DOCSLIB.ORG

Magnetic Resonance Imaging Versus Fine Needle Aspiration Biopsy in the Differential Diagnosis of Neoplastic Parotid Gland Lesions

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Magnetic Resonance Imaging Versus Fine Needle Aspiration Biopsy in the Differential Diagnosis of Neoplastic Parotid Gland Lesions Clinical Research ENT Updates 2019;9(1): 38-43 DOI: 10.32448/entupdates.541146 Magnetic Resonance Imaging versus Fine Needle Aspiration Biopsy in the Differential Diagnosis of Neoplastic Parotid Gland Lesions 1Muammer Melih Şahin MD., 2Melih Çayönü MD, 3Deniz Sözmen Cılız MD, 4Elvan Evrim Ünsal Tuna MD, 5Ayşe Seçil Kayalı Dinç MD, 6Süleyman Boynueğri MD, 7Fulya Eker Barut MD, 8Bülent Sakman, 9Adil Eryılmaz 1Ankara Numune Training and Research Hospital, Department of Ear Neck and Throat Surgery, Ankara, Turkey - ORCID ID: 0000-0002-1804-2730 2 Ankara Numune Training and Research Hospital, Department of Ear Neck and Throat Surgery, Ankara, Turkey - ORCID ID: 0000-0001-5542-1898 3 Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey - ORCID ID: 0000-0003-3640-9273 4 Kırşehir Ahi Evran University, Department of Ear Neck and Throat Surgery, Kırşehir, Turkey - ORCID ID: 0000-0003-0424-4152 5 Ankara Numune Training and Research Hospital, Department of Ear Neck and Throat Surgery, Ankara, Turkey - ORCID ID: 0000-0001-9004-8806 6 Ankara Numune Training and Research Hospital, Department of Ear Neck and Throat Surgery, Ankara, Turkey - ORCID ID: 0000-0002-1244-7294 7 Ankara Numune Training and Research Hospital, Department of Ear Neck and Throat Surgery, Ankara, Turkey - ORCID ID: 0000-0001-6769-7787 8 Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey - ORCID ID: 0000-0001-7748-6318 9 Ankara Numune Training and Research Hospital, Department of Ear Neck and Throat Surgery, Ankara, Turkey - ORCID ID: 0000-0003-3754-6317 Abstract tidectomy was carried out on 54, and total parotidecto- my on 20 individuals. FNAB had a sensitivity in the detec- Objective: This research aims to compare fine needle as- tion of malignancy of 73.3% with a specificity of 100%. piration biopsy (FNAB) with magnetic resonance imaging The accuracy was 93.4%. MRI, on the other hand, had a (MRI) in differentiating between neoplasms found with- sensitivity in the detection of malignancy of 81.2% with in the parotic gland. a specificity of 90.5%. The accuracy was 88.4%. Amongst benign lesions found, the most frequently occurring were Methods: Using a retrospective methodology, records pleomorphic adenome and Warthin’s tumour. MRI could were reviewed from 74 cases who had surgery for a pa- accurately identify the histopathological type in 90% of rotid neoplastic lesion between January 2013 and No- such cases, whilst FNAB identified 89.1%. vember 2018. 41 cases were men and 33 women, with a mean age of 51.3±12.8 years. In each instance, compar- Conclusion: In distinguishing between benign and ma- ison was made between the eventual histopathological lignant neoplastic lesions of the parotid gland, FNAB and diagnosis and the results of evaluation by FNAB or MRI MRI have similar abilities. Although MRI is unable to ad- prior to surgery. The comparison looked at how the two equately predict the histopathological subtype in malig- methods influenced surgical choice, their ability to distin- nant lesions, unlike FNAB, its role in surgical planning and guish between malignant and benign lesions and power tumour staging remains highly significant. to predict histopathological subtype. Key Words: Magnetic Resonance Imaging, Fine Needle Results: 57 cases (out of 74) represented benign lesions Aspiration Biopsy, Parotid Gland. (77%), whilst 17 were malignant (23%). Superficial paro- Correspondence: Ayşe Seçil Kayalı Dinç Online available at: Talatpasa Bulvarı No: 44 Kat:2 06230 Altındağ, Ankara/Türkiye. www.entupdates.org Email: [email protected] Received: February 02-2019; Accepted: March 02-2019 ©2019 Continuous Education and Scientific Research Association (CESRA) Magnetic Resonance Imaging versus Fine Needle Aspiration Biopsy in the Differential Diagnosis of Neoplastic Parotid Gland Lesions Introduction 9-76). 54 individuals underwent superficial parotidectomy Neoplasms of the salivary glands represent 3-5% of the to- whilst 20 individuals had a total parotidectomy. 7 patients tal neoplasms found in the head and neck region. Amongst additionally underwent neck dissection. salivary gland neoplasms, 80% arise within the parotid The following technique was employed to obtain gland. Benign neoplasms account for 80% of parotid neo- FNAB: the sample material was aspirated using a 22-gauge plasms [1]. Pleomorphic adenomas are the most frequently needle tip and sprayed onto a microscope glass slide. A thin occurring of beign parotid neoplasms, whilst mucoepider- layer of cells was achieved by using a second glass slide to moid carcinoma is the most frequently encountered parot- smear the sample, after which alcohol and other fixatives id malignancy [2]. The key indications in favour of surgical were used to dry and preserve the sample for cytological intervention are anatomical location and expectation of assessment. FNAB results included both an assessment of malignant character. In malignant lesions, particularly, the likely benign or malignant character and a provisional di- histopathological subtype greatly influences what surgical agnosis of likely histopathological subtype. measures are advised [3]. FNAB (fine needle aspiration bi- The MRI appearances were re-evaluated for the study opsy) is the usual method employed to inform the probable by a single experienced radiologist, who was requested to diagnosis prior to operative intervention. FNAB has sever- make a benign-malignant distinction and, if possible, spec- al key points to recommend its use: it is straightforward, ify a histological pre-diagnosis. Contrast agents were used allows swift interpretation and rarely results in compli- in all imaging. Irregularities in the mass wall, surrounding cations. Another significant advantage of the technique is tissue invasion, the existence of necrotic areas within the that it can identify those lesions (infective, calculus-related tumour mass and any suspicion of regional lymphadenopa- or lymphoma producing a mass effect) where surgery is not thy were signs deemed to point towards a likely malignant recommended [4,5]. There are, however, a number of limita- diagnosis. tions inherent in the FNAB technique, including adequa- In this research, surgical planning was based on the out- cy of the material sent for cytology and the experience of come of FNAB. For lesions reported as benign, either total the pathologist in examining such samples, and these lim- or superficial parotidectomy was performed. Total parot- itations entail the possibility of a false negative result [3,6]. idectomy was indicated by a tumour originating within the Thus, FNAB is not a technique offering a guarantee of re- deep lobe, whilst superficial parotidectomy was performed liability to the surgeon. Correspondingly, imaging modal- if the origin was superficial. For suspected malignant le- ities, especially MRI (magnetic resonance imaging) have sions, total parotidectomy was performed in every case. been assuming a greater role in informing the preoperative The results from FNAB and MRI were compared both diagnosis within the last several years. MRI assists in local- in terms of how they distinguished benign from malignant ising the lesion, indicating its likely character as benign or lesions and for how accurately they produced a pre-histo- malignant, and may even allow for accurate prediction of logical diagnosis. the histopathological subtype [7,8]. MRI also vitally assists Statistical analysis of the results was carried out by in identifying the anatomical relations of the tumour, any means of the SPSS 21.0 version statistical software applica- vascular or neural infiltration and clarifying whether there tion (SPSS Inc., Chicago, IL, USA). Correlation was exam- is any cervical lymph node involvement [8]. ined using the Pearson correlation test. The chi-square test This research aims to compare fine needle aspiration was used to assess how successfully FNAB and cross-sec- biopsy (FNAB) with magnetic resonance imaging (MRI) tional radiological examinations, separately and together, in ability to differentiate between benign and malignant informed the differential diagnosis. The sensitivity and neoplasms found within the parotic gland, indicate a histo- specificity of each technique was calculated. pathological subtype and guide surgical planning. Results Materials and methods All the cases enrolled in the study had previously been ad- The study sample consisted of 74 patients who underwent mitted to the clinic with a presenting complaint of swelling parotid surgery between January 2013 and November in the anterior and lateral cheeks. No facial paralysis was 2018. 41 (55.4%) cases were men and 33 (44.6%) were observable in any of these cases. Four individuals had facial women, with a mean age in years of 51.3±12.8 (range: pain in addition to the complaint of swelling in front of Volume 9 Issue 1 January 2019 39 Kayalı Dinç A S et al. the ear. The average time elapsed between formation of Table 2: Diagnostic values of fine needle aspiration biopsy (FNAB) and the mass and admission to hospital was 24 months (range magnetic resonance imaging (MRI) for the detection of malignancy in parotid gland neoplasms. 1-144 months). 74 patients were included in the study. In FNAB (n=72) MRI (n=69) 33 patients (44.6%), a mass was observed in the parotid gland on the right side and in 41 patients (55.4%) on the Sensitivity 73,33% 81,25% left. Specificity 100% 90,57% According to the final histopathological diagnosis, 57 Accuracy 93,44% 88,41% cases represented benign (77%) and 17 (23%) malignant Positive predictive value 100% 72,22% neoplastic lesions. The distribution according to histo- Negative predictive value 92% 94,12% pathological diagnosis is presented in Table 1. 74 cases were included in the study, of which 72 un- derwent FNAB. FNAB was found to possess 73.3% sen- itial diagnosis 90% of the time. 5 other cases also under- sitivity to diagnose malignancy, with a specificity of 100% went FNAB, of which two were reported to be benign on and diagnostic accuracy of 93.4%. The positive predictive cytology, although further characterisation was impossible. rate was 100%.
Load more

Recommended publications
  • Variations of Parotidectomy – Indications and Technique
    Variations of Parotidectomy – Indications and Technique Kerry D. Olsen, M.D. Professor and Chair Head and Neck Surgery Mayo Clinic Parotidectomy Personal experience > 32 years • 60 – 100 cases per year • Variety of neoplasms and anatomic variations • Minimal morbidity overall • Recurrent neoplasms – challenging cases 1 Parotid Surgery - Challenges Patient expectations Variety of tumors encountered Relationship and size of the tumor to the nerve Extend the operation as needed Role of pathology Parotidectomy Surgical options: • Superficial parotidectomy • Partial parotidectomy • Deep lobe parotidectomy • Total parotidectomy • Extended parotidectomy 4 2 Surgical Technique Superficial parotidectomy Deep lobe parotidectomy Surgeons will spend their entire career trying to learn when it is safe or necessary to do more or less than a superficial parotidectomy 5 Superficial Parotidectomy Indications • Neoplasm • Risk of metastasis • Recurrent infection/abscess • Surgical exposure – deep lobe/ parapharynx/ infratemporal fossa • Cosmesis 6 3 Pre-operative Discussion Individualized • Goals – rational – risks Goals – safe and complete removal with surrounding margin of normal tissue and preservation of facial nerve function 7 8 4 9 10 5 11 12 6 13 14 7 Facial Nerve Identification Helpful: • Cartilaginous pointer • Posterior belly of the digastric muscle • Mastoid tip Retrograde dissection Mastoid dissection 15 16 8 17 18 9 19 20 10 Superficial Parotidectomy Surgical goals • Avoid facial nerve injury • Remove tumor with surrounding
    [Show full text]
  • Outpatient Versus Inpatient Superficial Parotidectomy: Clinical and Pathological Characteristics Daniel J
    Lee et al. Journal of Otolaryngology - Head and Neck Surgery (2021) 50:10 https://doi.org/10.1186/s40463-020-00484-9 ORIGINAL RESEARCH ARTICLE Open Access Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics Daniel J. Lee1†, David Forner1,2†, Christopher End3, Christopher M. K. L. Yao1, Shireen Samargandy1, Eric Monteiro1,4, Ian J. Witterick1,4 and Jeremy L. Freeman1,4* Abstract Background: Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods: A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/ permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results: There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952).
    [Show full text]
  • Surgical Treatment of Chronic Parotitis
    Published online: 2018-10-24 THIEME Original Research 83 Surgical Treatment of Chronic Parotitis Rik Johannes Leonardus van der Lans1 Peter J.F.M. Lohuis1 Joost M.H.H. van Gorp2 Jasper J. Quak1 1 Department of ENT & Head and Neck Surgery, Diakonessenhuis, Address for correspondence Rik Johannes Leonardus van der Lans, Utrecht, Netherlands MD, Department of ENT- & Head and Neck Surgery, Diakonessenhuis, 2 Department of Pathology, Diakonessenhuis, Utrecht, Netherlands location Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, Netherlands (e-mail: [email protected]). Int Arch Otorhinolaryngol 2019;23:83–87. Abstract Introduction chronic parotitis (CP) is a hindering, recurring inflammatory ailment that eventually leads to the destruction of the parotid gland. When conservative measures and sialendoscopy fail, parotidectomy can be indicated. Objective to evaluate the efficacy and safety of parotidectomy as a treatment for CP unresponsive to conservative therapy, and to compare superficial and near-total parotidectomy (SP and NTP). Methods retrospective consecutive case series of patients who underwent paroti- dectomy for CP between January 1999 and May 2012. The primary outcome variables were recurrence, patient contentment, transient and permanent facial nerve palsy and Frey syndrome. The categorical variables were analyzed using the two-sided Fisher exact test. Alongside, an elaborate review of the current literature was conducted. Results a total of 46 parotidectomies were performed on 37 patients with CP. Near- total parotidectomy was performed in 41 and SP in 5 cases. Eighty-four percent of patients was available for the telephone questionnaire (31 patients, 40 parotidec- tomies) with a mean follow-up period of 6,2 years. Treatment was successful in 40/46 parotidectomies (87%) and 95% of the patients were content with the result.
    [Show full text]
  • Three-Dimensional Reconstruction of the Facial Nerve Course in Parotid Gland Tumor Using Double Echo Steady State with Water-Excitation Magnetic Resonance Images
    Precision and Future Medicine 2020;4(2):75-80 CASE https://doi.org/10.23838/pfm.2020.00086 REPORT pISSN: 2508-7940 · eISSN: 2508-7959 Three-dimensional reconstruction of the facial nerve course in parotid gland tumor using double echo steady state with water-excitation magnetic resonance images 1 2 2 1 Yong Gi Jung , Yi-Kyung Kim , Hyung-Jin Kim , Han-Sin Jeong 1 DepartmentofOtorhinolaryngologyHeadandNeckSurgery,SamsungMedicalCenter,SungkyunkwanUniversitySchoolof Medicine,Seoul,Korea 2 DepartmentofRadiology,SamsungMedicalCenter,SungkyunkwanUniversitySchoolofMedicine,Seoul,Korea Received: May 7, 2020 Revised: May 28, 2020 Accepted: May 29, 2020 ABSTRACT Functionalpreservationofthefacialnerve(FN)isessentialinparotidtumorsurgery. Corresponding author: Han-Sin Jeong Recently,directvisualizationoftheFNintheparotidgland(double-echosteady-state Department of sequencewithwaterexcitationmagneticresonanceimaging[DESS-WE-MRI])hasbeen Otorhinolaryngology Head attemptedwithpromisingdiagnosticaccuracy.Inthisreport,wepresentthree-dimen- and Neck Surgery, Samsung sional(3D)reconstructionoftheFNcourseintwoparotidglandtumorcasesusing Medical Center, Sungkyunkwan DESS-WE-MRIimagesforthefirsttime.Onepatienthadarecurrentbenignparotid University School of Medicine, glandtumor,whiletheotherpatienthadamalignantparotidglandtumor.Re- 81 Irwon-ro, Gangnam-gu, gions-of-interestincludingtheFNandthetumorsweremanuallyselectedineachsec- Seoul 06351, Korea tionoftheDESS-WE-MRIimages.The3DrenderingswerethencreatedwithanIn-Vesal- Tel: +82-2-3410-3579 iussoftware.TheFNswerewell-demarcatedtothetemporofacialandcervicofacial
    [Show full text]
  • Surgical Management of Parotid Sialolith. Int J Health Sci Res
    International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Case Report Surgical Management of Parotid Sialolith Roshni Sajid1*, Abdulla Mufeed2**, Jubin Hassan3*** 1Professor, 2Reader, 3Sr. Lecturer, *Department of Oral & Maxillofacial Surgery, **Department of Oral Medicine & Maxillofacial Radiology, ***Department of Orthodontics & Dentofacial Orthopedics MES Dental College, Perinthalmanna, Kerala, India. Corresponding Author: Abdulla Mufeed Received: 31/03/2015 Revised: 23/04/2015 Accepted: 27/04/2015 ABSTRACT Sialolith are calcareous deposits in the ducts of major or minor salivary glands or within the gland themselves. They are thought to form from a slowly calcifying nidus of tissue or bacterial nidus. Sialolithiasis accounts for 30% of salivary gland disease and commonly involves the submandibular gland (83-94%)and less frequently the parotid(4-10%) and sublingual gland(1-7%).This case report presents a rare case of parotid gland calculi which was managed surgically. Key words: Parotid gland, sialolith, sialolithiasis. INTRODUCTION organic and inorganic substance. The Salivary gland calculi or sialolith is a organic substance is glycoproteins, common disease of salivary gland, usually mucopolysaccharides and cellular debris. found in the submandibular gland and the The inorganic substances are mainly ducts. [‎1] Males are effected twice as much as calcium carbonates and phosphates. female.[‎2] Children are rarely effected but Calcium, magnesium and phosphate ions review of literature reveals 1000 cases of each comprise between 20 and 25% with submandibular calculi in children aged three other minerals making up the remainder. weeks to fifteen years of old.[‎3] Salivary Sialolith reach a critical size or position to calculi are usually unilateral, multiple cause a partial or complete obstruction of calculi are rare.
    [Show full text]
  • Quality of Life After Great Auricular Nerve Sacrifice During Parotidectomy
    ORIGINAL ARTICLE Quality of Life After Great Auricular Nerve Sacrifice During Parotidectomy Nilesh Patel, MD; Gady Har-El, MD; Richard Rosenfeld, MD, MPH Objective: To determine the impact of great auricular Even among patients experiencing symptoms, 23 (77%) nerve (GAN) sacrifice during parotidectomy on pa- reported only a little or no bother caused by the symp- tients’ quality of life. toms, and 27 (90%) reported no interference or almost none with their daily activities. The degree of bother or Design: Historical cohort survey of patients who had interference reported had a moderate positive correla- undergone GAN sacrifice during parotidectomy. tion with the number of abnormal sensations reported. Setting: Tertiary academic otolaryngologic practice. Conclusions: The results suggest that, while many pa- tients experienced sensory deficits, the overall quality of Patients and Methods: Fifty-three patients who had life was not significantly affected after GAN sacrifice dur- undergone GAN sacrifice during parotidectomy com- ing parotidectomy. Patients who report multiple abnor- pleted an 8-item quality-of-life survey with a 7-point re- mal sensations, however, would benefit from additional sponse scale designed to measure outcome after GAN sac- counseling and from reassurance that the number of sen- rifice during parotidectomy. sations will diminish with time. Further study evaluat- ing the effect of preservation of the posterior branch of Results: Thirty patients (57%) reported experiencing at the GAN during parotidectomy on patients’ quality of life least 1 abnormal symptom, but the mean number of symp- is needed. toms decreased significantly with time, from a mean of 2.3 during the first year to 0.2 after 5 years (P,.001).
    [Show full text]
  • PAROTIDECTOMY Johan Fagan
    OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY PAROTIDECTOMY Johan Fagan The facial nerve is central to parotid Structures that traverse, or are found surgery for both surgeon and patient. within the parotid gland Knowledge of the surgical anatomy and the landmarks to find the facial nerve are • Facial nerve and branches (Figure 1) the key to preserving facial nerve function. • External carotid artery: It gives off the Surgical Anatomy transverse facial artery inside the gland before dividing into the internal maxil- Parotid gland lary and the superficial temporal arteries (Figure 2). The parotid glands are situated anteriorly and inferiorly to the ear. They overlie the vertical mandibular rami and masseter muscles, behind which they extend into the retromandibular sulci. The glands extend superiorly from the zygomatic arches and inferiorly to below the angles of the mandible where they overlie the posterior bellies of the digastric and the sternoclei- domastoid muscles. The parotid duct exits the gland anteriorly, crosses the masseter muscle, curves medially around its anterior margin, pierces the buccinator muscle, and Figure 1: Main branches of facial nerve enters the mouth opposite the 2nd upper molar tooth. Superficial Muscular Aponeurotic System and Parotid Fascia The Superficial Muscular Aponeurotic System (SMAS) is a fibrous network that invests the facial muscles and connects them with the dermis. It is continuous with the platysma inferiorly; superiorly it at- taches to the zygomatic arch. In the lower face, the facial nerve courses deep to the SMAS and the platysma. The parotid Figure 2: Branches of the external carotid glands are contained within two layers of artery parotid fascia, which extend from the zygoma above and continue as cervical • Veins: The maxillary and superficial fascia below.
    [Show full text]
  • Factors Influencing Sialocele Or Salivary Fistula Formation Post-Parotidectomy Christopher J
    Factors Influencing Sialocele or Salivary Fistula Formation Post-Parotidectomy Christopher J. Britt, MD, Andrew P. Stein, BA, and Gregory K. Hartig, MD University of Wisconsin School of Medicine and Public Health Parotidectomy Volumetric and Extent of Resection Analysis Upon evaluation of patient characteristics of sialocele formation, we found no significant INTRODUCTION differences in sidedness of parotidectomy, gender, age, or BMI between groups. Pathologically, the Patients were stratified into groups based on the extent of facial nerve dissection during rate of malignancy was statistically lower in the sialocele group. This may be partially explained by Parotidectomy with facial nerve dissection can be performed for several different reasons the case. If the lower facial nerve division was primarily traced, we described this as an inferior the volume of tissue removed. There was a larger volume of tissue removed in the malignant group with several different operative goals. The extent of parotidectomy can vary based on tumor superficial parotidectomy. If the upper division was traced primarily, we describe this as a compared to the benign group; however, this was not significant. location, tumor size, tumor pathology, or need for lymphadenectomy. The range of parotid tissue superior superficial parotidectomy. If the dissection took place between the upper and lower removed can vary greatly depending on the surgery performed and size of the tumor. The extent divisions, we described this as a middle superficial parotidectomy. Groups for complete of gland resected also depends on whether the dissection is limited to the superficial aspect of the superficial parotidectomy, total parotidectomy, subtotal parotidectomy, and revision In our study, 72 (96%) patients who had sialocele, developed it within 1 month time and none gland or involves the deep lobe.
    [Show full text]
  • Sialolithiasis: Traditional and Sialendoscopic Techniques
    OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY SIALOLITHIASIS: TRADITIONAL & SIALENDOSCOPIC TECHNIQUES Robert Witt, Oskar Edkins Sialoliths vary in size, shape, texture, and (Figures 1 & 2). The veins are visible on the consistency; they may be solitary or multi- ventral surface of the tongue, and ac- ple. Obstructive sialadenitis with or without company the hypoglossal nerve (Figure 2). sialolithiasis represents the main inflamma- tory disorder of the major salivary glands. Approximately 80% of sialolithiasis invol- ves the submandibular glands, 20% occurs in the parotid gland, and less than 1% is found in the sublingual gland. Patients typically present with painful swelling of the gland at mealtimes when obstruction caused by the calculus becomes most acute. When conservative management with sialo- gogues, massage, heat, fluids and antibio- Figure 2: Ranine veins tics fails, then sialolithiasis needs to be surgically treated by transoral, sialendosco- The paired sublingual salivary glands are pic and sialendoscopy assisted techniques; located beneath the mucosa of the anterior or as a last resort, excision of the affected FOM, anterior to the submandibular ducts gland (sialadenectomy). and above the mylohyoid and geniohyoid muscles (Figures 3 & 4). The glands drain via 8-20 excretory ducts of Rivinus into the Surgical anatomy submandibular duct and also directly into the mouth on an elevated crest of mucous The paired submandibular ducts (Whar- membrane called the plica fimbriata which ton’s ducts) are immediately deep to the is formed by the gland and is located to mucosa of the anterior and lateral floor of either side of the frenulum of the tongue).
    [Show full text]
  • Clinical Indicators: Parotidectomy
    Clinical Indicators: Parotidectomy Procedure CPT Days1 Excision of parotid tumor or parotid gland; lateral lobe, without 42410 90 nerve dissection Excision of parotid tumor or parotid gland; lateral lobe, with 42415 90 dissection and preservation of facial nerve Excision of parotid tumor or parotid gland; total, 42420 90 with dissection and preservation of facial nerve Excision of parotid tumor or parotid gland; total; 42425 90 en bloc removal with sacrifice of facial nerve Excision of parotid tumor or parotid gland; total, 42426 90 with unilateral radical neck dissection Related Procedures CPT Days1 Drainage of abscess; parotid, simple 42300 10 Drainage of abscess, parotid, complicated 42305 90 Sialolithotomy; parotid, uncomplicated, intraoral 42330 10 Sialolithotomy; parotid, extraoral or complicated intraoral 42340 90 Biopsy of salivary gland, needle 42400 0 Biopsy of salivary gland, incisional 42405 10 Unlisted procedure, salivary glands or ducts 42699 Indications 1. History (one or more required) a) Parotid mass. b) History of radiation to the neck. c) Chronic parotitis. d) A neck mass with histologic findings of metastatic parotid tumor. e) Parotid duct stone. f) Malignancy of overlying skin extending into parotid g) Malignancy metastatic to parotid. 1 RBRVS Global Days 2. Related Symptoms a) Facial nerve paralysis. b) Pain of parotid region. 3. Physical Examination (required) a) Complete physical examination of the head and neck with emphasis on inspection and palpation of the parotid gland, oropharynx and neck. b) Examination of facial nerve function. 4. Tests (required) a) Pre-operative tests as required by institutional guidelines. 5. Tests (optional) a) Fine needle aspiration biopsy. b) Ultrasonography. c) CT scan of neck.
    [Show full text]
  • Management of Mucoceles, Sialoceles, and Ranulas
    Management of Mucoceles, Sialoceles, and Ranulas a b, Eve M.R. Bowers, BA , Barry Schaitkin, MD * KEYWORDS Mucocele Ranula Sialocele Lip Mouth floor Marsupialization Surgical management KEY POINTS Mucoceles are benign, mucin-filled cysts commonly found on the bottom lip, and are frequently managed with surgical excision. Sialoceles are a variant of mucocele that develop from the extravasation of saliva from injured parotid parenchyma. Acute salivary ductal injuries should be repaired when possible. Delayed presentations may require botulinum toxin or surgery for resolution. Ranulas are a type of mucocele that can vary from superficial floor-of-mouth lesions to plunging neck masses. Ranulas are extravasation pseudocysts that are most commonly managed by surgical excision of the cyst and the associated sublingual gland. INTRODUCTION Mucoceles, sialoceles, and ranulas are extravasation pseudocysts. The collection of mucus itself does not have an epithelial lining; therefore, removing the pseudocyst generally does not solve the problem. Each of these entities is discussed in turn for their unique aspects. The most common treatment modalities are highlighted. Mucocele Mucoceles are common, oral lesions that most frequently present as painless, clear or bluish cysts on the bottom lip of young adults and children. They are benign, mucus- filled growths that typically occur from damage to minor salivary glands or ducts (Fig. 1). Injury to the salivary glands through lip biting, sucking, or trauma can cause mucus to leak into surrounding subepithelial tissue, resulting in the most common variant of mucocele called a mucus extravasation cyst.1 Mucoceles may also develop from mucus buildup behind blocked glandular ducts, resulting in a less common Conflicts of interest: None.
    [Show full text]
  • Clinical Indicators: Parotidectomy
    Clinical Indicators: Parotidectomy Procedure CPT Days1 Excision of parotid tumor or parotid gland; lateral lobe, without 42410 90 nerve dissection Excision of parotid tumor or parotid gland; lateral lobe, with 42415 90 dissection and preservation of facial nerve Excision of parotid tumor or parotid gland; total, 42420 90 with dissection and preservation of facial nerve Excision of parotid tumor or parotid gland; total; 42425 90 en bloc removal with sacrifice of facial nerve Excision of parotid tumor or parotid gland; total, 42426 90 with unilateral radical neck dissection Related Procedures CPT Days1 Drainage of abscess; parotid, simple 42300 10 Drainage of abscess, parotid, complicated 42305 90 Sialolithotomy; parotid, uncomplicated, intraoral 42330 10 Sialolithotomy; parotid, extraoral or complicated intraoral 42340 90 Biopsy of salivary gland, needle 42400 0 Biopsy of salivary gland, incisional 42405 10 Unlisted procedure, salivary glands or ducts 42699 Indications 1. History (one or more required) a) Parotid mass. b) History of radiation to the neck. c) Chronic parotitis. d) A neck mass with histologic findings of metastatic parotid tumor. e) Parotid duct stone. f) Malignancy of overlying skin extending into parotid g) Malignancy metastatic to parotid. 1 RBRVS Global Days 2. Related Symptoms a) Facial nerve paralysis. b) Pain of parotid region. 3. Physical Examination (required) a) Complete physical examination of the head and neck with emphasis on inspection and palpation of the parotid gland, oropharynx and neck. b) Examination of facial nerve function. 4. Tests (required) a) Pre-operative tests as required by institutional guidelines. 5. Tests (optional) a) Fine needle aspiration biopsy. b) Ultrasonography. c) CT scan of neck.
    [Show full text]