Search Results (111)

Background: The majority of parotid gland tumors are benign, e.g., pleomorphic adenoma (PA) and Warthin’s tumor (WT). From a biomedical point of view, oxidative stress is of significant importance due to its established association with the initiation and progression of various types of cancer, including parotid gland cancers. This study aimed to assess whether blood prooxidant–antioxidant markers could aid in diagnosing and guiding surgery for recurrent malignancies after parotid tumor treatment. Methods: We examined patients (n = 20) diagnosed with WT (n = 14) and PA (n = 6) using histopathological verification and computed tomography (CT) who qualified for surgical treatment. Blood samples were taken before the surgery and again 10 days later for biochemical analysis. The activities of the antioxidant enzymes (SOD, CAT and GPx), the non-enzymatic antioxidants (GSH and UA) and oxidative stress markers (MDA and TOS) were determined in the blood. The activities of CK and LDH and the concentrations of Cor and TAS were measured in the serum. Hb and Ht were determined in whole blood. Results: The patients’ SOD, CAT, and GPx activities after surgery did not differ significantly from their preoperative levels. However, following surgery, their serum TOS levels were significantly elevated in all the patients compared to baseline. In contrast, the plasma MDA concentrations were markedly reduced after surgery. Similarly, the GSH concentrations showed a significant decrease postoperatively. No significant changes were observed in the CK and LDH activities, TAS concentrations, or levels of Hb, Ht and Cor following surgery. Conclusions: The surgical removal of salivary gland tumors did not result in a reduction in oxidative stress at 10 days after surgery. Therefore, further studies are needed to determine the effectiveness of endogenous defense mechanisms in counteracting the oxidative stress induced by salivary gland tumors. Full article

Background/Objectives: The aim of our study was to evaluate clinical outcomes in patients with small pleomorphic adenoma (PA) after extracapsular dissection (ED) versus superficial parotidectomy (SP). Methods: Following the PRISMA guidelines, a systematic review covering the years from 1950 to 2025 was conducted using the Pubmed/MEDLINE, Cochrane Library, Scopus, Ovid MEDLINE and Embase databases. A single-arm meta-analysis was performed to evaluate intraoperative capsular rupture, recurrence, transient and permanent facial nerve palsy, Frey’s syndrome, salivary fistula, seroma and hematoma of patients who underwent ED vs. those who underwent SP, and funnel plots were constructed to evaluate the robustness of the findings. Results: Of the 1793 identified papers, 21 articles met the inclusion criteria. The meta-analysis (2507 patients) reported the following: (1) the risk of recurrence is similar in patients treated with ED and SP; (2) the transient facial nerve palsy rate is lower after ED (p < 0.05), while the permanent facial nerve palsy rate is similar with ED and SP; (3) post-operative complications, especially Frey’s syndrome (p < 0.05), are more common after SP. Conclusions: Given the similar recurrence rate and the lower morbidity compared to SP, ED could be considered the treatment of choice for pleomorphic adenomas of the parotid gland that are up to 3 cm in size, mobile and located in the superficial lobe of the parotid gland. Full article

Background/Objectives: The purpose of this study was to determine the incidence of salivary gland tumors based on age, gender, histological type, and localization over an eleven-year period at the University Hospital of Split. Methods: The medical records of the Department of Otorhinolaryngology with Head and Neck Surgery and the Department of Maxillofacial Surgery at the University Hospital of Split regarding salivary gland tumors were searched from January 2012 to December 2022. The current fifth World Health Organization (WHO) Classification of Head and Neck Tumors and its criteria were considered during that process. Results: Out of 404 patients, 211 (52.20%) were female and 193 (47.77%) male. The mean age was 60. There were four pediatric patients. Six patients had a combination of two different histological types of salivary gland tumors present simultaneously at the exact localization. Therefore, there were 410 histological types in total, 214 related to females and 196 to males. A total of 361 (88.05%) benign and 49 (11.95%) malignant primary salivary gland tumors were detected. The parotid gland was the predominant location (N = 361, 87.8%). There were no cases affecting the sublingual gland. Pleomorphic adenoma was the most common benign histological type (N = 169, 41.2%). The most common malignant histological types were adenoid cystic carcinoma (N = 9, 2.2%) and mucoepidermoid carcinoma (N = 9, 2.2%). The average incidences of salivary gland tumors in the 11 years for the four Dalmatian counties and the Republic of Croatia were 4.45/100,000 and 0.9/100,000, respectively. Conclusions: The results of this study, primarily the ones concerning histological types and localization, do not deviate from general knowledge about salivary gland tumors. Simultaneous and ipsilateral occurrence of different histological types is a rare and extremely valuable finding. The average incidence for Dalmatian counties and the Republic of Croatia is within the range of the International Agency for Research on Cancer estimates. Full article

Background/Objectives: Necrotizing sialometaplasia (NS) is an inflammatory condition of the salivary glands that can closely mimic malignancy. While it predominantly affects the minor salivary glands of the hard palate, it can also occur in the parotid gland, leading to potential misdiagnosis and unnecessary treatment. This study aims to analyze the characteristics, diagnostic challenges, and management of parotid gland NS through a comprehensive literature review and a case report. Methods: A systematic literature review was conducted using PubMed, including all relevant publications up to December 2024. The research strategy focused on cases of NS affecting the parotid gland. Additionally, a rare case of misdiagnosed parotid NS is presented to highlight clinical and diagnostic challenges. Results: The review identified 30 patients, with a mean age of 49 years, and a nearly equal distribution between sexes. Their etiology was primarily linked to vascular insufficiency, often triggered by surgical trauma (20 cases), tumors (1 case), vascular fragility (4 cases), smoking (1 case), or other factors (4 cases). Clinically, NS can resemble squamous cell carcinoma, presenting with neck swelling, pain, and imaging features suggestive of malignancy. Histopathological assessment remains the gold standard for diagnosis. A rare case of a 23-year-old female misdiagnosed with squamous cell carcinoma emphasizes the importance of multiparametric MRI imaging and histological re-evaluation in atypical presentations. Conclusions: NS of the parotid gland is a rare but significant diagnostic challenge, due to its resemblance to malignant tumors. While conventional imaging may suggest a neoplastic process, advanced techniques such as DWI (Diffusion-Weighted Imaging) and ADC (Apparent Diffusion Coefficient) mapping can offer valuable noninvasive insights. A multidisciplinary approach, incorporating clinical history, imaging, and histopathological assessment, is essential in order to avoid unnecessary treatment. In cases where NS is suspected, a conservative approach with careful follow-up may be warranted to prevent overtreatment. Full article

Background: The objective of this study was to compare the value of ultrasound (US), magnetic resonance imaging (MRI), and US-guided fine-needle aspiration biopsy (FNAB) in the preoperative evaluation of parotid tumors. Methods: A three-year prospective study, including 35 patients, was conducted. Preoperative ultrasound, MRI, and US-guided FNAB were performed on each patient, after which an imaging and cytological diagnosis was obtained. Each patient underwent surgical treatment. The imaging and cytological diagnoses were compared with the histopathological reports. Results: Ultrasound and MRI showed the same diagnostic performance in discriminating benign from malignant parotid tumors: sensitivity—80%, specificity—97%, and accuracy—94%. In this regard, FNAB registered a sensitivity, specificity, and accuracy of 100%, 97%, and 97%, respectively. US, MRI, and FNAB were recorded as having high diagnostic accuracy in the detection of pleomorphic adenoma and Warthin tumors. Conclusions: Ultrasound and US-guided FNAB allow for the preoperative differential diagnosis of parotid tumors located in the superficial lobe. When US and FNAB results are inconclusive, MRI becomes mandatory. Full article

Background/Objectives: Differentiating between benign and malignant parotid gland tumors (PGT) is essential for establishing the treatment strategy, which is greatly influenced by the tumor’s histology. The objective of this study was to evaluate the role of MRI-based radiomics in the differentiation between Warthin’s tumors (WT) and malignant tumors (MT), two entities that proved to present overlapping imaging features on conventional and functional MRI sequences. Methods: In this retrospective study, a total of 106 PGT (66 WT, 40 MT) with confirmed histology were eligible for radiomic analysis, which were randomly split into a training group (79 PGT; 49 WT; 30 MT) and a testing group (27 PGT; 17 WT, 10 MT). The radiomic features were extracted from 3D segmentations of PGT performed on the following sequences: PROPELLER T2-weighted images and the ADC map, using a dedicated software. First- and second-order features were derived for each lesion, using original and filtered images. Results: After employing several feature reduction techniques, including LASSO regression, three final radiomic parameters were identified to be the most significant in distinguishing between the two studied groups, with fair AUC values that ranged between 0.703 and 0.767. All three radiomic features were used to construct a Radiomic Score that presented the highest diagnostic performance in distinguishing between WT and MT, achieving an AUC of 0.785 in the training set, and 0.741 in the testing set. Conclusions: MRI-based radiomic features have the potential to serve as promising novel imaging biomarkers for discriminating between Warthin’s tumors and malignant tumors in the parotid gland. Nevertheless, it is still to prove how radiomic features can consistently achieve higher diagnostic performance, and if they can outperform alternative imaging methods, ideally in larger, multicentric studies. Full article

Background: Facial nerve injury is one of the most concerning complications of parotid gland surgery, with temporary and permanent dysfunction rates varying widely in the literature. This study aimed to identify factors associated with facial nerve injury during surgery for benign parotid tumors and assess the protective efficacy of intraoperative nerve monitoring (NIM) in preventing nerve injury. Methods: This retrospective study analyzed 329 patients who underwent parotid gland surgery between 2010 and 2023. Data collected included patient demographics, tumor characteristics (size, location, histology), surgical parameters (operation time, NIM usage), and postoperative nerve function evaluated using a modified House–Brackmann scale. Descriptive and inferential statistical analyses, including Chi-square tests and logistic regression, were employed to identify predictors of facial nerve outcomes. Results: Facial nerve injury occurred in 5.2% of patients, comprising 4.6% temporary and 0.6% permanent damage. Tumors located in the deep and inferior lobes significantly increased the risk of facial paralysis/palsy (p = 0.035), while tumor size and histology showed no significant associations. Using NIM significantly reduced the risk of facial nerve injury (p < 0.05; OR: 0.35, 95% CI: 0.25–0.50). Age was also identified as a significant predictor of nerve dysfunction (p < 0.05). Conclusions: The findings emphasize the importance of NIM in mitigating facial nerve injury, especially in anatomically complex tumor locations. Tailored surgical approaches based on tumor location and patient-specific factors, combined with the routine use of NIM, are recommended to optimize nerve preservation and improve postoperative outcomes. Full article

Background: Oncological surgery of the parotid gland or of the temporal bone may require the contemporary sacrifice of the facial nerve (FN). In such cases, the immediate repair of the sacrificed FN is recommended. The aim of this study is to evaluate the impact of facial rehabilitation (FR) and, secondarily, of post-operative radiotherapy (PORT) on the FN outcome after FN sacrifice and reconstruction via cable graft. Methods: This is a multicentric retrospective study including patients affected by malignant tumors whose surgical excision required FN sacrifice and contextual FN reconstruction with a cable graft. Other FN reconstruction techniques were excluded. FN function was assessed using both House–Brackmann and Sunnybrook grading systems. Results: A total of 28 patients were included. Most of the patients underwent a total parotidectomy. The greater auricular nerve was the main donor for cable graft. FR and PORT were performed in 22 and 15 patients, respectively. In particular, 20 patients underwent neuro-muscular retraining (NMR). Patients who underwent FR had better FN outcomes compared to those who did not (p = 0.02 at 12 months and p = 0.0002 at 24 months). In contrast, there was no statistically significant difference between patients who underwent PORT and those who did not (p > 0.05). Pre-operative FN palsy is a risk factor of worse FN function outcomes after cable graft. Conclusions: Our study, even though it was limited to only 28 cases, may demonstrate that cable graft failure is not due to PORT, as widely believed among clinicians, but to the absence of a rehabilitation program. Moreover, we suggest that the key to obtaining the best possible FN function results after FN sacrifice is the association of a technically correct FN reconstruction with a proper and targeted FR. Full article

Backgrounds: Imaging of parotid tumors is crucial for surgery planning, but it cannot distinguish malignant from benign lesions with absolute reliability. The aim of the study was to establish a diagnostic MRI algorithm to differentiate parotid tumors. Methods: A retrospective study was conducted including all patients with parotid tumors, who underwent 3T-MRI and surgery. Morphological characteristics and normalized T2 and late postcontrast T1 signal intensities (SI) were assessed. “Ghosting sign” on late postcontrast T1 sequence was defined as indistinguishability of the tumor except for a thin peripheral enhancement. Patients were divided according to histology and imaging data were compared. A diagnostic MRI algorithm was established. Results: Thirty-six patients were included. The combination of normalized late T1 postcontrast SI, normalized T2 SI and “ghosting sign” allowed for the distinguishing of malignant from benign parotid tumors with high sensitivity (100%), specificity (93%), positive predictive value (80%), negative predictive value, (100%) and accuracy (94%). Moreover, pleomorphic adenomas often showed a homogeneous T2 signal and a complete capsule (p < 0.01), Warthin tumors protein-rich cysts and calcifications (p < 0.005 and p < 0.05), and malignant tumors an inhomogeneous contrast enhancement (p < 0.01). Conclusions: High field MRI represents a promising tool in parotid tumors, allowing for an accurate differentiation of malignant and benign lesions. Full article

(1) Background: Salivary gland tumors (SGTs) are a rare and diverse group of neoplasms arising in the parotid, submandibular, sublingual, and minor salivary glands distributed throughout the upper aerodigestive tract. Given the rarity and complexity of MSGTs, understanding their epidemiology across diverse populations is crucial for improving diagnostic and therapeutic strategies. (2) Methods: A retrospective analysis involving 45 patients diagnosed with malignant salivary gland tumors and treated with curative intention between 1 July 2016 and 1 July 2021 in a tertiary academic hospital was performed. (3) Results: Histologically, the most common subtype was adenoid cystic carcinoma in 12 (26.7%) cases, followed by carcinoma ex-pleomorphic adenoma in 7 (15.6%) cases, mucoepidermoid carcinoma in 6 (13.3%) cases, and adenocarcinoma in 6 (13.3%) cases. The majority of tumors were located in the parotid gland in 28 cases (62.2%). The three-year overall survival rate was 80% and the three-year specific survival rate was 86.7%. Tumor grade was significantly associated with local recurrence and the appearance of distant metastasis during the follow-up period (p = 0.04). We also evidenced a worse survival in patients with advanced T-Stage (p = 0.038) and positive nodes in the neck (p = 0.015). (4) Conclusions: Overall, our study reinforces the prognostic significance of tumor grade, T-Stage and N-Stage while challenging the conventional understanding of factors such as PNI, LNM, and margin status. Full article

Background: Salivary gland tumors are relatively rare neoplasms, comprising approximately 3–6% of all head and neck tumors. Parotid gland carcinoma (PGC) represents approximately 70–80% of all salivary gland malignancies. Treatment strategies depend on tumor histology, stage, and molecular characteristics, with surgical resection and adjuvant radiotherapy being the mainstays of treatment for localized disease. Conversely, in advanced stages, therapeutic approaches, including chemotherapy and targeted agents, are more challenging. Methods: We present a case report of a 60-year-old patient with hepatic and nodal metastases of parotid gland carcinoma HER2+ who received dual blockade with Pertuzumab and trastuzumab (PH) with addition of Docetaxel, with the aim of highlighting the management and treatment outcomes. Results: Our patient received 4 cycles of chemotherapy and PH with near-complete response. After lymph node dissection (level I–IV) with primitive tumor resection and radiosurgery on the residual liver metastases, currently she continues treatment as maintenance. Conclusions: Based on the patient’s overall condition and response to current treatment, the oncology team ought to consider further targeted therapies, radiotherapy, or surgery as future therapeutic options. Full article

Introduction: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. Clinical report: A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 × 2.7 × 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. Conclusions: Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the “wait and see” approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery. Full article

Background and Objectives: Salivary gland tumors (SGTs) are diverse lesions with varying morphological and clinical characteristics. Limited data exist on the distribution of SGTs in Saudi Arabia. We aimed to fill this gap by examining the distribution of SGTs across four tertiary hospitals in Riyadh. Materials and Methods: A retrospective analysis was conducted on SGT cases diagnosed from January 2010 to December 2022 to investigate the clinicopathological features (tumor location, patient sex, and age). Histological slides were evaluated by two independent certified oral pathologists and classified based on the latest 2022 World Health Organization classification (WHO). Results: There were 796 SGTs. Most cases occur in individuals in their 4th to 5th decades of life. The parotid gland was the predominant site (79.4%), followed by the submandibular gland (9.3%). More than half of the tumors (527, 66.2%) were benign, involving major and minor salivary glands. Pleomorphic adenoma was the most common benign tumor, accounting for 354 cases (44.5%), followed by Warthin tumor with 117 cases (14.7%). Mucoepidermoid carcinoma was the most prevalent malignant tumor, identified in 98 patients (12.3%). Additionally, 36 (4.5%) mesenchymal and 30 (3.8%) hematolymphoid non-epithelial SGTs were reported. Conclusions: This multicenter study is the largest of its kind in Saudi Arabia, identifying pleomorphic adenoma and mucoepidermoid carcinoma as the most commonly reported benign and malignant tumors, respectively. These findings offer valuable insights into the understanding of salivary gland tumors globally. Full article

Salivary gland tumors are rare head and neck tumors constituting up to 6% of all head and neck neoplasms; despite being mostly benign, these tumors present in diverse histological subtypes, making them challenging to diagnose and treat. Our research aims to investigate the link between inflammation and tumorigenesis within the salivary glands based on the literature regarding the etiopathogenesis of benign salivary gland tumors. This scoping review was conducted following the PRISMA extension for scoping reviews and reporting guidelines. The search was conducted using the Pubmed and Embase databases. Articles published between 2004 and May 2024 were included in the review. A total of 1097 papers were collected and identified. After 271 duplicates were removed, 826 titles and abstracts were independently reviewed by two researchers. Based on the title and abstract, 735 citations were excluded, and 91 articles were assessed for eligibility. Data were extracted from 46 articles that met the inclusion criteria. The review highlights the significance of inflammation-related factors and its relations with benign salivary gland tumors (SGTs). Knowledge of the etiopathogenesis of these tumors remains insufficient, and their rich immunological background poses challenges in diagnosis. The findings also point to directions for further clinical research, which will be necessary to implement these molecules in clinical practice. Full article

Background and Clinical Significance: Epithelial–myoepithelial carcinoma (EMC) is a rare, low-grade malignant tumor of the salivary glands. It is characterized by a low malignancy potential, as indicated by its low rate of lymph node involvement and distant metastasis, and has a local recurrence rate of approximately 50%. Due to the rarity of EMC and the limited data available in the literature, there are no established treatment or follow-up guidelines. Case Presentation: We report the case of an 83-year-old man who presented with swelling in the left submandibular region, occurring 9 years following an initial diagnosis of EMC in the ipsilateral parotid gland. After radiological examinations and an ultrasound-guided fine-needle aspiration biopsy, the patient underwent surgical excision of the lesion with a histological diagnosis of recurrence/metastasis of low-grade epithelial–myoepithelial carcinoma. Conclusions: This is the first documented case of loco-regional lymph node metastasis 9 years after an initial diagnosis of EMC of the parotid gland. Based on our experience, EMC of the parotid gland, even when diagnosed at an early stage, seems to require a long follow-up period. Full article