 2009;11(5): Free abdominal fat transfer for reconstruction of the total parotidectomy defect. onger BT, Gourin CG. Laryngoscope Jul;118(7): Free fat grafting in superficial parotid surgery to prevent Frey's syndrome and improve aesthetic outcome. Chan LS, Barakate MS, Havas TE. J Laryngol Otol Jul 9:1-6. Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Curry JM, Fisher KW, Heffelfinger RN, Rosen MR, Keane WM, Pribitkin EA. Laryngoscope Feb;118(2): Measuring Patient-Reported Outcomes in Facial Aesthetic Patients: Development of the FACE-Q. Klassen, Cano, Scott, Snell, Pusic. Facial plast Surg 2010; 26(4): Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale: a new patient-reported outcome instrument for facial aesthetics patients. Pusic AL Klassen AF, Scott AM, Cano SJ. Clin Plast Surg Apr;40(2): Measuring health-related quality of life outcomes in head and neck reconstruction. Pusic et al. Clin Plast Surg Apr;40(2):341-9.
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