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Objectives: The preoperative classification of pleomorphic adenomas (PMA) and Warthin tumors (WT) in the parotid gland plays an essential role in determining therapeutic strategies. This study aims to develop and validate an ultrasound-based ensemble machine learning (USEML) model, employing nonradiative and noninvasive features to differentiate PMA from WT. Methods: A total of 203 patients with histologically confirmed PMA or WT who underwent parotidectomy from two centers were enrolled. Clinical factors, ultrasound (US) features, and radiomic features were extracted to develop three types of machine learning model: clinical models, US models, and USEML models. The diagnostic performance of the USEML model, as well as that of physicians based on experience, was evaluated and validated using receiver operating characteristic (ROC) curves in internal and external validation cohorts. DeLong's test was used for comparisons of AUCs. SHAP values were also utilized to explain the classification model. Results: The USEML model achieved the highest AUC of 0.891 (95% CI, 0.774–0.961), surpassing the AUCs of both the US (0.847; 95% CI, 0.720–0.932) and clinical (0.814; 95% CI, 0.682–0.908) models. The USEML model also outperformed physicians in both internal and external validation datasets (both p < 0.05). The sensitivity, specificity, negative predictive value, and positive predictive value of the USEML model and physician experience were 89.3%/75.0%, 87.5%/54.2%, 87.5%/65.6%, and 89.3%/65.0%, respectively. Conclusions: The USEML model, incorporating clinical factors, ultrasound factors, and radiomic features, demonstrated efficient performance in distinguishing PMA from WT in the parotid gland. Clinical relevance statement: This study developed a machine learning model for preoperative diagnosis of pleomorphic adenoma and Warthin tumor in the parotid gland based on clinical, ultrasound, and radiomic features. Furthermore, it outperformed physicians in an external validation dataset, indicating its potential for clinical application. Key Points: • Differentiating pleomorphic adenoma (PMA) and Warthin tumor (WT) affects management decisions and is currently done by invasive biopsy. • Integration of US-radiomic, clinical, and ultrasound findings in a machine learning model results in improved diagnostic accuracy. • The ultrasound-based ensemble machine learning (USEML) model consistently outperforms physicians, suggesting its potential applicability in clinical settings. [ABSTRACT FROM AUTHOR]

Abstract Background Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting. Case presentation A 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma. Conclusions Surgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.

Abstract Objectives We primarily aimed to evaluate whether parotid incidental lesion (PIL) in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging evaluation of patients with hepatocellular carcinoma (HCC) would represent a possibility of extrahepatic metastasis or second primary malignancy (SPM). Additionally, we explored the incidence of PIL in HCC patients and examined any associated risk factors. Methods We retrospectively analyzed patients with HCC who underwent 18F-FDG PET/CT at our institution from 2010 to 2022. The pathological findings of PILs in HCC patients were investigated for confirmatory identification of the risk of HCC metastasis or SPM in parotid gland. Healthy controls received 18F-FDG PET/CT for health screening were also enrolled to compare the incidence of PILs with HCC patients. Various parameters associated with patient demographics and characteristics of HCC were analyzed to find the related factors of PILs. Results A total of 17,674 patients with HCC and 2,090 healthy individuals who had undergone 18F-FDG PET/CT scans were enrolled in the analyses. Among the 54 HCC patients who underwent pathological confirmation for PILs, benign primary parotid tumor was most commonly observed (n = 43 [79.6%]); however, no malignant lesions were detected, including HCC metastasis. The incidence of PILs was higher in patients diagnosed with HCC compared with the control group (485 [2.7%] vs. 23 [1.1%], p = 0.002). Analysis for the risk factors for PILs revealed that patient age, sex, and positive viral markers were significantly associated with the incidence of PILs in patients with HCC (all p

Objective: Malignant melanoma situated in the parotid gland represents a rare clinical presentation, and the prognosis of these patients remains inadequately understood in comparison to other forms of malignant melanoma. This study aims to evaluate cases of parotid gland-located malignant melanoma under follow-up in our clinic. Material and Method: Records of five patients aged 18 and above, diagnosed with melanoma localized within or adjacent to the parotid gland, were retrospectively reviewed. Relevant clinical information such as patients' demographic data including age and gender, medical histories, presenting symptoms, treatment modalities, and outcomes were evaluated. The overall survival of the patients was examined. Results: None of the patients included in the study had primary parotid gland melanoma. Among all patients, 4 patients had primary lesions that were cutaneous melanomas originating from the head and neck region, while in one patient, the primary lesion was uveal melanoma of the eye. While 3 patients included in the study had died, 2 patients were still being followed up. Conclusion: Primary melanomas localized to the parotid gland are extremely rare, and when encountered, a thorough medical history and careful physical examination can often reveal that the primary lesion is cutaneous melanoma, predominantly located in the head and neck region. It should be kept in mind that although rare, there may be primary intranodal melanoma cases whose primary is unknown or cannot be found in the parotid gland. [ABSTRACT FROM AUTHOR]

To assess the diagnostic performance of quantitative parameters from dual-energy CT (DECT) in differentiating parotid gland tumors (PGTs). 101 patients with 108 pathologically proved PGTs were enrolled and classified into four groups: pleomorphic adenomas (PAs), warthin tumors (WTs), other benign tumors (OBTs), and malignant tumors (MTs). Conventional CT attenuation and DECT quantitative parameters, including iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Z eff), electron density (Rho), double energy index (DEI), and the slope of the spectral Hounsfield unit curve (λ HU), were obtained and compared between benign tumors (BTs) and MTs, and further compared among the four subgroups. Logistic regression analysis was used to assess the independent parameters and the receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance. Attenuation, Z eff , DEI, IC, NIC, and λ HU in the arterial phase (AP) and venous phase (VP) were higher in MTs than in BTs (p < 0.001–0.047). λ HU in VP and Z eff in AP were independent predictors with an area under the curve (AUC) of 0.84 after the combination. Furthermore, attenuation, Z eff , DEI, IC, NIC, and λ HU in the AP and VP of MTs were higher than those of PAs (p < 0.001–0.047). Z eff and NIC in AP and λ HU in VP were independent predictors with an AUC of 0.93 after the combination. Attenuation and Rho in the precontrast phase; attenuation, Rho, Z eff , DEI, IC, NIC, and λ HU in AP; and the Rho in the VP of PAs were lower than those of WTs (p < 0.001–0.03). Rho in the precontrast phase and attenuation in AP were independent predictors with an AUC of 0.89 after the combination. MTs demonstrated higher Z eff , DEI, IC, NIC, and λ HU in VP and lower Rho in the precontrast phase compared with WTs (p < 0.001–0.04); but no independent predictors were found. DECT quantitative parameters can help to differentiate PGTs. [ABSTRACT FROM AUTHOR]

Background/Aim: The parotid is the largest salivary gland and is located anteriorly to the sternocleidomastoid muscle and laterally to the ramus of the mandible. Neoplasms in this gland are relatively rare, with 80% being benign and 20% malignant, primarily represented by mucoepidermoid carcinoma. In the head and neck region, lymphoepithelial carcinoma (LEC) accounts for 0.4% of malignant salivary gland tumors. Case Report: A 35-year-old man with no previous comorbidities was admitted to a Head and Neck Surgery Specialty Service for a painless right cervical mass of uncertain growth. Extensive diagnostic investigation revealed involvement of the contralateral parotid, associated with systemic lymph node enlargement. Thus, adjuvant radiotherapy was decided by the treating team. Conclusion: This case confirms the heterogeneous features and distinctive behavior that the disease can present, as seen with bilateral parotid LEC. [ABSTRACT FROM AUTHOR]

Objectives: We primarily aimed to evaluate whether parotid incidental lesion (PIL) in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging evaluation of patients with hepatocellular carcinoma (HCC) would represent a possibility of extrahepatic metastasis or second primary malignancy (SPM). Additionally, we explored the incidence of PIL in HCC patients and examined any associated risk factors. Methods: We retrospectively analyzed patients with HCC who underwent 18F-FDG PET/CT at our institution from 2010 to 2022. The pathological findings of PILs in HCC patients were investigated for confirmatory identification of the risk of HCC metastasis or SPM in parotid gland. Healthy controls received 18F-FDG PET/CT for health screening were also enrolled to compare the incidence of PILs with HCC patients. Various parameters associated with patient demographics and characteristics of HCC were analyzed to find the related factors of PILs. Results: A total of 17,674 patients with HCC and 2,090 healthy individuals who had undergone 18F-FDG PET/CT scans were enrolled in the analyses. Among the 54 HCC patients who underwent pathological confirmation for PILs, benign primary parotid tumor was most commonly observed (n = 43 [79.6%]); however, no malignant lesions were detected, including HCC metastasis. The incidence of PILs was higher in patients diagnosed with HCC compared with the control group (485 [2.7%] vs. 23 [1.1%], p = 0.002). Analysis for the risk factors for PILs revealed that patient age, sex, and positive viral markers were significantly associated with the incidence of PILs in patients with HCC (all p < 0.001). Conclusions: Our study demonstrates that PILs are more frequently identified in patients with HCC on 18F-FDG PET/CT. However, no malignant PIL, including extrahepatic metastasis of HCC, was identified. Therefore, the presence of PIL should not impede or delay the treatment process for patients with HCC. Additionally, we suggested that for future swift and straightforward differential diagnoses of PIL, the development of additional protocols within the PET/CT imaging could be beneficial. [ABSTRACT FROM AUTHOR]

Rationale and objectives: Preoperative differentiation of malignant tumors (MT), pleomorphic adenomas (PA), and other benign tumors of the parotid gland is critical to clinical strategy, this study aimed to develop and validate a T2-weighted image (T2WI) based radiomics model through machine learning approaches for the triple classification of parotid gland tumors. Materials and methods: We retrospectively enrolled 147 patients from January 2010 to July 2022. T2WIs were used to extract radiomics features. Max-Relevance and Min-Redundancy (mRMR) and Extreme Gradient Boosting (XGBoost) algorithms were used to select features. Using a 5-fold cross-validation strategy, radiomics models were constructed using a Support Vector Machine (SVM), Logistic Regression (LR), and k-Nearest Neighbor (KNN) for the triple classification of parotid tumors. The three models were evaluated and compared using the receiver operator characteristic (ROC) curve, sensitivity, specificity, and accuracy. Results: A total of 1057 radiomics features were extracted, and 8 features were selected to developed the radiomics model, including First-order Median, First-order Skewness, First-order Minimum, Original_shape_Flatness, Glcm Inverse Variance, Glcm Inverse Variance, Glszm Low Gray Level Zone Emphasis, and Glszm Small Area Low Gray Level Emphasis. The mean area under the curves (AUCs) for the radiomics models in training and validation sets through LR, SVM and KNN were 0.85 and 0.80, 0.85 and 0.80 and 0.83 and 0.79, respectively. Conclusion: The T2WI-based radiomics models through LR, SVM and KNN demonstrated good performance in the triple classification of parotid tumors.

AbstractObjective: To evaluate the efficacy and feasibility of ultrasound-guided percutaneous thermal ablation (TA) for treating benign parotid tumors.Methods: Patients with benign parotid tumors who underwent ultrasound-guided microwave ablation (MWA) or radiofrequency ablation (RFA) between January 2020 and March 2023 were included in this retrospective study. Change in tumor size (maximum diameter, tumor volume(V), volume reduction rate (VRR)) and cosmetic score (CS) were evaluated during a one-year follow-up period. We also recorded the incidence of any complications associated with TA.Results: A total of 23 patients (13 males and 10 females; median age 65 years, range 5–91 years) were included. The mean VRR at 1, 3, 6, and 12 months after TA was 37.03%±10.23%, 56.52%±8.76%, 82.28%±7.89%, and 89.39%±6.45%, respectively. Mean CS also changed from 3.39 ± 0.66 to 1.75 ± 0.93 (p

In parotid gland cancer (PGC), cervical lymph node metastasis (LNM) and intra-parotid LNM are known as significant indicators of poor prognosis. However, the topography of LNM in the affected parotid gland and the lymphatic progression of PGC has never been explored in detail. This was a retrospective analysis of data from 423 patients with previously untreated primary PGC (2005 to 2020), excluding patients with squamous cell carcinoma, lymphoma or metastatic disease in the parotid gland. The pattern of LNM was analyzed by neck sub-level and parotid sub-site. Using the conditional probability of neck level involvement, a probability diagram was plotted on several thresholds to visualize the sequential progression of LNM in PGC. The pattern of LNM progression was found to be similar between low- and high-grade pathology, but the incidence differed significantly (8.0% vs. 45.4%). Intra-parotid LNs and level IIa LNs were the most common sites (57.3% and 61.0%) of LNM in PGC, followed by level III (31.7%), Ib (25.6%), IV (22.0%), IIb (20.7%) and Va (20.7%) LNM. In intra-parotid LNs, the incidence of LNM in the deep parotid LNs was relatively low (9.4%); most intra-parotid LNMs were observed in the superficial parotid (90.6%) and peri-tumoral (in contact with the tumor) (31.3%) LNs. LNM to levels Ia, Vb and contra-lateral LNM occurred only in the very late stage. Our results provide detailed information about LNM progression in PGC at the sub-level and can help clinicians decide the treatment extent, including surgery or radiation. [ABSTRACT FROM AUTHOR]

Background: Facial nerve dysfunction is the principal postoperative complication related to parotidectomy.

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Background: The objective of this study was to examine the utility of postoperative radiation for low and intermediate grade cancers of the parotid and submandibular glands. Methods: The authors conducted a retrospective, Canadian‐led, international, multi‐institutional analysis of a patient cohort with low or intermediate grade salivary gland cancer of the parotid or submandibular gland who were treated from 2010 until 2020 with or without postoperative radiation therapy. A multivariable, marginal Cox proportional hazards regression analysis was performed to quantify the association between locoregional recurrence (LRR) and receipt of postoperative radiation therapy while accounting for patient‐level factors and the clustering of patients by institution. Results: In total, 621 patients across 14 tertiary care centers were included in the study; of these, 309 patients (49.8%) received postoperative radiation therapy. Tumor histologies included 182 (29.3%) acinic cell carcinomas, 312 (50.2%) mucoepidermoid carcinomas, and 137 (20.5%) other low or intermediate grade primary salivary gland carcinomas. Kaplan–Meier LRR‐free survival at 10 years was 89.0% (95% confidence interval [CI], 84.9%–93.3%). In multivariable Cox regression analysis, postoperative radiation therapy was independently associated with a lower hazard of LRR (adjusted hazard ratio, 0.53; 95% CI, 0.29–0.97). The multivariable model estimated that the marginal probability of LRR within 10 years was 15.4% without radiation and 8.8% with radiation. The number needed to treat was 16 patients (95% CI, 14–18 patients). Radiation therapy had no benefit in patients who had early stage, low‐grade salivary gland cancer without evidence of nodal disease and negative margins. Conclusions: Postoperative radiation therapy may reduce LLR in some low and intermediate grade salivary gland cancers with adverse features, but it had no benefit in patients who had early stage, low‐grade salivary gland cancer with negative margins. This was a retrospective, Canadian‐led, international, multi‐institutional analysis of 621 patients with low or intermediate grade salivary gland cancer of the parotid or submandibular gland, of whom 309 patients (49.8%) received postoperative radiation therapy. In regression analysis, postoperative radiation therapy was an independent protective factor against locoregional recurrence with an adjusted hazard ratio of 0.53 (95% confidence interval, 0.29–0.97). [ABSTRACT FROM AUTHOR]

Objectives: To develop deep learning–assisted diagnosis models based on CT images to facilitate radiologists in differentiating benign and malignant parotid tumors. Methods: Data from 573 patients with histopathologically confirmed parotid tumors from center 1 (training set: n = 269; internal-testing set: n = 116) and center 2 (external-testing set: n = 188) were retrospectively collected. Six deep learning models (MobileNet V3, ShuffleNet V2, Inception V3, DenseNet 121, ResNet 50, and VGG 19) based on arterial-phase CT images, and a baseline support vector machine (SVM) model integrating clinical-radiological features with handcrafted radiomics signatures were constructed. The performance of senior and junior radiologists with and without optimal model assistance was compared. The net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the clinical benefit of using the optimal model. Results: MobileNet V3 had the best predictive performance, with sensitivity increases of 0.111 and 0.207 (p < 0.05) in the internal- and external-testing sets, respectively, relative to the SVM model. Clinical benefit and overall efficiency of junior radiologist were significantly improved with model assistance; for the internal- and external-testing sets, respectively, the AUCs improved by 0.128 and 0.102 (p < 0.05), the sensitivity improved by 0.194 and 0.120 (p < 0.05), the NRIs were 0.257 and 0.205 (p < 0.001), and the IDIs were 0.316 and 0.252 (p < 0.001). Conclusions: The developed deep learning models can assist radiologists in achieving higher diagnostic performance and hopefully provide more valuable information for clinical decision-making in patients with parotid tumors. Key Points: • The developed deep learning models outperformed the traditional SVM model in predicting benign and malignant parotid tumors. • Junior radiologist can obtain greater clinical benefits with assistance from the optimal deep learning model. • The clinical decision-making process can be accelerated in patients with parotid tumors using the established deep learning model. [ABSTRACT FROM AUTHOR]

Most of salivary tumors are benign in nature and are typically diagnosed and classified based on their histopathological presentation. Basal cell adenoma of the salivary glands is a rare, benign disease accounting for 1% to 3% of salivary gland tumors. Despite its low incidence, basal cell adenoma is the third most common benign tumor of the salivary gland after pleomorphic adenoma and Warthin's tumor. It usually appears as a firm and slow-growing mass. Due to the prognosis, differential diagnosis with basal cell adenocarcinoma, adenoid cystic carcinoma and basaloid squamous cell carcinoma is required. In this report, we present two cases; a 62-year-old woman who presented with an asymptomatic, and slow-growing mass and a 64-year-old woman with a static-sized mass in the parotid gland. In both cases, the mass was completely excised, postoperative pathology reports confirmed the diagnosis of basal cell adenoma. We also review the literature and discuss this rare entity. Abbreviations: BCA, basal cell adenoma; BCAC, basal cell adenocarcinoma; CT, computed tomography; FNA, fine needle aspiration; MRI, magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Cutaneous metastasis from malignant tumors can cause symptoms such as exudates, bleeding, and pain, which remarkably reduce patient's quality of life. Herein, we report a case in which radiation therapy using the Quad Shot regimen was effective in the treatment of cutaneous metastasis from parotid gland cancer. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the incidence of intraparotid lymph node metastasis in parotid malignancies and its association with overall survival. Methods: This study retrospectively reviewed the charts and histopathological findings of 43 patients with parotid malignancies who underwent surgery between 2008 and 2015. Epidemiological and pathological data were recorded. Overall survival was calculated, and univariate and multivariate analyses were used to determine the role of metastasis intraparotid lymph node as a prognostic factor. Results: The incidence of metastasis intraparotid lymph node was 46.5%. Advanced-stage and high-grade tumors were associated with a higher metastasis intraparotid lymph node risk. Survival was significantly decreased in the metastasis intraparotid lymph node group, overall cohort (hazard ratio, 7.52), and advanced-stage group (hazard ratio, 4.62). No significant prognostic factor was revealed by multivariable analysis. Conclusion: Metastasis intraparotid lymph node is common and may negatively affect survival in parotid malignancies. [ABSTRACT FROM AUTHOR]

Key Clinical Message Cutaneous metastasis from malignant tumors can cause symptoms such as exudates, bleeding, and pain, which remarkably reduce patient's quality of life. Herein, we report a case in which radiation therapy using the Quad Shot regimen was effective in the treatment of cutaneous metastasis from parotid gland cancer.

Objectives: The differentiation of Warthin tumor and pleomorphic adenoma before treatment is crucial for clinical strategies. The aim of this study was to develop and test a T2-weighted-based radiomics model for differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. Methods: A total of 117 patients, including 61 cases of Warthin tumor and 56 cases of pleomorphic adenoma, were retrospectively enrolled from two centers between January 2010 and June 2022. The training set included 82 cases, and the validation set included 35 cases. From T2-weighted images, 971 radiomics features were extracted. Seven radiomics features remained after a two-step selection process. We used the seven radiomics features and clinical factors through multivariable logistic regression to build radiomics and clinical models, respectively. A radiomics–clinical model was also built that combined the independent clinical predictors with the radiomics features. Through ROC curves, the three models were evaluated and compared. Results: In the radiomics model, AUCs were 0.826 and 0.796 in training and validation sets, respectively. In the clinical model, the AUCs were 0.923 and 0.926 in the training and validation sets, respectively. Decision curve analysis revealed that the radiomics–clinical model had the best diagnostic performance for distinguishing Warthin tumor from pleomorphic adenoma of the parotid gland (AUC = 0.962 and 0.934 for the training and validation sets, respectively). Conclusion: The radiomics–clinical model performed well in differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. Key points: • The clinical model outperformed the radiomics model in distinguishing pleomorphic adenoma from Warthin tumor of the parotid gland. • The radiomics features extracted from T2-weighted images could help differentiate pleomorphic adenoma from Warthin tumor of the parotid gland. • The radiomics–clinical model was superior to the radiomics and the clinical models for differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. [ABSTRACT FROM AUTHOR]

The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. The mean (± standard deviation) surgical time did not differ significantly between the groups: 64 ± 22.4 min for PSP and 59 ± 19.8 min for ECD-TFND (P = 0.302). There was a significant difference in sialocele: 18 (36.7%) patients in the PSP group and four (10%) in the ECD-TFND group (P = 0.002). There was also a significant difference in facial nerve injuries: temporary paralysis was observed in 13 (26.5%) patients in the PSP group and two (5%) in the ECD-TFND group (P = 0.007). It appears that TFND is a viable and safe approach when performing ECD for benign tumours in the tail of the parotid gland. ECD-TFND should be preferred over PSP for benign tumours in the tail of the parotid gland. [ABSTRACT FROM AUTHOR]

Objective: In primary parotid gland malignancies, the incidence of level‐specific cervical lymph node metastasis in clinically node‐positive necks remains unclear. This study aimed to determine the incidence of level‐specific cervical node metastasis in clinically node‐negative (cN0) and node‐positive (cN+) patients who presented with primary parotid malignancies. Data Sources: Electronic databases (MEDLINE, EMBASE, PubMed, Cochrane). Review Methods: Random‐effects meta‐analysis was used to calculate pooled estimate incidence of level‐specific nodal metastasis for parotid malignancies with 95% confidence intervals (CIs). Subgroup analyses of cN0 and cN+ were performed. Results: Thirteen publications consisting of 818 patients were included. The overall incidence of cervical nodal involvement in all neck dissections was 47% (95% CI, 31%‐63%). Among those who were cN+, the incidence of nodal positivity was 89% (95% CI, 75%‐98%). Those who were cN0 had an incidence of 32% (95% CI, 14%‐53%). In cN+ patients, the incidence of nodal metastasis was high at all levels (level I 33%, level II 73%, level III 48%, level IV 39%, and level V 37%). In cN0 patients, the incidence of nodal metastasis was highest at levels II (28%) and III (11%). Conclusion: For primary parotid malignancies, the incidence of occult metastases was 32% compared to 89% in a clinically positive neck. It is recommended that individuals with a primary parotid malignancy requiring elective treatment of the neck have a selective neck dissection which involves levels II to III, with the inclusion of level IV based on clinical judgment. Those undergoing a therapeutic neck dissection should undergo a comprehensive neck dissection (levels I‐V). [ABSTRACT FROM AUTHOR]

Introduction and objective: Our aim is to establish the profitability of cytological diagnosis by fine needle aspiration (FNA) and the usefulness of preoperative imaging in the management of parotid masses. Method: A retrospective study of a sample of 142 patients with parotid tumors operated on by the HUPR Otorhinolaryngology Service in the last 10 years, with preoperative radiological (ultrasound, CT, MRI) and cytological diagnosis, by FNA, was carried out. The results of both tests have been classified as positive or negative for malignancy and were compared with the pathological diagnosis. Results: The average age was 56, 61.3% were men. FNA had a sensitivity to detect malignancy of 75% and a specificity of 100%; with positive and negative predictive values (NPV) of 100 and 97%, respectively. The sensitivity of the radiological study was 25%, and the specificity 99%. The positive predictive value for malignancy was 80%, and the negative predictive value was 89%. Conclusions: FNA is a simple test, but of limited utility for diagnostic orientation due to its low sensitivity and high false negatives; however, its high specificity and high NPV make it a more accurate test against a benign or negative result. The previous radiological study is useful in the diagnosis of tumor extension and characteristics, although it is limited by itself in the differential diagnosis of malignancy. MRI has become the imaging modality of choice. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the usefulness of management of sialocele formation and to evaluate the quality of life of patients under elective management post‐parotidectomy. Materials and Methods: A prospective study was performed including patients who underwent postoperative management with either compression therapy or observation. The self‐filled questionnaire method was used to assess the quality of life of participants who changed from compression therapy to observation. Demographic and operative data, variables regarding wound complications and scores for quality of life were documented and analysed. Results: A total of 86 patients met the eligibility criteria. The respective rates of sialocele formation within 1 month were 5.3% in the compression therapy group (2/38) and 16.0% in the observation group (4/25), but no significant difference was observed (p = 0.204). Meanwhile, both groups displayed comparable times of needle aspiration and time for sialocele resolution (p > 0.05). Based on 23 valid paired questionnaires, scores for physical and social‐emotional function before changing from compression therapy to observation were significantly lower than scores after the change (p < 0.001). Conclusion: The application of observation after partial superficial parotidectomy appears to have acceptable clinical outcomes and considerable improvements in quality of life. [ABSTRACT FROM AUTHOR]

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Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Characterization of parotid tumors before surgery using multi-parametric magnetic resonance imaging (MRI) scans can support clinical decision making about the best-suited therapeutic strategy for each patient. Objective: This study aims to differentiate benign from malignant parotid tumors through radiomics analysis of multi-parametric MR images, incorporating T2-w images with ADC-map and parametric maps generated from Dynamic Contrast Enhanced MRI (DCE-MRI).Material and Methods: MRI scans of 31 patients with histopathologically-confirmed parotid gland tumors (23 benign, 8 malignant) were included in this retrospective study. For DCE-MRI, semi-quantitative analysis, Tofts pharmacokinetic (PK) modeling, and five-parameter sigmoid modeling were performed and parametric maps were generated. For each patient, borders of the tumors were delineated on whole tumor slices of T2-w image, ADC-map, and the late-enhancement dynamic series of DCE-MRI, creating regions-of-interest (ROIs). Radiomic analysis was performed for the specified ROIs. Results: Among the DCE-MRI-derived parametric maps, wash-in rate (WIR) and PK-derived Ktrans parameters surpassed the accuracy of other parameters based on support vector machine (SVM) classifier. Radiomics analysis of ADC-map outperformed the T2-w and DCE-MRI techniques using the simpler classifier, suggestive of its inherently high sensitivity and specificity. Radiomics analysis of the combination of T2-w image, ADC-map, and DCE-MRI parametric maps resulted in accuracy of 100% with both classifiers with fewer numbers of selected texture features than individual images. Conclusion: In conclusion, radiomics analysis is a reliable quantitative approach for discrimination of parotid tumors and can be employed as a computer-aided approach for pre-operative diagnosis and treatment planning of the patients.

Abstract Background In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when performing parotidectomy. However, further clinical study is critically needed before this landmark could be applied in clinical practice. Methods For 31 patients enrolled, we tried to identify the FN by the guide of the PAA during parotidectomy. Additionally, the FN function was evaluated during follow‐up. Results PAA could be exposed in 28 out of 31 (90.3%) patients during parotidectomy. Moreover, the FN trunk could be identified by the guide of the PAA in all these 28 patients with identifiable PAA. Furthermore, no iatrogenic FN damage happened in this study and the transient FN dysfunction rate was 5.7%. Conclusion The PAA is an ideal landmark for early identification of the FN trunk when performing parotidectomy.

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Improvements in preoperative diagnostics and intraoperative techniques have made the surgical excision of benign parotid gland tumours less invasive. Extracapsular dissection (ECD) has become more popular in comparison to superficial parotidectomy (SP), the gold standard. Although clinical outcomes have been reported, reports on cost-effectiveness are limited. The aim of this retrospective study was to analyse the surgical outcomes and cost-effectiveness of ECD versus SP in benign parotid tumour surgery. A retrospective cohort of 161 patients treated between 2012 and 2020 was collected. Data concerning demographics, clinical outcomes, and cost-efficiency were recorded. Analysis of the 161 unilateral parotidectomy cases (59 SP, 102 ECD) showed a significantly longer operation time, anaesthesia time, and length of stay for SP patients (all P < 0.001). Regarding postoperative complications, transient facial nerve weakness (P < 0.001) and haematoma formation (P = 0.016) were more prevalent in the SP patients. The frequency of positive margins was lower for SP (P = 0.037). No case of recurrence was identified with either technique. ECD showed excellent clinical outcomes as well as a reduction in complications when compared to SP. ECD is a viable alternative for superficial benign parotid gland tumours after thorough preoperative clinical, pathological, and radiological examination. The reduction in operation, anaesthesia, and hospitalization times with ECD is likely to result in a gain in cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To design a deep learning model based on multimodal magnetic resonance image (MRI) sequences for automatic parotid neoplasm classification, and to improve the diagnostic decision‐making in clinical settings. Methods: First, multimodal MRI sequences were collected from 266 patients with parotid neoplasms, and an artificial intelligence (AI)‐based deep learning model was designed from scratch, combining the image classification network of Resnet and the Transformer network of Natural language processing. Second, the effectiveness of the deep learning model was improved through the multi‐modality fusion of MRI sequences, and the fusion strategy of various MRI sequences was optimized. In addition, we compared the effectiveness of the model in the parotid neoplasm classification with experienced radiologists. Results: The deep learning model delivered reliable outcomes in differentiating benign and malignant parotid neoplasms. The model, which was trained by the fusion of T2‐weighted, postcontrast T1‐weighted, and diffusion‐weighted imaging (b = 1000 s/mm2), produced the best result, with an accuracy score of 0.85, an area under the receiver operator characteristic (ROC) curve of 0.96, a sensitivity score of 0.90, and a specificity score of 0.84. In addition, the multi‐modal paradigm exhibited reliable outcomes in diagnosing the pleomorphic adenoma and the Warthin tumor, but not in the identification of the basal cell adenoma. Conclusion: An accurate and efficient AI based classification model was produced to classify parotid neoplasms, resulting from the fusion of multimodal MRI sequences. The effectiveness certainly outperformed the model with single MRI images or single MRI sequences as input, and potentially, experienced radiologists. Level of Evidence: 3 Laryngoscope, 133:327–335, 2023 [ABSTRACT FROM AUTHOR]

Cavernous hemangioma (CH), or cavernoma, is a type of benign tumor occurring mostly in the brain, liver, skin, and retina.1,2 Although less commonly, CH can also occur in the spine, orbit, gastrointestinal tract, skeletal muscle, and long bones.1 CH comprises a cluster of abnormally dilated blood vessels that form a mass or lesion.2,3 CH is more commonly found in women than men and typically occur between the ages of 40 and 60. Their precise incidence needs to be well-established; however, they account for 2-4% of all parotid gland tumors.2 Still, they are considered one of the less parotid gland common types of tumors.2,3 Most parotid gland tumors are benign, with only about 20% malignant.1,2 CH is typically diagnosed by imaging tests such as MRI or CT scans. The location, size, symptoms, and general health of the patient are among the variables that affect how cavernous hemangiomas are treated. Treatment options in symptomatic cases with functional impairment and high risk of bleeding, include medical (steroid or interferon), embolization, surgery, or radiosurgery.2,4 Parotid gland tumors can be either benign or malignant. CH of the parotid gland is a relatively rare but well-documented entity in the medical literature. There is currently not enough knowledge on the prevalence of CH in the parotid gland; there were roughly 50 cases reported worldwide, most of which were individual case reports. Overall, the literature suggests that cavernous hemangioma of the parotid gland is a rare benign entity more common in females and typically presents as a painless mass in the parotid gland area. Surgical removal is the primary treatment, and this entity has a good prognosis and a low recurrence risk.1-4 CH of the parotid gland can present with various symptoms, including a painless mass or swelling in the area of the gland, facial nerve weakness or paralysis, and even hearing loss in some cases. The diagnosis of a CH is usually based on imaging studies such as MRI or CT scans, which can show a well-defined, sharply demarcated mass with areas of low and high intensity.2-4 A hemangioma's histopathological appearance can help determine the appropriate management and treatment options. Capillary hemangiomas may be treated with topical or oral medications, while surgical removal may be necessary for cavernous hemangiomas, depending on their size and location.2,3 Treatment options for parotid gland cavernous hemangiomas depend on the lesion’s size and location, the patient's symptoms and overall health status. In some cases, surgical removal of the tumor may be necessary, which can be challenging due to the proximity of the facial nerve and the risk of its injury. In other cases, observation or radiation therapy may be recommended.3-5 Cavernous hemangioma is a type of vascular malformation, but other types of vascular malformations can present with similar symptoms or imaging findings. The differential diagnosis of vascular malformation with cavernous hemangioma includes (i) Venous malformation: a type of vascular malformation that affects veins, and it can look similar to cavernous hemangioma on imaging studies. However, venous malformations typically have a more uniform appearance, while cavernous hemangiomas have a characteristic “popcorn” appearance due to multiple blood-filled spaces; (ii) Capillary malformation: a type of vascular malformation that affects small blood vessels called capillaries. Capillary malformations can present as flat, red, or pink marks on the skin and can sometimes be mistaken for cavernous hemangioma; (iii) arteriovenous malformation: a type of vascular malformation that involves abnormal connections between arteries and veins. Arteriovenous malformations can cause symptoms such as headaches, seizures, and neurological deficits and can be mistaken for cavernous hemangioma on imaging studies; (iv) Lymphatic malformation: a type of vascular malformation that affects the lymphatic vessels and can cause swelling or abnormal growths. Lymphatic malformations can sometimes be mistaken for cavernous hemangioma in imaging studies.4,5 Figure 1 refers to a 42-year-old female patient with a painless, slowly growing mass in the right parotid region. The mass had been present for the past 6 months and has gradually increased. The patient reported no other significant symptoms, such as facial weakness or pain. The physical examination revealed a soft, non-tender mass in the right parotid region that measured approximately 6 cm. The overlying skin was normal, and there were no palpable lymph nodes in the neck. The ultrasound examination showed a well-circumscribed, hypoechoic lesion within the superficial lobe of the parotid gland, measuring 5.2 cm. The lesion had a cystic appearance with internal septations, consistent with a vascular lesion. The patient underwent an MRI, which confirmed the presence of a well-defined, lobulated mass in the superficial lobe of the right parotid gland, measuring 5.5 cm. The lesion was hyperintense on T2-weighted images and demonstrated heterogeneous enhancement with gadolinium. The imaging findings were consistent with a diagnosis of vascular malformation of the parotid gland. The patient was referred to a head and neck surgeon for further evaluation and treatment. Due to the lesion’s size and location, surgical resection was recommended. The patient underwent a superficial parotidectomy, and the postoperative course was uneventful. Histopathological examination of the resected specimen confirmed the diagnosis of CH (Figure 1A-1D). The patient was followed up for several months after the surgery, and there was no evidence of recurrence or complications. Figure 1A - gross image showing normal salivary gland tissue along with a well-encapsulated tumor with areas of hemorrhage and comprising of numerous cystic spaces (vascular channels) scale bar = 2,5 cm; B - microscopic examination at low magnification showing normal salivary gland parenchyma along with a capsulated tumor comprised of many dilated vascular channels (H&E 100X); C - higher magnification image showing thick and thin walls vascular spaces in between fibro-muscular stroma (H&E, 400X); D - immunohistochemical reaction for smooth muscle actin (SMA) demonstrating smooth muscle bundles and vessel walls (SMA, 400X).:

Introduction: Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. Objective: To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands Methods: This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). Results: The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p = 0.001), referral origin from the public health system (p = 0.011), T stage (p = 0.007), M stage (p 50 years was independently associated with a poor prognosis (p = 0.016). The level of education was the only factor more prevalent in older patients (p = 0.011). Conclusion: Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.