Thank You Joe Curry, MD David Cognetti, MD Ryan Heffelfinger, MD

Transcription

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

28

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

41

42

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.

46

47

48

49

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

61

62

63

64

65

66

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.