• 대한두경부종양학회지
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• 제10권2호
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• pp.171-177
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• 1994

We reviewed retrospectively 152 patients' records with salivary gland tumors confirmed histologically at Hanyang University Hospital from Jan. 1984 to Dec. 1993. The results obtained were as follows: 1) Sites of tumors were parotid gland in 102 cases(67%), submandibular gland in 29 cases(19%) and minor salivary glands in 21 cases (14%). 2) 113 cases(74%) were benign. and 39 cases(26%) were malignant. 3) The incidence of benign and malignant tumors were 81% & 19%, 69% & 31% and 48% & 52% in the parotid gland, the submandibular gland and the minor salivary glands respectively. 4) The most frequent histologic types of benign and malignant tumors were pleomorphic adenoma (64%) and mucoepidermoid carcinoma (11%) respectively. 5) The surgical procedures include superficial parotidectomy. total parotidectomy. extended total parotidectomy & neck dissection in the parotid gland. wide excision & neck dissection in the submandibular gland and wide excision, partial maxillectomy & neck dissection in the minor salivary glands. 6) The postoperative recurrence rate were 4.4% in benign tumors and 27% in malignant tumors.

• Korean Journal of Radiology
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• 제24권9호
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• pp.860-870
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• 2023

Objective: The intra-parotid facial nerve (FN) can be visualized using three-dimensional double-echo steady-state water-excitation sequence magnetic resonance imaging (3D-DESS-WE-MRI). However, the clinical impact of FN imaging using 3D-DESS-WE-MRI before parotidectomy has not yet been explored. We compared the clinical outcomes of parotidectomy in patients with and without preoperative 3D-DESS-WE-MRI. Materials and Methods: This prospective, non-randomized, single-institution study included 296 adult patients who underwent parotidectomy for parotid tumors, excluding superficial and mobile tumors. Preoperative evaluation with 3D-DESS-WE-MRI was performed in 122 patients, and not performed in 174 patients. FN visibility and tumor location relative to FN on 3D-DESS-WE-MRI were evaluated in 120 patients. Rates of FN palsy (FNP) and operation times were compared between patients with and without 3D-DESS-WE-MRI; propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for surgical and tumor factors. Results: The main trunk, temporofacial branch, and cervicofacial branch of the intra-parotid FN were identified using 3D-DESS-WE-MRI in approximately 97.5% (117/120), 44.2% (53/120), and 25.0% (30/120) of cases, respectively. The tumor location relative to FN, as assessed on magnetic resonance imaging, concurred with surgical findings in 90.8% (109/120) of cases. Rates of temporary and permanent FNP did not vary between patients with and without 3D-DESS-WE-MRI according to PSM (odds ratio, 2.29 [95% confidence interval {CI} 0.64-8.25] and 2.02 [95% CI: 0.32-12.90], respectively) and IPTW (odds ratio, 1.76 [95% CI: 0.19-16.75] and 1.94 [95% CI: 0.20-18.49], respectively). Conversely, operation time for surgical identification of FN was significantly shorter with 3D-DESS-WE-MRI (median, 25 vs. 35 min for PSM and 25 vs. 30 min for IPTW, P < 0.001). Conclusion: Preoperative FN imaging with 3D-DESS-WE-MRI facilitated anatomical identification of FN and its relationship to the tumor during parotidectomy. This modality reduced operation time for FN identification, but did not significantly affect postoperative FNP rates.

• 대한두경부종양학회지
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• 제26권1호
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• pp.19-23
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• 2010

Objectives : In parotidectomy, facial nerve dissection technique had been evolved for its safety. Surgical landmarks are important and good guides to facial nerve detection. Conventional exposure and release of the nerve requires hemostat for elevation of parotid tissue from nerve and #11 blade for cutting the parotid away from the nerve. Material and Methods : The rolling the parotid tissue over the nerve after dissecting with Metzembaum scissors instead of knife, lessen pulling trauma and nerve cutting by knife. Eleven superficial parotidectomies since June 2009 were done with rolling technique and preliminary report is presented. Results : Total 11 parotidectomies were done using proposed technique with tolerable complications(temporary facial dysfunction in 4 cases). Conclusion : Rolling method using metzembaum scissors could be applied to parotid operation.

• 대한두경부종양학회지
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• 제28권1호
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• pp.31-33
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• 2012

Mucoepidermoid carcinoma is most frequent malignant tumor of parotid gland. However, mucoepidermoid carcinoma arising from pleomorphic adenoma has been disputed and rarely reported. 54-year-old woman with pleomorphic adenoma underwent superficial parotidectomy. And 15 years later, she diagnosed mucoepidermoid carcinoma at the same side. We report the case with a review of literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권3호
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• pp.247-253
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• 2006

우리는 좌측 전이부 및 하악지 부위에 생긴 $10\times7\times5cm$ 크기의 거대한 종물을 주소로 내원한 67세 남자 환자에서 임상검사, 방사선동위원소 타액선스캔, 전산화단층촬영 및 조직생검 등을 통해 좌측 이하선의 다형성 선종으로 진단하고 변형 Blair 절개법을 통해 안면신경을 보존하면서 이하선 천층엽절제술을 시행하여 기능적 및 심미적으로 만족스러운 결과를 얻었다. 이하선 천층엽절제술과 안면신경의 분리 및 보존을 시행할 경우 단순적출술에 비해 국소 재발율이 낮고 안면신경이 보존되므로 이하선 다형성 선종의 수술법으로 적절함을 알 수 있었다.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.607-610
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• 2008

Purpose: Salivary duct carcinoma(SDC) is uncommon but high grade adenocarcinoma arising in the ductal epithelium of salivary glands. SDC is characterized by distinctive clinical and pathologic features. The most important histologic aspect of this neoplasm is its resemblance to ductal carcinoma of the breast. Clinically SDC is defined by cervical lymph node involvement and distant metastasis with a high rate of recurrence and mortality. We described some of the clinical and pathological features of SDC and the management using case report for our patient. Methods: We present a case of a 40-year-old male with 2-year history of a swelling arising in his left preauricular region. There was a single painless, firm and solid $2{\times}1.5cm$ mass in the left parotid area. Facial nerve function was intact and no cervical lymph node were palpable. In August 2005, we found out $1.7{\times}1.8cm$ sized cystic, nodular lesions that were located in the superficial lobe of left parotid gland through Computed tomography. And then superficial parotidectomy and postoperative radiation therapy were performed in Jan 2007. Results: Pathologically, the specimen were consisted of homogeneous, chondoid to myxoid type of tissues. It was yellow mass that has multiloculated cystic lesions. In postoperative PET(Positiron emission tomography) CT, there was no evidence of uptaking FDG(Fluorodeoxyglucose) into the deep layers of parotid gland and distant metastasis were not seen. Conclusion: Salivary duct carcinoma(SDC) is a rare but high grade adenocarcinoma related to pleomorphic adenocarcinoma. The prognosis of SDC can be different according to the type of tumor such as mucoepidermoid adenocarcinoma, adenoid duct carcinoma and acinar cell carcinoma. So we need to study more carefully for accurate diagnosis in early stage of diagnosis. Although radiotherapy has not yet proven to be a significant factor in overall survival, the combination of parotidectomy and postoperative radiation therapy can lead to more favorable results in treating of SDC.

• 대한두경부종양학회지
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• 제12권2호
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• pp.177-180
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• 1996

Warthin's tumor is a benign and slow growing tumor found exclusively in the parotid gland or the periparotid lymph nodes. It mostly affects males between the age of forty to seventy years and is closely related with smoking history. Between January 1981 and June 1996, 42 patients underwent surgical excision of Warthin's tumor of the parotid gland; which made up 10.6% of all parotid gland surgeries(398 cases) during the same period. Their ages ranged from 36 to 75 years with a mean age of 56 years. There were 33 male and 9 female patients with a 4.3 : 1 male to female ratio. The majority of the tumors were situated in the parotid tail whereas one was in the deep lobe. Bilateral simultaneous involvements of the parotid gland were found in 4 patients(9.5%) ; therefore total of 46 parotid glands were involved. Four(8.7%) of the 46 parotid glands had multifocal tumors ranginging from two to three lumps. Tumor sizes varied from 1.5 to 6.0cm with mean diameter of 3.lcm. Of the 42 patients, 26(61.9%) were diagnosed preoperatively or peroperatively by means of CT scans, ultrasound, 99m-Tc. scan, fine needle aspiration cytology or intraoperative frozen section biopsy. Of the 46 tumors, 30 underwent a superficial(n=29) or total(n=1) parotidectomy and for 16 cases with tumors suspected preoperatively or peroperatively of being single Warthin's tumor, only enucleation was performed. No cases of recurrence were identified during the follow up period regardless of type of operation performed, however the postoperative complication rate was much higher in the parotidectomy group(33.3%) than in the enucleation only group(12.5%). We feel that an enucleation procedure may be appropriate for the patients with single Warthin's tumor.

• 대한두경부종양학회지
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• 제15권2호
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• pp.205-210
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• 1999

Objectives: Major salivary gland tumor mainly develops in the parotid gland and pleomorphic adenoma is a large percentage. The aim of this study is to get clinicopathologic characteristics of overall major salivary gland tumors and suggestions regarding surgical management through collective review of 315 cases. Materials and Methods: This is a clinicopathologic review of 315 cases of major salivary gland tumor who were treated surgically at Department of Surgery, Head and Neck Clinic, Pusan Paik Hospital, Inje University during the period of 18 years from 1980 to 1997. Analysis was performed regarding the incidence, classification, surgery and its complications, and survival rate of salivary gland cancer. Results : 1) Parotid gland was the most prevalent site of salivary gland tumor(78%) and submandibular gland(21%) was next in order. Benign tumors were 257cases(81%) and malignant tumors were 58 cases(19%). 2) Male to female sex ratio was 1:1.2, the most prevalent age group was 3rd decade and the second group was 4th decade. 3) Histopathologically, the most common benign salivary gland tumor was pleomorphic adenoma. Warthin's tumor was next common. Among the malignant tumors, mucoepidermoid carcinoma was most common, and the next were adenoid cystic carcinoma and acinic cell carcinoma. 4) In pleomorphic adenoma, superficial parotidectomy was performed in 129 cases, and extracapsular tumorectomy was performed in 3 cases. In non-pleomorphic benign tumor, tumorectomy was performed in 21 cases. In 40 cases of deep lobe tumor, total parotidectomy was performed in only 2 cases and deep parotidectomy was performed in 38 cases. 5) Surgical complications were facial nerve injury 19 cases, Frey syndrome 13 cases, and salivary fistula 3 cases. 6) Overall 5-year survival rate of salivary gland cancer was 63%. Conclusion: Postoperative recurrence rate is low in benign tumor, but high in cancer of salivary gland tumor. Surgical procedure should not be aggressive in benign tumor, especially in parotid tumor, but should be aggressive in malignant salivary gland tumors.

• 대한두경부종양학회지
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• 제19권1호
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• pp.3-8
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• 2003

Background: Surgical management of recurrent pleomorphic adenoma of the parotid gland has a considerable risk of facial nerve injury and a high re-recurrence rate. To obtain more insight into the issue of recurrent pleomorphic adenoma and more specifically to evaluate our experience and results of treatment, a retrospective study was carried out. Materials and Methods: During the period from 1989 to 2002, the medical records of 14 patients who underwent a operation for recurrent pleomorphic adenoma of the parotid gland were reviewed retrospectively. The initial operation for parotid tumor, clinical features of recurrence, reoperation after recurrence, po stop complication were analysed. Results: The male to female ratio was 6 : 9. Median age of the patients at the time of the initial operation was 33 years and at the time of the reoperation was 43 years. The median interval until recurrence was 105 months (6-252 months). The initial operations performed were excision or enucleation in 10 patients, superficial parotidectomy in 3 patients, total parotidectmy in 1 patients. The thirteen patients were underwent reoperation (8 superficial parotidectomies, 3 total parotidectomies, 1 neartotal parotidectomy, 1 wide excision). The facial nerve paralysis after the reoperation occured in 6 patients but all of them were recovered from 3 months to 1 year after surgery. Conclusion: In the management of pleomorphic adenoma of the parotid gland, excision or enucleation is to be avoided due to the higher recurrence rate and superficial or total parotidectomy with preservation of the facial nerve are to be preferred. Because the risk of facial nerve injury during operation for the recurrent tumor was higher than initial surgery, more careful surgical procedure is mandatory for preserving the facial nerve.

• 대한두경부종양학회지
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• 제24권1호
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• pp.9-14
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• 2008

The most important concern to do parotidectomy is correct identification of the facial nerve and preservation of the nerve function. Many descriptions for the localization and branching types of the facial nerve trunk have existed. During the parotid surgery, it is necessary to have knowledges about the incidence and prognostic aspect of a invasion of the facial nerve by the parotid tumors. The method of the dissection and the surgical extent of the parotid gland would be decided not only by the anatomic variation of the facial nerve. but also the size and location of the tumor. Invasion of the facial nerve in parotid malignancies is the most significant factors affecting the prognosis, so radical parotidectomy which consists of the total extirpation of the parotid gland in conjunction with resection of the facial nerve is often required for proper management. Radical parotidectomy is advocated for the surgical treatment of high grade malignancies and in selective recurrent benign tumors intimately involving the facial nerve. Unfortunately, the morphologic and functional deficits created by sacrificing the facial nerve can be emotionally and physically traumatizing to the patient. Therefore, when the facial nerve is sacrificed, immediate reconstruction of the facial nerve should be necessary. Immediate nerve repair with direct anastomosis of the resected nerve ends or placement of a cable nerve graft provides the better cosmetic and functional results. Surgical resection remains the mainstay of treatment for cancer of the parotid gland, and there is general agreement that facial nerve should not be sacrificed unless the tumor is adherent to, or surrounds the nerve. The following statement is described general principles of troublesome management of the facial nerve during surgery for parotid tumor.