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The etiology of a subacute inflammatory swelling in the area of the right parotid gland in a 62-years old man could not be resolved clinically. The histomorphological examination of the surgical specimen showed an intraglandular area of predominantly chronic histiocytic inflammation with foreign body reaction in the intimate neighbourhood of a small, subtotally infarcted Warthin's tumour. Not birefringent spindle-shaped crystals could be demonstrated both within the parotitis or intraluminally in vital parts of the Warthin's tumour. In terms of the possible causes of the severe intraglandular inflammation, all arguments favour a primary infarction of the Warthin's tumour with the release of intraluminal preformed crystals which secondarily induce a massive inflammation with foreign body reaction, corresponding to the clinical presentation of a subacute parotitis.

An inflammatory myofibroblastic tumor, previously known as an inflammatory pseudotumor, is an uncommon neoplasm. This tumor, which has characteristic morphological and immunohistochemical features, is mostly seen in the lung. Herein we present a rare case of an inflammatory myofibroblastic pseudotumor of the parotid gland as well as a review of the literature. The patient was a 66-year-old man with recurrent painful swelling of the parotid gland. A total parotidectomy with preservation of the facial nerve branches was performed. The patient showed no signs of recurrence > 3 years after surgery. The presence of clonal cytogenic abnormalities supported the neoplastic origin of this process. The treatment consisted of complete resection. Clinicians should however be aware that an inflammatory myofibroblastic tumor may mimic a reactive process.

Objective: To document the etiology and successful treatment of severe recurrent pneumoparotid., Study Design: Computed tomography, ductal measurement by probe size, surgical treatment., Results: We performed a superficial parotidectomy for a 13-year-old with a history of recurrent parotitis. He subsequently developed recurrent pneumoparotid in the contralateral gland with subcutaneous dissection of air into the face, neck, and mediastinum. At surgery, Stensen's ducts were measured and found to be abnormally patent bilaterally compared to standardized norms. Parotid duct ligation, commonly used for sialorrhea, was employed as a novel treatment and was curative., Conclusion: Insufflation of air into the parotid duct system can trouble woodwind instrument players, can complicate dental procedures, or can be self-induced. It is generally a benign condition requiring no therapy. Occasionally, pneumoparotid can be recurrent and lead to inflammation and infection of the parotid or subcutaneous emphysema., Significance: In selected cases of recurrent pneumoparotid, ductal ligation may be curative.

A 12-year-old male presented for a superficial parotidectomy for chronic parotitis. The patient had an unremarkable past medical history and was admitted on the day of surgery for his procedure without further anaesthetic or surgical review. During the patient's intraoperative course, higher than expected blood pressures were noted and treated with clonidine. After further high blood pressure readings in the postoperative care unit, close surveillance of blood pressures for the following 24 h was arranged. The hypertension was ongoing, and further examination and investigation confirmed the diagnosis of coarctation of the aorta. We examine the possible reasons for failure to diagnose this patient's hypertension preoperatively and suggest that there is a need for greater surveillance of blood pressures in the paediatric population presenting for surgery. A discussion of the significance of hypertension in paediatrics and recommendations for minimum standards of care to address shortcomings in the diagnosis and treatment of paediatric hypertension are proposed.

A new method for the treatment of chronic sialodochitis and sialolithiasis is suggested for cases with essential dilatation of the duct in the intraglandular compartment of the parotid gland: the external wall of dilated duct is dissected and the two resultant parts are twisted inside and sutured to the internal wall of the dilated duct; the parotid duct is ligated at the site of its exit from the gland.

Chronic parotitis is an insidious inflammatory disorder, which is characterized by a recurrent, often painful, swelling of the gland or glands. Sialography remains the investigation of choice. Diagnostic siladenoscopy may complement or supersede sialography as the diagnostic procedure of choice, as more experience is gained in this technique and its use becomes more widespread. The management options are conservative or surgical, but controversy exists regarding the timing and method of surgical intervention. The surgical methods that have been described include injection of methyl violet - a sclerosing agent, ductal ligation, ductoplasty, tympanic neurectomy, and parotidectomy. Parotidectomy is considered the ultimate surgical option but because of its significant morbidity the exact technique and procedure that should be used remains contentious.

Sialoadenitis is a non-inflammatory condition that affects mainly the parotid, and is characterised by bilateral, painless swelling, which is an appreciable problem in young women. A 28-year-old woman presented with parotid sialoadenitis with masseteric hypertrophy. She was treated by superficial parotidectomy and ostectomy of the mandibular angle and made an uncomplicated recovery.

A case is reported in which a unilateral parotid gland cystadenolymphoma was combined with actinomycosis. A 48-year-old woman presented with a mass in the left parotid region and paresis of the lower left palpebra. The computed tomography, echography, and parotid radiographic findings did not exclude a neoplasm of the left parotid gland. The ramus of the mandible was involved in the process. Intraoperative freezing histology, total parotidectomy, and partial mandibulectomy were performed, with sacrifice of the facial nerve followed by nerve reconstruction. The final histological evaluation was Warthin tumor with actinomycosis. Four years after treatment, the patient is free of disease. No similar cases seem to have been reported thus far.

Objective: The purpose of this paper was to analyse parotideal abscesses on the basis of a larger number of patients., Patients and Methods: The data of 36 patients (mean age 44 years) with a parotideal abscess was analysed., Results: Ultrasound scan was always necessary to verify the diagnosis. The surgical drainage was done under myoelectric monitoring of the facial nerve. Only in 1 patient a temporary minor paralysis of the mandibular branch was noticed. The most common bacteria were Staph. aureus, Streptococcus, and Peptostreptococcus. In 2 cases a tuberculosis and in 2 children an atypical mycobacterial infection was discovered. In another patient a metastasis of a squamous cell carcinoma was found., Conclusions: In every patient with an acute swelling of the parotid region without consideration of age, number of leucocytes or a typical fluctuation, an ultrasound scan should be used. The surgical drainage of the abscess should be done under myoelectric monitoring (Cave: muscle relaxant). In every case, a specimen for microbiological analysis (bacterial determination) and a biopsy (to exclude malignoma or atypical mycobacteria) are necessary. A peri- and post-operative therapy with a combination of aminopenicillin and clavulanic acid or with cephalosporine is recommended.

Objective: To analyse the usefulness of facial nerve monitoring by continuous electromyography during parotidectomy., Patients and Methods: Fifty-two consecutive patients who underwent parotidectomy (27 unmonitored and 25 monitored) between 1987 and 1998. Both groups had a similar distribution of superficial and total parotidectomy., Results: Facial nerve monitoring reduced the incidence and severity of facial nerve paralysis independently of the kind of surgery performed. The incidence of temporary facial paralysis was significantly lower in the monitored group (36%) than in the unmonitored group (70%) (p = 0.013). The rates of permanent deficit were 4% for the monitored group and 30% for the unmonitored group (p = 0.025)., Conclusions: The results suggest that intraoperative facial nerve monitoring reduces the incidence of postoperative facial deficit. The routine use of facial nerve monitoring is controversial. However, it is considered useful in surgery where there is a higher risk of injury to the facial nerve such as total parotidectomy, re-interventions or chronic inflammatory conditions.

This is a retrospective review of a single surgeon's experience over a 20-year period, and covers the presentation, investigation, histology, management and complications of the surgical treatment of chronic parotid disease. There were 46 superficial parotidectomies (23 with ductal ligation); 3 required removal of calculi and there was one ductoplasty and one total parotidectomy. There were 28 cases of temporary palsy of the VIIth cranial nerve (55%, mean duration 4 months) and this was predominantly panfacial (79%). There were no cases of permanent palsy. Five patients who initially had a superficial parotidectomy required subsequent total parotidectomy for recurrent disease (11%). We have now adopted a policy of near total parotidectomy for the surgical treatment of chronic parotid disease., (Copyright 2000 The British Association of Oral and Maxillofacial Surgeons.)

The preoperative findings and operative outcome were evaluated in 49 patients who underwent tympanic neurectomy to treat chronic parotitis. Forty-two patients had chronic non-suppurative parotitis and 7 patients had chronic suppurative parotitis. The main symptoms prior to operation were recurrent swelling and pain of the parotid gland. After operation, 40 patients (82%) had relief of their symptoms (28 patients were totally free of symptoms and 12 patients were markedly improved). In 9 patients (18%) the symptoms remained the same. Three patients (6%) had a tympanic membrane perforation due to the operation.

Chronic sclerosing sialadenitis (also known as Küttner tumor) is a chronic inflammatory condition of the salivary glands, first described by Küttner in 1896. Clinically, the disease cannot be distinguished from a true neoplasm. The submandibular gland is affected more commonly than any other salivary gland. This report is of a case of widespread swelling of the salivary glands in which histologic features of chronic sclerosing sialadenitis were seen in the submandibular and parotid glands. The etiology, pathogenesis, and differential diagnosis of this disease and the clinical outcome of this case are discussed and presented.

The clinical records, preoperative sialograms and histopathological slides of 33 patients who had been operated on for symptoms of obstructive salivary gland disease were reviewed. Twenty patients had had superficial parotidectomy and 13 excision of the submandibular gland. Among those who had required parotidectomy, preoperative sialograms tended to suggest more architectural damage than was actually noted on definitive histopathological examination. Patients whose symptoms had been present for longer had more severe sialographic and histopathological changes. In the submandibular group, there was a closer relation between sialographic and histopathological changes, and a positive correlation between a short history and the severity of histopathological grading. These differences may reflect the different aetiology and course of obstructive disease in the two types of gland.

The demographic profile and complications are compared and contrasted for 150 consecutive parotidectomies. All patients were under the care of one surgeon (JDL) over a twenty-year period (1977-1997). The case records and contemporaneous database were analysed retrospectively. 111 (74%) procedures were performed for tumours and 39 (26%) for inflammatory disease. The incidence of unexpected permanent facial nerve palsy was 1.8% in the tumour group and zero in the inflammatory group. The overall unexpected palsy rate was 1.3%. Transient paralysis was more common in the inflammatory group than the tumour group (61.5% compared with 33.3%, P<0.02) and was more likely to be panfacial (48.7% compared with 17.1%, P<0.0002). The overall incidence of Frey's syndrome was less than 20% and both salivary fistulae and sialocoeles were infrequent.

Chronic non-specific sialadenitis of the parotid gland is an insidious inflammatory disorder which is characterised by intermittent, often painful, swelling of the gland. The disease tends to progress and may lead to the formation of a fibrous mass. The purpose of this paper is to review our experience in the surgical management of patients with chronic non-specific parotid sialadenitis. In a consecutive series of 100 patients treated for benign parotid disease, 19 were found to have chronic non-specific sialadenitis; 10 were male and 9 female. Mean age was 46 years and the mean duration of symptoms was 4.6 years. Sialography was performed in two-thirds of the patients and 17 patients were treated by superficial parotidectomy. Thirteen patients developed temporary facial nerve weakness and three Frey's syndrome. Three patients complained of temporary paraesthesia of the cheek, and two developed painful neuroma of the greater auricular nerve. Although there were two cases of infection of the parotid duct remnant, no recurrence of deep lobe sialadenitis or fistula formation was noted. Histologically, 3 lesions showed mild chronic sialadenitis, the rest had widespread involvement of the gland, and prolonged duration of symptoms was associated with extensive and severe involvement of the gland. Superficial parotidectomy has a very high success rate, with minimal long-term complications, and should be offered early in established cases, to reduce unnecessary morbidity.

Tumors of the salivary glands are exceptional, representing approximately 2% of head and neck tumors. The parotid gland is most often involved, at a frequency reaching 80%. Histology examination generally shows a pleomorphous adenoma. The choice of a surgical technique best adapted to curative treatment depends on the type of tumor and is widely debated. Our management strategy is based on simultaneous histology examination and superficial parotidectomy. Several pre and intra-operative factors determine the need for resection. We verified our strategy with a retrospective study.

Objective: To assess the success of superficial parotidectomy in the treatment of chronic parotitis (a potentially debilitating disease heralded by recurrent painful swellings) and purulent sialorrhea., Design: A retrospective review., Methods: Ten patients who were managed by superficial parotidectomy after failure of all conservative measures at the Department of Otolaryngology, McGill University were studied., Results: Eight had complete resolution of their disease, and two had minor persistence on follow-up. None of them had permanent facial nerve injury., Conclusion: We therefore advocate superficial parotidectomy for this condition on failure of conservative measures.

Acute suppurative parotitis and parotid gland abscess are infrequently encountered among children. Fourteen children were diagnosed in the Sheba Medical Center as suffering from these infections and their clinical features are described. Discussion reveals neither significant differences nor predominating factors to differentiate between these two entities.

A new method for plasty of the parotid duct with its appreciable dilatation is proposed. A semioval flap is cut from the wall of a dilated duct and sutured to the buccal mucosa. A proper opening of the parotid duct is thus created and injuries to facial nerve branches during surgery are prevented.

A series of 17 consecutive parotidectomies for chronic sialoadenitis is presented. This comprises 10% of all parotidectomies performed by one surgeon over the 5-year period between 1987 and 1991. In 16 patients, symptoms were relieved by surgery. The extent of surgery was guided by the clinical findings. In this series, near total and superficial parotidectomy were equally efficacious and no patient suffered permanent facial nerve dysfunction. Surgery is a safe and effective treatment for parotitis.

In the present study 162 patients with clinically suspected diseases of the major salivary glands were examined via sonography (n = 162), sialography (n = 111) and CT-sialography (n = 49). The reliability of the three radiological procedures was assessed in diagnosing sialoadenitis, sialolithiasis and glandular and extraglandular tumors. Forty-seven patients were examined with all three methods, 64 patients with sonography and sialography, 2 patients with sonography and CT-sialography and 49 patients with only sonography. The results were compared retrospectively with histologically (70%), cytologically (26%) and clinically proven diagnoses. A sialoadenitis was diagnosed via sonography at a sensitivity of 58%. Sialography frequently produced a false diagnosis of "glandular tumor", which resulted in a comparatively lower sensitivity of 54%. This finding contrasted with the experiences of other authors. A glandular tumor was correctly diagnosed by all three methods and had approximately the same sensitivity (sonography 89%, sialograph 91% and CT-sialography 92%). The correct diagnosis of salivary gland tumors was found by sonography and CT-sialography in 76% of cases and by sialography in 83% of cases. CT-sialography was clearly the superior diagnostic method for detecting extraglandular tumors. Sonography proved its worth as the fundamental procedure for special diagnostic testings of the salivary glands. Sialography is necessary for obtaining important additional information, especially in cases with suspect glandular tumors. CT-sialography is indispensable in the diagnosis of tumors, especially if a malignant, extraglandular or medially localized process is suspected.

A retrospective study was done on 64 patients who underwent superficial or subtotal parotidectomy for a primary benign tumor of the parotid gland. Factors, such as age, sex, smoking, alcohol consumption, type of surgery, duration of surgery, pathology of lesion, and size of lesion, were reviewed in a multivariate statistical analysis to determine if any factor alone or in combination contributed to the development of functional facial nerve weakness postoperatively. Only the age of the patient was found to have a statistically significant causal relation using the Pearson chi-square method (p = 0.015). The marginal mandibular branch was affected in nine of 10 cases. Different surgical approaches cited in the literature are discussed, along with the possible role of ischemic injury to the facial nerve during parotidectomy.

We report a retrospective study of 154 patients after parotidectomy. The patients were examined immediately and on average about 40 months after the operation. The emphasis of the examination was to assess both functional as well as aesthetic results. The function of the facial nerve was evaluated by Stennert's score. We found a median score of 20% 3.3 days after operation. The late postoperative results (34.3 months after operation) indicated that 91% of the patients had no paresis. There was no significant difference between superficial parotidectomy and total parotidectomy in regard to the aesthetic result. The decision for partial or total parotidectomy should be based exclusively on pathological and oncological considerations.

Today parotidectomy is a common, safe surgical procedure. With the increase in the number of parotidectomies being performed there have been many reviews of both the immediate and delayed operative complications. Postoperative salivary fistula, although a common occurrence, is usually glossed over or barely mentioned in most reviews. The present study reviews the parotid experience at a major teaching hospital, The Wellesley Hospital, University of Toronto, over a 10-year period. This information was used to draw general conclusions concerning the incidence, etiology and treatment of salivary fistulas as well as their prevention.

Chronic parotitis is a disorder characterized by recurrent painful swelling of the gland with purulent sialorrhea. Occasionally, the condition fails to respond to medical management and definitive surgical therapy is necessary. Sialolithiasis is the usual etiology in cases of parotitis, although occasionally severe recurrent parotid infections are superimposed on underlying Sjögren's disease. Total parotidectomy with facial nerve dissection has been used in such cases in our department and has proved to be an excellent way to manage this disease. A summary of our results indicate that the recurring infections were eradicated and that the complication rate is tolerable, considering the magnitude of the problem. We feel that it is better to use surgical management early rather than wait for the formation of fistulae or abscesses.

Etoposide is an important component of several intensive therapy regimens in allogeneic and autologous bone marrow transplantation for advanced hematologic malignancies. We observed the occurrence of transient acute parotid and submandibular sialoadenitis in nine of 19 patients receiving high dose etoposide and melphalan followed by autologous bone marrow rescue. Manifestations included pain, tenderness and swelling of the parotid and submandibular glands. Symptoms arose 4-16 h after completion of etoposide infusion and resolved within 72 h. Elevation of serum amylase accompanied the symptoms, and was also observed in some patients who were asymptomatic. Discomfort was controlled with analgesics and the clinical course was uncomplicated in all cases. Transient parotitis is a relatively frequent and benign complication of high dose etoposide therapy.

A case of suppurative parotitis due to Streptococcus pneumoniae is reported in a patient with Sjögren's syndrome. The rarity of this condition is noted by a review of the literature.

Division of the great auricular nerve is commonly performed during superficial parotidectomy and leads to anaesthesia of the ear lobe. In the case presented here, this gave rise to an accidental self-inflicted thermal burn of the ear lobe. This might have been avoided had the posterior branch of the nerve been preserved.

A patient presenting to the emergency department with simultaneous parotitis and epiglottitis is described. She underwent emergency airway intervention within 3 hours of presentation. This is the first case of simultaneous parotitis and epiglotitis. Diagnostic symptoms are discussed.

Recurrences of benign and malignant tumors and inflammatory complications are the main indications for revision parotidectomy. Many of these operations could be avoided if the primary surgical procedure had been adequate. Revision parotidectomy is difficult to perform when the facial nerve is embedded in scar tissue. Indications for and risks of revision parotidectomy are demonstrated for typical situations such as recurrent pleomorphic adenomas and malignancies, postoperative fistulas, and recurrences of previously operated chronic parotitis.

A short survey of the therapeutical possibilities available in cases of chronic parotitis is followed by a discussion of the results achieved after surgical treatment. This discussion is based on the findings obtained in follow-up checks. The - very strict - indication for surgery was not made until all conservative measures had been exhausted and thus it involved only 2.4% of 380 surgical patients suffering from various diseases of the parotis gland. It was possible to achieve a sustained total absence of complaints in all cases, with partial or subtotal resection being sufficient in most instances. Although postoperatively partial loss of the N. facialis function occurred relatively frequently, permanent damage was not observed in any single case.

We examined the effect of tympanic neurectomy on the clinical symptoms and secretory function of the parotids in 13 patients with chronic parotitis or sialadenosis for 3 years. Each patient had significantly fewer complaints immediately after the surgery. In quite a few patients the improvement was transient only. Three years after neurectomy 3 of the 10 examined patients were free from complaints and 4 further patients had less severe complaints than before the surgery. Neurectomy was followed by a significant decrease in parotid flow rate and an increase in the sodium concentration of parotid saliva, while potassium concentration showed a slight decrease. Three years after the surgery the flow rate and the sodium concentration were moderately higher than before that. There was a significant, long-lasting change in the amylase activity of parotid saliva; 3 years after neurectomy it attained one-third of the preoperative value. A pharmacological test, carried out 3 years after neurectomy in 2 patients, suggested parasympathetic reinnervation of the parotid.

The parotid glands are subject to many pathological disorders other than neoplastic diseases. This large group of disorders is classified for the parotid glands into infectious, metabolic and endocrine, traumatic, congenital, and acquired cystic diseases. The other major salivary glands also can be affected by many of these conditions. In recent years more and more patients have been examined and treated who have had diseases classified according to our concepts. Surgical procedures are now commonly recommended for these groups of patients not only for diagnosis but for treatment as well. The microscopic examination of permanently prepared, stained excised tissues still remains the final diagnostic procedure in most patients in spite of more recently developed diagnostic techniques. Further, the well trained surgeon of today is in a position to assure the patient that permanent injury to the facial nerve trunk or to its branches is only a remote possibility. Lastly, our medical and surgical experiences are discussed in the following groups of patients: those with acute suppurative sialadenitis, those with acute abscess, those with chronic obstructive and non-obstructive sialadenitis, those with traumatic lesions, those with congenital lesions, and those with acquired cystic lesions.

Ligation of Stenon's duct represents a possibility for treatment of chronic-recurrent parotitis. This procedure leads to an atrophy of the gland parenchyma. In one case, observed by us as a complication of this method ligation of the duct was followed by the formation of a great parotid gland cyst. Under respect of this casuistic report, possibilities are discussed to prevent similar and other complications. They consist in the section of the preganglionic fibers of the tympanic plexus respectively in a simultaneous radiation therapy of the diseased gland.

Summary--Nine patients suffering from chronic parotitis, gustato sweating syndrome, and gustato lacrymation syndrome underwent tympanic neurectomy. Follow-up showed discrepancies between the good clinical results and the unchanged parotid scans in eight out of nine patients. Parasympathetic bypasses to the parotid gland are discussed.

Between 1969 and 1986 parotid gland surgery was performed on 86 children and adolescents in the ENT clinic of the University of Tübingen. Chronic recurrent parotitis was found to be the most common chronic inflammatory disease in our young patients. Total parotidectomy was done on 24 children. Because of the high incidence of potential complications the indication for a total parotidectomy in chronic parotitis should be carefully considered. A more hopeful attitude applies to the cystic tumours (haemangioma, lymphangioma and branchiogenic cysts). A solid tumour of the parotid gland in children and adolescents, however, necessitates surgical extirpation without delay because one-third of these tumours are malignant.