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Parotid gland neoplasms include a quite heterogeneous group of histotypes with markedly different biological characteristics and evolution, thus requiring different forms of treatment. The present study evaluated the effects surgery and radiotherapy have on local disease control, survival rates and onset of locoregional recurrences. 126 malignant parotid tumors were examined (59 males, 67 females; age range 11 to 88 years; mean age 62 years) with a minimum of 1 year follow-up. The most malignant tumors were those most frequently seen in this case study (68%). Surgery was performed in 81 subjects (83.5%). Conservative total parotidectomy was the procedure most frequently performed (60/81, 74%). The overall 5-year survival rate was around 54% while 47% were "disease-free" patients at 5 years. When the subjects were broken down into 2 groups according to the degree of malignancy (high or low), the survival curve for disease-free subjects showed some differences (respectively 52% and 42%). The choice of treatment for the primary T significantly affect survival. Radiotherapy alone proved much less satisfactory than surgery (p < 0.01). The 5-year survival rate following a combination of surgery and subsequent radiotherapy was 52%, while it was 47% for those treated by surgery alone. An examination of the type of surgery performed revealed a difference in survival between those treated with preservation of the VII cranial nerve (52% at 5 years) and the more radical surgery (43% at 5 years) although this difference was not statistically significant. The incidence of recurrence was 25.7% (25 cases out of 97), of which 88% arose within the first 2 years. In conclusion, it has been seen that malignant parotid gland neoplasms are highly aggressive and the treatment of choice appears to be surgery plus radiotherapy whenever the clinical-biological features of the neoplasm warrant it. The surgical approach to the facial nerve should be as conservative as possible, reserving utmost radicality for the most advanced cases compromising the adjacent structures.
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An accessory parotid gland occurs in approximately 21 percent of human subjects. It is located anterior to the main parotid gland, usually just above Stensen's duct and connected by its own duct to the latter. Any lesions that can occur in the main parotid gland can also arise in an accessory parotid gland. For the excision of lesions of the accessory parotid gland, we prefer to turn the same cervicofacial flap used for a lateral or total parotidectomy. This permits one to fully visualize the superficial and deep main parotid segments, the trunk and the branches of the facial nerve, and the accessory parotid gland along with its duct system and Stensen's duct.
The activity of total amylase and isoamylases in the rat parotid gland is reduced by treatment with Amitriptylin (Laroxyl) for 3 and 7 days while the protein content of the glands remains constant. These changes are no longer visible after treatment for 21 days and following a period without drug application. To differentiate the disturbances of protein secretion (proteodyschylia) prominent in the clinical picture of sialadenosis, the following classification is proposed. We suggest the term "stimulatory proteodyschylia" for a decrease of acinar amylolytic activity, here caused by Amitriptylin application, as opposed to the "inhibitory proteodyschylia" characterized by an acinar amylase congestion.
Parotid secretion of alpha-amylase and potassium (K+) was determined in young adults following intense exercise. Exercise stress led to a significant elevation in alpha-amylase and K+ secretion, indicating an activation of adrenergic receptors supplying the parotid gland. Evidence of circadian variation or adaptation over days was not found.
Congenital absence of major salivary glands, especially the parotid gland, is a rare entity. It is usually monolateral and is not correlated with accessory salivary gland tissue. Aplasia of parotid gland may occur alone or in association with abnormalities of other salivary glands, first branchial arch developmental disturbances or other congenital anomalies.We report an interesting case of bilateral aplasia of the parotid glands together with bilateral accessory parotid tissue, without other congenital or developmental anomalies, and we describe the clinical and radiological findings.
Parotid gland sarcoidosis occurs in 6% of patients with sarcoidosis. It was bilateral in 24 (73%), slightly commoner in women, and presented in the majority in the 20 to 40 year age group. There was widespread involvement of other systems, particularly intrathoracic, peripheral lymph-adenopathy, uveitis, lacrimal gland enlargement and skin disease. Patterns of involvement may be pathognomonic as in Heerfordt's syndrome. This account provides the differential diagnosis, imaging and biopsy techniques, and treatment.
The parotid gland of the olive baboon, Papio anubis, was examined by electron microscopy. The acini are all serous in nature, and consist of pyramidal cells with abundant secretory granules of varying size. These granules consist of a dense matrix in which a denser spherule or lenticular body is present. Granules linked by a short isthmus are observed in the apical cytoplasm, and granules in the process of discharging their contents to the acinar lumen may be connected to the luminal plasma membrane by a neck-like protrusion. Intercalated duct cells contain granules reminiscent of those found in the rat submandibular acinar cells. The striated ducts consist of tall cells interlocked in a complex fashion near their bases, with numerous vertically-oriented mitochondria lodged in their basal crenulations. Small vesicles whose contents vary in density are present in the apical cytoplasm as are large deposits of lipofuscin. The striated duct cells display a proclivity for ballooning into the duct lumen. Excretory ducts consist of simple to pseudostratified columnar epithelium, and lack basal striations or apical blebs.
A parotid gland mass with presenting features of malignancy is a diagnostic and therapeutic challenge. The histological nature of the lesion must be clearly determined before proceeding with facial nerve sacrificing surgery. Although rare, tuberculosis of the parotid gland must be included in the differential diagnosis of a parotid gland mass especially when the social characteristics of the patient suggests a mycobacterial infection. Primary tuberculosis of the parotid gland is generally encountered among populations with a high incidence of pulmonary disease. The difficulty in the differential diagnosis of a parotid gland malignancy may be helped by a high degree of clinical suspicion, since laboratory tests generally do not identify the specific causative organism. This article reports the first case of parotid gland tuberculosis with clinical and radiodiagnostical features simulating malignancy in which the diagnosis was confirmed by the polymerase chain reaction (PCR).
Accessory parotid glands are true parotid tissue lying distinctly separate from the parotid gland proper. They lie along and drain into Stensen's duct. Although literature describing the accessory parotid gland is limited, its anatomy and pathology have been described. Controversies exist in the literature regarding the diagnosis and management of pathological changes seen in these glands. We have found magnetic resonance imaging to be extremely helpful in their diagnosis and treatment. A review of the literature and an illustrative example are presented.
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BACKGROUND: Kimura's disease is a chronic inflammatory disorder of unknown etiology commonly seen among orientals and characterized histologically by lymphatic follicles, vascular proliferation, and marked eosinophilic infiltration. It has a predilection for the head and neck region. The lesion is benign but can be mistaken to be a malignant lesion. METHODS: Between January 1987 and December 1999, eight cases of Kimura's disease were treated at the Department of Plastic Surgery, Hospital Kuala Lumpur. All the patients underwent surgical excision followed by initial high-dose steroid therapy and low-dose maintenance. RESULTS: All the patients are men, seven belong to the Malay race and one is Chinese. The patients' ages at diagnosis are 18 to 46 years. All were initially seen with swelling in the parotid gland, ranging from 1 year to 20 years' duration. Pruritus of the overlying skin was seen in seven patients. Treatment by surgical excision and steroid therapy has led to no recurrences. CONCLUSION: Kimura's disease of parotid gland is rare. It is a chronic inflammatory condition also called eosinophilic hyperplastic lymphogranuloma. Treatment by surgical excision and steroid therapy has led to no recurrences.
BACKGROUND: Among salivary glands, the parotid gland is the most common site for secondary neoplastic involvement, and carcinomas and melanomas are the two most common secondary tumors. METHODS: We present a case of testicular seminoma metastasizing to the parotid gland. The patient, who had a remote history of testicular seminoma, was initially seen with a parotid mass. A primary parotid lesion was anticipated, and excisional biopsy was performed. The diagnosis of testicular seminoma metastasizing to the parotid gland was established on the basis of histologic findings and was confirmed by immunohistochemical analysis. RESULTS: Metastatic and primary seminomas have the same morphologic features and cellular composition, and granulomatous reaction is often present in both neoplasms. Extragonadal seminoma often occurs in the midline (presacral, retroperitoneal, anterior mediastinal, and pineal regions); when present in any other locations, the tumor should be considered to be metastatic. Placenta alkaline phosphatase is a useful immunohistochemical stain to confirm the diagnosis, and cytokeratin immunohistonegativity rules out carcinomas or epithelioid sarcomas. CONCLUSIONS: To our knowledge, this is the first published case of metastatic testicular seminoma to the parotid gland. Cytomorphologic features of seminoma and the presence of granulomatous giant cells are important diagnostic clues. Two other neoplasms with granulomatous reactions, nasopharyngeal carcinoma and epithelioid sarcoma, should be considered in the differential diagnosis.
PURPOSE: The position of the parotid gland in relation to surrounding structures was investigated. MATERIALS AND METHODS: Sixty-five patients with head and neck tumours were prospectively evaluated. Parotid position was determined using beam's eye views of CT images projected on simulator films. Distances between the different borders of the parotid gland and surrounding bony marks were quantitatively assessed. RESULTS: The parotid gland volume ranged from 12.9 to 46.4 cm(3). The distance between the cranial border of the parotid gland and the tuberculum anterior of the atlas ranged between 0.7 and 4.8 cm. The position of the parotid gland was unaffected by the angle of the mandible. CONCLUSIONS: The size and position of the parotid gland varies largely among patients. As the extent of radiation-induced salivary dysfunction depends on the volume of the gland tissue exposed, CT-based simulation of radiation fields is necessary.
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