Surgical treatment of tumor pathology of the parotid gland. Descriptive study of 263 parotidectomies.
Abstract Introduction and objetive: Salivary tumors account for 3-10% of head and neck tumors, 75-80% being of parotid origin and mostly benign. Parotidectomy is a surgical technique that consists of exeresis of the parotid gland. There are various types; Superficial parotidectomy (PS), partial superficial parotidectomy (PSP), and total parotidectomy (PT). In the latter, since the facial nerve (FN) is not spared, complications are more frequent. Our objective is to analyze the outcome (recurrence rate and complications) of parotidectomy as a surgical technique used in the management of parotid pathology, as well as to evaluate which complementary test is the most effective in the pre-surgical diagnosis of tumorous parotid pathology. Material and methods: We performed a retrospective study including 263 patients treated by SP or TP between January 2004 and December 2020 at the Fuenlabrada University Hospital. Demographic data, time of lesion evolution, complementary tests, surgical protocol and postoperative complications were recorded. The positive correlation between the pre-surgical tests performed (Fine needle aspiration (FNA), ultrasound, CT and MRI) and the definitive anatomopathological diagnosis obtained after examining the surgical specimen is analyzed. The rate of paresis/facial paralysis and other complications is also described. Results: We included 263 patients treated by parotidectomy. The mean time of evolution of the parotid lesions was 15 months (SD 19.88). The sensitivity of FNA in our study was 68.7 %. Ultrasound was performed in 44.10% of patients (116/263), CT in 77.94% (205/263) and MRI in 15.20% (40/263), showing a positive correlation of 18.05%, 31.21% and 45%, respectively. The most frequent surgery was SP 43.3%, (114/263), closely followed by PSP (41.1%, 108/263) and finally the least common was TP (15.58%, 41/263). Benign tumors were more prevalent 84.79%, (223/263), with pleomorphic adenoma being the most frequent, 45.73% (102/223). Within the group of malignant tumors 15.20%, (40/263), the most common subtype was mucoepidermoid carcinoma (17.5%, 7/40) and metastases (17.5%, 7/40). Facial paresis, according to the House-Brackmann scale, was mild (grade I and II) and transient in most cases, appearing in 31.55%. After a mean follow-up period of 6 years, no recurrences were found in our study. Conclusion: In our sample, benign tumors represented the majority of parotid pathology. Within this group, pleomorphic adenoma was the most frequent. FNA was the complementary test with the best correlation with the definitive anatomopathologic diagnosis, followed by MRI. Mild and transitory facial paresis (grades I and II) was the most common post-surgical complication.
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Kochhar A, Larian B, Azizzadeh B. Facial Nerve and Parotid Gland Anatomy. Otolaryngol Clin North Am. 2016;49(2):273-84. doi: 10.1016/j.otc.2015.10.002.
Plaza G, Aparicio JM. Patología de las glándulas salivales. Ponencia del XI Congreso de la AMORL. Fuenlabrada, junio de 2016. Madrid: ERGON. 2016. ISBN: 978-84-16732-08-1. Disponible en :http://www.amorl.es/images/pdf/ponencia_patologia_glandulas_salivales.pdf (consultado el 15 de junio de 2022).
Maahs GS, Oppermann, Maahs LG, Machado Filho G, Ronchi AD. Parotid gland tumors: a retrospective study of 154 patients. Braz J Otorhinolaryngol. 2015;81(3):301-6. doi: 10.1016/j.bjorl.2015.03.007.
Chang YJ, Huang TY, Liu YJ, Chung HW, Juan CJ. Classification of parotid gland tumors by using multimodal MRI and deep learning. NMR Biomed. 2021;34(1):e4408. doi: 10.1002/nbm.4408.
Quer M, Vander Poorten V, Takes RP, Silver CE, Boedeker CC, de Bree R et al. Surgical options in benign parotid tumors: a proposal for classification. Eur Arch Otorhinolaryngol. 2017;274(11):3825-3836. doi: 10.1007/s00405-017-4650-4.
Quer M, Guntinas-Lichius O, Marchal F, Vander Poorten V, Chevalier D, León X et al. Classification of parotidectomies: a proposal of the European Salivary Gland Society. Eur Arch Otorhinolaryngol. 2016;273(10):3307-12. doi: 10.1007/s00405-016-3916-6.
Quer M, Pujol A, León X, López M, García J, Orús C et al. Parotidectomies in benign parotid tumours: "Sant Pau" surgical extension classification. Acta Otorrinolaringol Esp. 2010;61(1):1-5. doi: 10.1016/j.otorri.2009.10.003.
Plaza G, Amarillo E, Hernández-García E, Hernando M. The role of partial parotidectomy for benign parotid tumors: A case-control study. Acta Otolaryngol. 2015;135(7):718-21. doi: 10.3109/00016489.2015.1020394.
Hernando M, Plaza G. Tratamiento quirúrgico de los tumores de glándulas salivales. Acta Otorrinolaringol Esp. 2009;60(5):340-5. doi: 10.1016/j.otorri.2009.04.001.
Siddiqui AH, Shakil S, Rahim DU, Shaikh IA. Post parotidectomy facial nerve palsy: A retrospective analysis. Pak J Med Sci. 2020;36(2):126-130. doi: 10.12669/pjms.36.2.1706.
Infante-Cossio P, Gonzalez-Cardero E, Garcia-Perla-Garcia A, Montes-Latorre E, Gutierrez-Perez JL, Prats-Golczer VE. Complications after superficial parotidectomy for pleomorphic adenoma. Med Oral Patol Oral Cir Bucal. 2018;23(4):e485-e492. doi: 10.4317/medoral.22386.
Chiesa-Estomba CM, Larruscain-Sarasola E, Lechien JR, Mouawad F, Calvo-Henriquez C, Diom ES et al. Facial nerve monitoring during parotid gland surgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2021;278(4):933-943. doi: 10.1007/s00405-020-06188-0.
Guntinas-Lichius O, Eisele DW. Facial Nerve Monitoring. Adv Otorhinolaryngol. 2016;78:46-52. doi: 10.1159/000442124.
Motz KM, Kim YJ. Auriculotemporal Syndrome (Frey Syndrome). Otolaryngol Clin North Am. 2016;49(2):501-9. doi: 10.1016/j.otc.2015.10.010.
Bovenzi CD, Ciolek P, Crippen M, Curry JM, Krein H, Heffelfinger R. Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases. J Otolaryngol Head Neck Surg. 2019;48(1):64. doi: 10.1186/s40463-019-0387-y.
Wille-Bischofberger A, Rajan GP, Linder TE, Schmid S. Impact of the SMAS on Frey's syndrome after parotid surgery: a prospective, long-term study. Plast Reconstr Surg. 2007;120(6):1519-1523. doi: 10.1097/01.prs.0000282036.04717.1d.
Foresta E, Torroni A, Di Nardo F, de Waure C, Poscia A, Gasparini G et al. Pleomorphic adenoma and benign parotid tumors: extracapsular dissection vs superficial parotidectomy--review of literature and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117(6):663-76. doi: 10.1016/j.oooo.2014.02.026.
Sood S, McGurk M, Vaz F. Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S142-S149. doi: 10.1017/S0022215116000566.
Wang Y, Xie W, Huang S, Feng M, Ke X, Zhong Z et al. The Diagnostic Value of Ultrasound-Based Deep Learning in Differentiating Parotid Gland Tumors. J Oncol. 2022 12;2022:8192999. doi: 10.1155/2022/8192999.
Chen H, Bao X, Wan L. Application of Contrast-Enhanced Ultrasound Combined with Elastic Imaging Technology in Differential Diagnosis of Salivary Gland Tumors. J Healthc Eng. 2022 12;2022:4600751. doi: 10.1155/2022/4600751.
Singh Nanda KD, Mehta A, Nanda J. Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions. J Oral Pathol Med. 2012;41(1):106-12. doi: 10.1111/j.1600-0714.2011.01069.x.
Marzouki HZ, Altabsh MA, Albakrei MO, Al-Khatib TA, Merdad MA, Farsi NJ. Accuracy of preoperative fine needle aspiration in diagnosis of malignant parotid tumors. Saudi Med J. 2017;38(10):1000-1006. doi: 10.15537/smj.2017.10.20988.
Altin F, Alimoglu Y, Acikalin RM, Yasar H. Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy. Braz J Otorhinolaryngol. 2019;85(3):275-281. doi: 10.1016/j.bjorl.2018.04.015.
Bova R, Saylor A, Coman WB. Parotidectomy: review of treatment and outcomes. ANZ J Surg. 2004;74(7):563-8. doi: 10.1111/j.1445-2197.2004.02988.x.
Soler R, Bargiela A, Requejo I, Rodríguez E, Rey JL, Sancristan F. Pictorial review: MR imaging of parotid tumours. Clin Radiol. 1997;52(4):269-75. doi: 10.1016/s0009-9260(97)80052-9.
Stoia S, Baciut G, Lenghel M, Badea R, Csutak C, Rusu GM et al. Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors. An updated literature review. Bosn J Basic Med Sci. 2021;21(1):19-32. doi: 10.17305/bjbms.2020.5028.
Zouhair N, Mallouk S. Corrélation entre l’imagerie par résonnance magnétique, l’extemporanée et l’histologie définitive des tumeurs parotidiennes: série de cas-.. Pan Afr Med J. 2020;37:80. doi: 10.11604/pamj.2020.37.80.21192.
Iro H, Zenk J. Role of extracapsular dissection in surgical management of benign parotid tumors. JAMA Otolaryngol Head Neck Surg. 2014;140(8):768-9. doi: 10.1001/jamaoto.2014.1218.
Albergotti WG, Nguyen SA, Zenk J, Gillespie MB. Extracapsular dissection for benign parotid tumors: a meta-analysis. Laryngoscope. 2012;122(9):1954-60. doi: 10.1002/lary.23396.
Zbären P, Vander Poorten V, Witt RL, Woolgar JA, Shaha AR, Triantafyllou A et al. Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Am J Surg. 2013;205(1):109-18. doi: 10.1016/j.amjsurg.2012.05.026.
Edwards BM, Kileny PR. Intraoperative neurophysiologic monitoring: indications and techniques for common procedures in otolaryngology-head and neck surgery. Otolaryngol Clin North Am [Internet]. 2005;38(4):631–42, viii.
Preuss SF, Guntinas-Lichius O. On the diagnosis and treatment of parotid gland tumors: results of a nationwide survey of ENT hospitals in Germany. HNO. 2006;54:868–74.
Thölken R, Jering M, Mayer M, Schiele S, Müller G, Zenk J. Prospective study on complications using different techniques for parotidectomy for benign tumors. Laryngoscope Investig Otolaryngol. 2021;6(6):1367-1375. doi: 10.1002/lio2.694.
Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope. 2021;131(3):571-579. doi: 10.1002/lary.28912.
Plaza G, Aparicio JM. Patología de las glándulas salivales. Ponencia del XI Congreso de la AMORL. Fuenlabrada, junio de 2016. Madrid: ERGON. 2016. ISBN: 978-84-16732-08-1. Disponible en :http://www.amorl.es/images/pdf/ponencia_patologia_glandulas_salivales.pdf (consultado el 15 de junio de 2022).
Maahs GS, Oppermann, Maahs LG, Machado Filho G, Ronchi AD. Parotid gland tumors: a retrospective study of 154 patients. Braz J Otorhinolaryngol. 2015;81(3):301-6. doi: 10.1016/j.bjorl.2015.03.007.
Chang YJ, Huang TY, Liu YJ, Chung HW, Juan CJ. Classification of parotid gland tumors by using multimodal MRI and deep learning. NMR Biomed. 2021;34(1):e4408. doi: 10.1002/nbm.4408.
Quer M, Vander Poorten V, Takes RP, Silver CE, Boedeker CC, de Bree R et al. Surgical options in benign parotid tumors: a proposal for classification. Eur Arch Otorhinolaryngol. 2017;274(11):3825-3836. doi: 10.1007/s00405-017-4650-4.
Quer M, Guntinas-Lichius O, Marchal F, Vander Poorten V, Chevalier D, León X et al. Classification of parotidectomies: a proposal of the European Salivary Gland Society. Eur Arch Otorhinolaryngol. 2016;273(10):3307-12. doi: 10.1007/s00405-016-3916-6.
Quer M, Pujol A, León X, López M, García J, Orús C et al. Parotidectomies in benign parotid tumours: "Sant Pau" surgical extension classification. Acta Otorrinolaringol Esp. 2010;61(1):1-5. doi: 10.1016/j.otorri.2009.10.003.
Plaza G, Amarillo E, Hernández-García E, Hernando M. The role of partial parotidectomy for benign parotid tumors: A case-control study. Acta Otolaryngol. 2015;135(7):718-21. doi: 10.3109/00016489.2015.1020394.
Hernando M, Plaza G. Tratamiento quirúrgico de los tumores de glándulas salivales. Acta Otorrinolaringol Esp. 2009;60(5):340-5. doi: 10.1016/j.otorri.2009.04.001.
Siddiqui AH, Shakil S, Rahim DU, Shaikh IA. Post parotidectomy facial nerve palsy: A retrospective analysis. Pak J Med Sci. 2020;36(2):126-130. doi: 10.12669/pjms.36.2.1706.
Infante-Cossio P, Gonzalez-Cardero E, Garcia-Perla-Garcia A, Montes-Latorre E, Gutierrez-Perez JL, Prats-Golczer VE. Complications after superficial parotidectomy for pleomorphic adenoma. Med Oral Patol Oral Cir Bucal. 2018;23(4):e485-e492. doi: 10.4317/medoral.22386.
Chiesa-Estomba CM, Larruscain-Sarasola E, Lechien JR, Mouawad F, Calvo-Henriquez C, Diom ES et al. Facial nerve monitoring during parotid gland surgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2021;278(4):933-943. doi: 10.1007/s00405-020-06188-0.
Guntinas-Lichius O, Eisele DW. Facial Nerve Monitoring. Adv Otorhinolaryngol. 2016;78:46-52. doi: 10.1159/000442124.
Motz KM, Kim YJ. Auriculotemporal Syndrome (Frey Syndrome). Otolaryngol Clin North Am. 2016;49(2):501-9. doi: 10.1016/j.otc.2015.10.010.
Bovenzi CD, Ciolek P, Crippen M, Curry JM, Krein H, Heffelfinger R. Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases. J Otolaryngol Head Neck Surg. 2019;48(1):64. doi: 10.1186/s40463-019-0387-y.
Wille-Bischofberger A, Rajan GP, Linder TE, Schmid S. Impact of the SMAS on Frey's syndrome after parotid surgery: a prospective, long-term study. Plast Reconstr Surg. 2007;120(6):1519-1523. doi: 10.1097/01.prs.0000282036.04717.1d.
Foresta E, Torroni A, Di Nardo F, de Waure C, Poscia A, Gasparini G et al. Pleomorphic adenoma and benign parotid tumors: extracapsular dissection vs superficial parotidectomy--review of literature and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117(6):663-76. doi: 10.1016/j.oooo.2014.02.026.
Sood S, McGurk M, Vaz F. Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S142-S149. doi: 10.1017/S0022215116000566.
Wang Y, Xie W, Huang S, Feng M, Ke X, Zhong Z et al. The Diagnostic Value of Ultrasound-Based Deep Learning in Differentiating Parotid Gland Tumors. J Oncol. 2022 12;2022:8192999. doi: 10.1155/2022/8192999.
Chen H, Bao X, Wan L. Application of Contrast-Enhanced Ultrasound Combined with Elastic Imaging Technology in Differential Diagnosis of Salivary Gland Tumors. J Healthc Eng. 2022 12;2022:4600751. doi: 10.1155/2022/4600751.
Singh Nanda KD, Mehta A, Nanda J. Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions. J Oral Pathol Med. 2012;41(1):106-12. doi: 10.1111/j.1600-0714.2011.01069.x.
Marzouki HZ, Altabsh MA, Albakrei MO, Al-Khatib TA, Merdad MA, Farsi NJ. Accuracy of preoperative fine needle aspiration in diagnosis of malignant parotid tumors. Saudi Med J. 2017;38(10):1000-1006. doi: 10.15537/smj.2017.10.20988.
Altin F, Alimoglu Y, Acikalin RM, Yasar H. Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy. Braz J Otorhinolaryngol. 2019;85(3):275-281. doi: 10.1016/j.bjorl.2018.04.015.
Bova R, Saylor A, Coman WB. Parotidectomy: review of treatment and outcomes. ANZ J Surg. 2004;74(7):563-8. doi: 10.1111/j.1445-2197.2004.02988.x.
Soler R, Bargiela A, Requejo I, Rodríguez E, Rey JL, Sancristan F. Pictorial review: MR imaging of parotid tumours. Clin Radiol. 1997;52(4):269-75. doi: 10.1016/s0009-9260(97)80052-9.
Stoia S, Baciut G, Lenghel M, Badea R, Csutak C, Rusu GM et al. Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors. An updated literature review. Bosn J Basic Med Sci. 2021;21(1):19-32. doi: 10.17305/bjbms.2020.5028.
Zouhair N, Mallouk S. Corrélation entre l’imagerie par résonnance magnétique, l’extemporanée et l’histologie définitive des tumeurs parotidiennes: série de cas-.. Pan Afr Med J. 2020;37:80. doi: 10.11604/pamj.2020.37.80.21192.
Iro H, Zenk J. Role of extracapsular dissection in surgical management of benign parotid tumors. JAMA Otolaryngol Head Neck Surg. 2014;140(8):768-9. doi: 10.1001/jamaoto.2014.1218.
Albergotti WG, Nguyen SA, Zenk J, Gillespie MB. Extracapsular dissection for benign parotid tumors: a meta-analysis. Laryngoscope. 2012;122(9):1954-60. doi: 10.1002/lary.23396.
Zbären P, Vander Poorten V, Witt RL, Woolgar JA, Shaha AR, Triantafyllou A et al. Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Am J Surg. 2013;205(1):109-18. doi: 10.1016/j.amjsurg.2012.05.026.
Edwards BM, Kileny PR. Intraoperative neurophysiologic monitoring: indications and techniques for common procedures in otolaryngology-head and neck surgery. Otolaryngol Clin North Am [Internet]. 2005;38(4):631–42, viii.
Preuss SF, Guntinas-Lichius O. On the diagnosis and treatment of parotid gland tumors: results of a nationwide survey of ENT hospitals in Germany. HNO. 2006;54:868–74.
Thölken R, Jering M, Mayer M, Schiele S, Müller G, Zenk J. Prospective study on complications using different techniques for parotidectomy for benign tumors. Laryngoscope Investig Otolaryngol. 2021;6(6):1367-1375. doi: 10.1002/lio2.694.
Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope. 2021;131(3):571-579. doi: 10.1002/lary.28912.
Martínez-Ruiz-Coello, M. del M., Hernández-García, E., Miranda-Sánchez, E., García-García, C., Arenas-Brítez, Óscar, & Plaza-Mayor, G. (2022). Surgical treatment of tumor pathology of the parotid gland. Descriptive study of 263 parotidectomies. Revista ORL, 14(1), e29831. https://doi.org/10.14201/orl.29831
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