Parotid Gland

The purpose of this study was to systematically monitor anatomic variations and their dosimetric consequences during intensity modulated radiation therapy (IMRT) for head and neck (H&N) cancer by using a graphics processing unit (GPU)-based deformable image registration (DIR) framework. Eleven IMRT H&N patients undergoing IMRT with daily megavoltage computed tomography (CT) and weekly kilovoltage CT (kVCT) scans were included in this analysis. Pretreatment kVCTs were automatically registered with their corresponding planning CTs through a GPU-based DIR framework. The deformation of each contoured structure in the H&N region was computed to account for nonrigid change in the patient setup. The Jacobian determinant of the planning target volumes and the surrounding critical structures were used to quantify anatomical volume changes. The actual delivered dose was calculated accounting for the organ deformation. The dose distribution uncertainties due to registration errors were estimat...

To report long-term outcomes for HIV-positive patients who underwent radiation therapy (RT) for benign lymphoepithelial cysts (BLEC) of the parotid glands. In this single institution retrospective study of HIV-associated BLEC of the parotids, the medical records of 37 HIV-positive patients who were treated with RT between 1987-2012 were reviewed. Patients were stratified into two groups; group A consisted of 15 patients (40.5%) who received a total dose of ≤18Gy, with a median dose 10 Gy (range 8-18Gy), and group B consisted of 22 patients (59.5%) who received a total dose of 24 Gy. In addition to dosing information, additional patient data were collected, including demographics, HAART compliance, follow-up, and re-treatment status. The median age at the time of treatment was 41 (range=7-70) years. With a median follow-up of 35 (range=12-75) months for the entire cohort, the complete response (CR) and partial response (PR) rates were 35% and 8%, respectively. All but one of 15 patie...

Acute parotid gland enlargement in association with general anesthesia is rare and has also been called anesthesia mumps. We present two patients who were scheduled for lumbar spine surgery under general anesthesia. Each developed acute unilateral parotid gland enlargement over one side of the face proven by sonography. Case 1: A 52-year-old man was scheduled for his third lumbar spine to first sacral spine surgery for scoliosis and spondylolisthesis. The patient was provided general anesthesia with oral endotracheal intubation and placed in the prone position with the neck flexed at approximately 10 degrees. The head was turned to the left side and the right side of the face was placed on a soft gel rolling pad. After 6 hours of surgery, swelling of the right parotid gland was noted upon endotracheal extubation. Twenty four hours later, the patient received sonographic examination of the salivary gland which showed dilatation of the right parotid duct with obstructive inflammation....

Background The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; hence anatomical landmarks and adequate operative exposure can aid such identification and preservation. In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically. Methods The clinical component of the study included prospective reviewing of 100 consecutive routine parotidectomies; while, the anatomical component of the study involved dissecting 50 cadaveric hemifaces. Results We could consistently identify a supplying vessel, stylomastoid artery, which tends to vary less in position than the facial nerve. Following this vessel, a few millimetres inferiorly and medially, we have gone on to identify the facial nerve trunk, which it supplies, with relative ease. The origin of the stylomastoid artery, in our study, was either from the occipital artery or the posterior auricular artery. Conclusion This anatomical aid, the stylomastoid artery, when supplemented by the other more commonly known anatomical landmarks and intra-operative facial nerve monitoring further reduces the risk of iatrogenic facial nerve damage and operative time.

The percutaneous Hartel transoval route goes through an inverted pyramid, with an inferior summit and a superior base that includes three compartments. The danger of the inferior compartment is the parotid duct. The middle compartment contains many branches of the mandibular nerve. The superior compartment is crossed by the internal maxillary artery and its branches, as well as the auditory tube. The base of the pyramid presents not only the foramen ovale, but also the foramen lacerum, where the trocar may injure the internal carotid, and the foramen jugulare, where the trocar may meet the internal jugular vein and nerves of the pars nervosa (IX, X, XI). The trigeminal cave contains, within the trigeminal cistern, the trigeminal ganglion, extended backward by the triangular plexus (the target for thermocoagulation). These structures are undercrossed by the masticatory motor branch of the trigeminal nerve.

Various skin incision for access to the parotid region are described by different authors, which differ in extension and localization of the scar. Therefore after parotidectomy, patients are often left with a retromandibular and cervical depression. Maintaining normal facial contour may be difficult in parotidectomy defects, but a good symmetry can and should be achieved when reconstructing the parotid region with a specific approach. The authors show their experience in parotid gland surgery using a new skin incision to improve the aesthetic and functional results and three different techniques the reconstruction of the parotid region.

Facial nerve paralysis is a daunting potential complication of parotid surgery and is widely reported. Knowledge of the key landmarks of the facial nerve trunk is essential for safe and effective surgical intervention in the region of the parotid gland. In current practice, wide ranges of landmarks are used to identify the facial nerve trunk, however, there is much debate in the literature about the safety and reliability of each of these landmarks. The aim of this study, therefore, was to evaluate the relation of the surrounding anatomical structures and surgical landmarks to the facial nerve trunk. The anatomical relationship of the facial nerve trunk to the surrounding structures was determined after micro-dissection on 40 adult cadavers. The shortest distances between the facial nerve and the “tragal pointer”, attachment of the posterior belly of digastric muscle, tympanomastoid suture, external auditory canal, transverse process of the axis, angle of the mandible and the styloid process were measured. In addition, these distances were compared in the right and left sides, males and females and edentulous and non-edentulous mandibles. The distance of the facial nerve trunk from each of the surrounding landmarks ranged from (mm): tragal pointer, 24.3 to 49.2 (mean 34); posterior belly of digastric, 9.7 to 24.3 (mean 14.6); external auditory canal, 7.3 to 21.9 (mean 13.4); tympanomastoid suture, 4.9 to 18.6 (mean 10.0); styloid process, 4.3 to 18.6 (mean 9.8); transverse process of the axis, 9.7 to 36.8 (mean 16.9); angle of the mandible, 25.3 to 48.69 (mean 38.1). The length of the facial nerve trunk from its point of exit from the stylomastoid foramen to its bifurcation into upper and lower divisions ranged from (mm) 8.6 to 22.8 (mean 14.0). The results demonstrated that the posterior belly of digastric, tragal pointer and transverse process of the axis are consistent landmarks to the facial nerve trunk. However, it should be noted that the tragal pointer is cartilaginous, mobile, asymmetrical and has a blunt, irregular tip. This study advocates the use of the transverse process of the axis as it is easily palpated, does not require a complex dissection and ensures minimum risk of injury to the facial nerve trunk.

The prototype of a salivary lymphoepithelial lesion is the autoimmune disease Sjögren's syndrome with the characteristic lymphoepithelial duct lesions (LEL). The distinction of Sjögren's syndrome from cases with initial transformation into associated marginal zone B-cell lymphoma (MALT type) can be very challenging, whereby the presence of small "halos" can lead to over-diagnosis. The HIV-associated cystic lymphoepithelial lesion can be histologically almost identical to Sjögren's syndrome and often needs clinical correlation. The sporadic lymphoepithelial cyst of the parotid gland is a frequent finding and has no clinical consequence; however, this entity needs to be identified and distinguished from the above-mentioned entities. The most frequent diagnosis in resected submandibular glands is chronic-fibrosing sialadenitis, so-called Küttner's tumour. Altogether, there is a wide spectrum of lymphoepithelial interaction in the area of salivary glands, including biphasic lymphoepithelial tumours with an obligate lymphoid component, epithelial tumours with facultative tumour-associated lymphoid proliferation, and different processes of intraparotid lymph nodes. The immunohistological reaction for pan-keratin can be very helpful for a thorough pattern analysis of the different lymphoepithelial lesions. The relative frequency of the lesions in different salivary glands can also be diagnostically helpful.

Juvenile Sjögren's syndrome is a rare condition that affects children and adolescents with distinctive clinical features. Parotid swelling usually precedes regular oral and ocular symptoms, while typical serological findings may be absent. Hence, diagnosing juvenile Sjögren's syndrome may be challenging to the attending pediatric dentist, and long-term management without proper diagnosis may be jeopardized. The purpose of this report was to detail the features of an adolescent with primary Sjögren's syndrome diagnosed 12 years after the onset of the disease. An updated literature review highlighted the unusual aspects of the pediatric form of the disease.

Oncocytic carcinomas are uncommon; they represent 11% of all oncocytic salivary gland neoplasms, 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. A 65-year-old woman was admitted to our ENT clinic with a history of a painless left preauricular mass. No lymph node was palpable on either side of her neck. Computed tomography demonstrated a 3×3-cm solid lesion in the left parotid gland. As oncocytes and atypical cells were seen at the cytologic examination of a fine-needle aspiration biopsy, this finding suggested a malignant epithelial tumor. Total parotidectomy by preserving the facial nerve was performed. The result of the pathologic examination was oncocytic carcinoma regarding histopathologic and immunohistochemical findings and especially the invasive growth pattern. We preferred a close follow-up to an elective neck dissection, and reserved the neck dissection for a recurrence. The prognosis of oncocytic carcinomas is not well known because of their low incidence. Further investigation of the prognosis of patients with oncocytic carcinoma of the parotid gland is warranted as more cases are reported.

Citation: Diakakis N, Karadima V. Equine Sialolithiasis of the Distal Parotid Duct. Retrospective Study on 4 Cases. Archives of Veterinary Science and Medicine 4 (2021): 13-23. Abstract Sialolithiasis is an infrequently encountered condition in equids, although it occurs more frequently in equine species than other domestic species. Sialoliths appear smooth or slightly spiculated, and gray, yellowish, or white. The most common presentation is within the parotid duct, usually at its most rostral portion, just before it opens into the vestibule opposite the third upper cheek tooth with very few cases affecting the mandibular duct. Typically, a non-painful, movable, firm structure is palpable on the lateral aspect of the face near the rostral end of the facial crest, and it can be present for many years before additional clinical signs develop and lead to veterinary attention. In total, three horses and one donkey (four equines) were included in this study. All animals were in good clinical condition. None of these cases showed signs of concurrent sialadenitis or had problems eating. A detailed teeth examination showed severe enamel overgrowths on all arcades. In all cases, diagnosis of sialolithiasis was based on clinical presentation and palpation and was confirmed by surgically removing the sialolith. All sialoliths were removed with the animals standing under sedation and local anesthesia. In one case, a decision was made to remove the sialolith through a Arch Vet Sci Med 2021; 4 (1):13-23 Archives of Veterinary Science and Medicine 14 transcutaneous approach with ligation of the parotid duct at its rostral end. For the remaining three cases the transoral technique was elected. Although the size of the removed sialoliths varied, they ranged from 6 to 8cm in length. All four sialoliths were dissected, with no evidence of a plant or any other foreign material found in any of them. The first horse, in which the transcutaneous excision was elected, developed a marked distention of the parotid duct. Although the incision wound closed nicely, a visible blemish was created because of the retrograde distention of the parotid duct. In the remaining three animals, which were operated via the transoral technique, improvement was immediately seen following surgery and no blemishes or any other complications were noted. On patient follow-up via telephone 3 years post-operatively, no signs of sialolith re-growth were noted by the owners. Based on the results of this study, it is recommended that sialoliths should be identified as early as possible at the course of the disease, before they grow substantially in size, and that the transoral surgical excision is the treatment of choice provided that the sialolith is accessible orally.