• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.5
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• pp.384-387
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• 2009

Tumors of the deep lobe of parotid gland are rare. These benign tumors have usually been treated by total parotidectomy, which has functional and esthetic side effects. Recently, there has been a trend for operations of parotid gland benign tumors to be less radical and selective deep lobe parotidectomy has been introduced. This technique preserves the superficial lobe and facial nerve when tumor is located in the deep lobe. Selective deep lobe parotidectomy preserves parotid salivary function, minimizes the incidence of facial nerve damage and gustatory sweating (Frey's syndrome) and improves cosmetic outcome. We report a case of pleomorphic adenoma of the deep lobe that was successfully treated by selective deep lobe parotidectomy with satisfactory result.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.2
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• pp.170-177
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• 2005

The pleomorphic adenoma is well recognized as the most common salivary neoplasm. We examined 49 patients who had received surgical excision of the pleomorphic adenoma from 1989 to 1998 with over 5 years follow-up period. We retrospectively evaluated the patients' age, sex, chief complaints, surgical methods, and recurrence or complication rates after analysis of one's clinical and surgical records. The results are as follows : 1. There were 15 cases in parotid gland, 23 cases in palate, 8 cases in submandibular gland, and 3 cases in cheek. The ratio of male to female was 1 : 1.13. The mean age was 44. The tumor of submandibular gland occurred in more younger age than that of other salivary gland. 2. In 15 patients of parotid pleomorphic adenoma, there was 1 case(6.7%, 1/15) of recurrence. That was transformed into the malignant pleomorphic adenoma after 4 years of first surgery. We performed superficial parotidectomy of 9 cases(56.2%, 9/16), total parotidectomy of 6 cases(37.5%, 6/16), and radical parotidectomy of 1 case(6.3%, 1/16). 3. We used the rotational Sternocleidomastoid muscular flap to cover the exposed facial nerve in 12 cases(75%) after parotidectomy(7 cases of superficial parotidectomy and 5 cases of total parotidectomy). We could see 3 cases(18.7%) of facial nerve palsy and 1 case(6.3%) of Frey's syndrome after parotidectomy. We examined Frey's syndrome in only 1 case which was not used SCM muscular flap after parotidectomy. 4. In 23 patients of palatal pleomorphic adenoma, there were 2 cases(8.7%) of recurrence. In recurrence cases, We performed re-excision after 4 and 5 years of first surgery, respectively. We preserved partial thin overlying palatal mucosa during tumor excision in 5 cases(20%), which were proved as benign mixed tumor in preoperative biopsy. That mucosa-preserved cases had thick palatal mucosa, did not show mucosa ulceration and revealed well encapsulated lesions in preoperative CT. 5. In palatal tumors, we could see the 13 cases(52%) of bony invasion in preoperative CT views and the 4 cases(16%) of oro-nasal fistula after tumor excision. In two cases of recurrence, one(20%, 1/5) was in palatal mucosa-preserved group and the other(5.5%, 1/18) was in palatal mucosa-excised group. 6. We excised tumors with submandibular glands in the all cases of submandibular pleomorphic adenoma. There was no specific complication or recurrence in these cases. 7. After excision of the cheek pleomorphic adenomas, we could not see any complication or recurrence.

• Korean Journal of Head & Neck Oncology
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• v.24 no.1
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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.

• Korean Journal of Head & Neck Oncology
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• v.13 no.2
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• pp.221-227
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• 1997

The authors reviewed 106 cases of parotid gland tumor at Presbyterian Medical Center seen during the past 10 years between January, 1986 and December, 1995. The results were obtained as follows; 1) 86 cases(81.1%) were benign tumors and 20 cases(18.9%) were malignant tumors. 2) Overall male and female sex ratio was 1 : 1.4. 3) For benign tumors, the mean age was 47.9 and for malignant tumors, the mean age was 43.4. 4) Clinical manifestations in benign tumors were palpable mass in 86 cases(100%), pain in 6 cases(6.9%), facial nerve palsy in 2 cases(2.3%), lymphadenopathy in 1 case(1.2%); and in malignant tumors, palpable mass in 20 cases(100%), pain in 7 cases(35%), facial nerve palsy in 2 cases(10%) and lymphadenopathy in 3 cases(15%). Thus, the presence of pain, facial nerve palsy and lymphadenopathy suggest malignant tumors. 5) Operative procedures in benign tumors included superficial parotidectomy in 53 cases(61.6%), total parotidectomy in 10 cases(11.6%), local excision in 23 cases(26.7%); and in malignant tumors, superficial parotidectomy in 3 cases, total parotidectomy in 1 case, local excision in 1 case, superficial parotidectomy with supraomohyoid neck dissection in 6 cases, total parotidectomy with supraomohyoid neck dissection in 8 cases, total parotidectomy with radical neck dissection in 1 case. 6) Postoperative complications in benign tumors were transient facial nerve palsy in 14 cases, Frey's syndrome in 2 cases. In malignant tumors complications included transient facial nerve palsy in 3 cases and permanent facial nerve palsy in 1 case. 7) Pleomorphic adenoma was the most common benign parotid tumor and mucoepidermoid carcinoma was the most common malignant tumor. 8) In our review of 20 patients with malignant parotid tumors, all patients who received supraomohyoid neck dissection and postoperative radiation therapy remain alive from 1986 to 1995 years. Two deaths in this series were adenoid cystic carcinoma patients who failed to receive postoperative radiation therapy. These series of cases have been studied in order to determine whether supraomohyoid neck dissection and postoperative radiation therapy may have further therapeutic effect.

• Korean Journal of Head & Neck Oncology
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• v.13 no.1
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• pp.81-85
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• 1997

Basal cell adenocarcinoma is a rare, recently described neoplasm of the salivary gland. We have experienced three cases of basal cell adenocarcinoma of the parotid gland. The tumors from patient 1 and patient 2 showed intraparotid growth in superficial lobe without cervical lymphnode metastasis. So, patient 1 and patient 2 underwent only a superficial parotidectomy and subdigastric lymphnode dissection without any adjuvant therapy. They are alive without recurrence or distant metastasis. But that of patient 3 showed widely invasive growth with multiple cervical lymph node metastases. The CT scan showed a $8{\times}7cm$ sized huge mass replacing the parotid gland with irregular margin and multiple lymphnode enlargements along the internal jugular vein. Total parotidectomy with sacrifying the facial nerve and standard radical neck dissection were caried out. Microscopically, the tumor consisted of solid nest and sheet of uniform basaloid cells separated by a fibrous connective tissue stroma with the evidence of lymphovascular invasion. As a result of the lymphnode metastasis and invasiveness of the tumor, radiation therapy was given postoperatively. We thought that close follow-up would be mandatory in this patient because of high risk of possible local recurrence and distant metastasis.

• Korean Journal of Head & Neck Oncology
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• v.10 no.1
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• pp.46-52
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• 1994

This review is based on the 52 cases of salivary gland tumors treated at the department of surgerym Hallym University Kangdong Sacred Heart hospital during the period from March 1987 to May 1992. There were 43 benign and 9 malignant tumors. Twenty eight(54%) of these cases were located in the parotid gland, 14(27%) in the submandibular gland, the rest of 10 cases(19%) in the minor salivary glands. Female outnumbered male by the ratio 1.6:1. Pleomorphic adenoma was the most common tumor followed by carcinoma and adenolymphoma(Warthin's tumor). The most common presenting symptom in both benign and malignant tumors was palpable mass. However, some patients with malignancy presented symptoms such as pain, facial palsy and dysphagia. Among 9 cases with malignancies 3 cases were found to have metastasis in the regional lymphnodes and two cases had distant metastasis. In majority of benign parotid tumors, superficial parotidectomy was carried out. In three cases of carcinoma of parotid gland with lymphnode metastasis, total parotidectomy with radical neck dissection was done. One case out of two cases of carcinoma of submandibular gland was treated with total excision of the gland with radical neck dissection. There were no postoperative mortalies. Two cases each of facial palsies and wound infections were observed as complication.

• Archives of Craniofacial Surgery
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• v.9 no.1
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• pp.23-26
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• 2008

Salivary duct carcinoma is a high-grade adenocarcinoma arising from the ductal epithelium and has very low prevalence. We report a case of salivary duct carcinoma in high risk group with satisfactory result. A 65-year-old male was referred to our clinic complaining of mass on Rt. cheek. Preoperative CT and MRI shows $2.0{\times}1.9cm$ sized multilobulated, cystic mass on the superficial lobe of Rt. parotid gland and multiple lymph node enlargement thorough the Rt. internal jugular chain. Total parotidectomy and modified radical neck dissection with adjuvant radiation therapy was performed. Pathologic result was salivary duct carcinoma and resection margin was free. Postoperative radiation therapy with 6400 cGy($200cGy{\times}12fx$) was performed. During the 24-months of follow up periods, recurrence or complications associated with operation and radiation therapy was not observed. Salivary duct carcinoma is rare disease with very poor prognosis. Lymph node metastasis is commonly accompanied at the time of diagnosis. Distant metastasis is the most common cause of death. Total parotidectomy, radical neck disssection and adjuvant radiation therapy can be the appropriate modality for the control of the salivary duct carcinoma especially in high risk group.

• Archives of Plastic Surgery
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• v.42 no.4
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• pp.461-468
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• 2015

Background Functional restoration of the facial expression is necessary after facial nerve resection to treat head and neck tumors. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection. Methods Patients who underwent cable grafting from April 2007 to August 2011 were reviewed, in which a harvested branch of the sural nerve was grafted onto each facial nerve division. Twelve patients underwent facial nerve cable grafting after radical parotidectomy, total parotidectomy, or schwannoma resection, and the functional facial expression of each patient was evaluated using the Facial Nerve Grading Scale 2.0. The results were analyzed according to patient age, follow-up duration, and the use of postoperative radiation therapy. Results Among the 12 patients who were evaluated, the mean follow-up duration was 21.8 months, the mean age at the time of surgery was 42.8 years, and the mean facial expression score was 14.6 points, indicating moderate dysfunction. Facial expression scores were not influenced by age at the time of surgery, follow-up duration, or the use of postoperative radiation therapy. Conclusions The results of this study indicate that facial nerve cable grafting using the sural nerve can restore facial expression. Although patients were provided with appropriate treatment, the survival rate for salivary gland cancer was poor. We conclude that immediate facial nerve reconstruction is a worthwhile procedure that improves quality of life by allowing the recovery of facial expression, even in patients who are older or may require radiation therapy.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.161-168
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• 1996

The neuorogenic tumor is known to be originated from neural crest, and the involved cells are Schwann cell, ganglion cell, and paraganglion cell. The Schwannoma, neurofibroma, and malignant schwannoma arise from the schwann cell, ganglioneuroma is from ganglion cell, and carotid body tumor and glomus tumor are originated from paraganglion cell. Authors reviewed thirty-eight patients of the neurogenic tumors in the head and neck, excluding intracranial tumor and Von-Recklinghausen disease, surgically treated at the Department of Surgery, Pusan Paik Hospital from January 1981 to May 1996. Of the 38 cases, 28 cases were schwannoma, 6 cases neurofibroma, 2 cases malignant schwannoma, and 2 cases paraganglioma. These tumors occurred at any age, but the majority of patients occurred in the fourth decade of life. There was female preponderance (M : F=1 : 1. 53) in sex ratio. The lateral cervical region was the most common distribution. 12 cases arose from the anterior triangle of neck, and 12 cases from the posterior triangle of neck. The major nerve origin of tumor could be identified in 30 cases (80%). 11 cases were treated by simple excision, and partial excision was 3 cases. Excision with parotidectomy 1 case, enucleation 11 cases, enucleation with parotidectomy 7 cases, radical neck dissection 1 cases, upper neck dissection 2 cases, suprahyoid dissection 1 case, Caldwell­Luc operation 1 case. The postoperative complications were hoarseness (2 cases), facial palsy (1 case), Homer syndrome (1 case), and hypoesthesia of tongue (1 case).

• Korean Journal of Head & Neck Oncology
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• v.28 no.2
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• pp.125-128
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• 2012

Salivary duct carcinoma(SDC) is a highly malignant tumor of the salivary gland. The tumor is clinically characterized by a rapid onset and progression, the neoplasm is often associated with pain and facial paralysis. The nodal recurrence rate is high, and distant metastasis is common. SDC resembles high-grade breast ductal carcinoma. Curative surgical resection and postoperative radiation were the mainstay of the treatment. If facial paralysis is present, a radical parotidectomy is mandatory. Regardless of the primary location of SDC, ipsilateral functional neck dissection is indicated, because regional lymphatic spread has to be expected in the majority of patients already at time of diagnosis. If there is minor gland involvement, a bilateral neck dissection should be performed, because lymphatic drainage may occur to the contralateral side. The survival of SDC patient is poor, with most dying within three years. We experienced a unique case of SDC in parotid deep lobe. We report the clinicopathologic features of this tumor with a review of literature.