Search

Benign tumours of salivary glands represent 2%–3% of all tumours and parotid gland is most often affected. Keratocystoma is a rare benign tumour with multilocular cystic lesions filled with keratin materials. Histologically, it is characterised by solid epithelium islands containing keratinised lamellae with multicystic spaces. We report a case of a woman in her mid-70s with painless mass in her left parotid gland which increased in size over 1 year. Ultrasound scan revealed a 38×20 mm diameter hypoanechoic mass. Neck CT with contrast medium and fine needle aspiration were performed with diagnostic hypothesis of Warthin tumour. So, extracapsular parotid dissection with no facial nerve damage was performed. Histological examination revealed a keratocystoma. The patient had a 16-month follow-up without signs of relapse or malignancy. Despite its rarity, keratocystoma must be considered among the possible differential diagnostic hypotheses when we find parotid masses, to ensure the best treatment to the patient.

Retromandibular venous ectasia is a rare lesion that may imitate a parotid gland mass. Accurate radiological diagnosis prevents unnecessary invasive procedures. We present the case of a 69-year-old male patient presenting a right-sided, painless, compressible parotid region mass, fluctuating in size with head position and Valsalva maneuver. No thrill was palpable on physical examination. Doppler ultrasound demonstrated an anechoic compressible intra-parotid lesion, with luminal color filling, and venous spectral waveform. Contrast-enhanced computed tomography and Magnetic resonance angiography of the neck revealed an ectatic retromandibular vein. The patient was conservatively managed and regularly followed up. No complications occurred. Cervical region venous ectasias are rare and commonly misdiagnosed. They should be considered in the soft neck masses differential diagnosis. Imaging plays a key diagnostic role.

Background The aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer. Patients and methods The retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made. Results Twelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive. Conclusions Favourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.

PURPOSE To report the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of parotid infantile hemangiomas that did not respond appreciably to propranolol. MATERIALS AND METHODS A total of 21 infants (12 male and 9 female) with large propranolol-resistant infantile hemangiomas in the parotid region were enrolled in this study. During TASE, the feeding arteries of the lesions were embolized using pingyangmycin-lipiodol emulsion and polyvinyl alcohol particles (300-500 μm) to reduce the blood flow rate. All children were followed up as outpatients at 2 weeks and monthly thereafter. The curative effect was evaluated at the 1- and 3-month follow-up visits. RESULTS Nine lesions were located on the right side of the parotid gland, whereas 12 were located on the left side. The feeding arteries in all patients originated from branches of the external carotid artery. TASE was technically successful in all patients. The mean (± SD) maximal diameter of the hemangiomas significantly decreased from 6.50 cm ± 2.28 before treatment to 3.56 cm ± 1.84 at 1 month after TASE (P

The aim of this paper is to present and discuss the symptoms, clinical signs, diagnostic methods and a conservative surgical approach to large parotid pleomorphic adenomas arising from deep lobe and extending to the parapharyngeal space. In this case series we are describing four such cases which presented with painless swelling of different sizes in the parotid region along with intraoral swelling. Detailed diagnostic workup which included computed tomography scan, fine needle aspiration biopsy and magnetic resonance imaging was undretaken for confirming the diagnosis. Complete excision of the tumour via transcervical and transparotid approach without mandibulotomy and after securing local neurovascular structures was performed in all cases. This conservative lateral approach reduces the likelihood of complications. All the four patients were discharged without any complications and a proper follow up was done.

Tuberculosis of the parotid gland is a rare entity in children. Manifestations can vary from acute parotitis to indolent benign parotid lesions, abscesses and fistulas in the parotid region. Diagnosis is challenging in the absence of constitutional symptoms and essentially non-contributory test reports. We discuss a series of six cases of parotid tuberculosis in children with different clinical presentations and management and review the literature on the subject.

Background: The spindle cell lipoma is a rare benign tumor that originated from subcutaneous adipose tissue. It is a slow growing lesion and may become voluminous causing the patient an aesthetic disfigure. The diagnosis is made by the histological examination combined with immunohistochemical analysis. Radiological features present a variety of description because of the proportions difference of spindle cell lipoma components, but imaging is useful to determine the mass extents. The treatment of this kind of benign tumors is surgery which must be completed without need for other therapy. Aim: This case report highlights the exceptional location of spindle cell lipoma in the soft tissues of the parotid-masseter lodge, which may raise differential diagnosis problems with a primary parotid gland tumor. Case Presentation: A 58-year-old man, with no medical history, was presenting a swelling of the parotid region, growing progressively for 6 years, without other associated sign. The patient benefited from a careful physical examination. A computed tomography and magnetic resonance imaging were carried out. Clinical and radiological findings were suggesting a benign tumor occupying the left parotid-masseter lodge. The patient went through a surgical excision of the tumor. Histological and immunohistochemical features revealed a classic shape of spindle cell lipoma. After one year of follow-up, we notice a good recovery without local recurrence. Conclusion: Surgeons and pathologists have to keep in mind the possible development of spindle cell lipoma in any subcutaneous site even if unusual one.

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a rare type of malignant salivary gland tumor. Myoepithelial carcinoma (MEC) as the malignant component in Ca ex PA is an even rarer occurrence. Preoperative pathological diagnosis of Ca ex PA often goes unnoticed in many cases as they may be clinically indolent and the malignant component may not be picked up on fine-needle aspiration cytology. However, features such as rapid growth, recurrent tumor, and pain point toward a malignant transformation. We present a case of a 40-year-old female who presented with a history of recurrent swelling over parotid region with cytological diagnosis of pleomorphic adenoma, which on excision was reported as Ca ex PA with MEC being the malignant constituent. Till date, few cases of MEC arising from PA have been reported. It presents as a diagnostic challenge to both clinicians and pathologists alike; prognosis is still not clear due to few number of cases and lack of follow-up in most of them.

Background Cancer involving the parotid gland region may originates from parotid parenchyma itself or from locoregional organs and in rare cases, the facial nerve (FN) has to be sacrificed during tumor resection. In these cases, cancer extension often goes beyond the parotid compartment and requires extensive local resection responsible for complex multitissular defects. The goals of reconstruction may be summarized in the following two components: (1) restoration of the volumetric tissue defect and (2) FN reconstruction. The aim of this study is to describe our surgical technique and our cosmetic results using the chimeric scapulodorsal vascularized nerve (SDVN) flap to reconstruct extensive maxillofacial defects associated with FN sacrifice. Methods All patients undergone an extensive maxillofacial resection with FN sacrifice and primarily reconstructed with a SDVN flap were included. We classified the maxillofacial defects into six groups based on the type of resection. Intraoperative data including flap composition, topography of FN injury, length of nerve gap, and number of nervous anastomosis were recorded. Results Twenty-nine patients were included. Mean follow-up was 38.7 months. The harvested flaps included the SDVN combined with different components according to the defect group. A satisfactory volumetric restoration was obtained in 93% of cases. The mean number of distal nervous anastomosis was 4.5. The length of the vascularized grafted nerve ranged from 7 to 10 cm. Conclusion This is largest series presented in literature on primary FN reconstruction utilizing a vascularized nerve graft. We believe that the chimeric SDVN flap should be highly considered for these cases due to its versatility. The surgeon is able to use single donor site available soft and hard tissues components along with a vascular motor nerve graft, which offers a great length and number of distal branches, and easily matches with the extracranial FN trunk and its peripheral ramifications.

The authors report their experience regarding parotidectomy performed under a three-dimensional-high-definition (3D-HD) exoscope, with the aim of evaluating its effectiveness in parotid surgery. This is a prospective study on nine patients treated by the same surgeon. All patients underwent parotidectomy for extrafacial primary tumours without preoperative involvement of the skin or of the facial nerve from March 2019 to June 2019 with the use of a 3D-HD exoscope. Magnification was variable from 8x to 30x with direct vision supplied by a 3D monitor. Six men and three women, mean (range) age 47.8 (19-74) years underwent parotidectomy. No patient experienced postoperative complications or definitive facial palsy. The mean (range) time of surgery was 149.4 (115 - 210) minutes. The 3D exoscope represents a valid alternative to the operative microscope or surgical loupe for parotid surgery. It is a light instrument allowing for precise surgical dissection of the parotid region by reducing the risks for iatrogenic lesions of the facial nerve using a real 3D magnification of the anatomical structures in HD. Furthermore, its use does not prolong the operative time and shows high potential for training and educational purposes since the operating room staff can better perceive the procedure and the surgeon's fine gestures. Although the preliminary applications show promising results, there is still a need for wider scientific validation.

Hemangiopericytoma of the parotid gland is a very rare presentation in the head and neck region. It occurs mainly in the lower extremities, retroperitoneum, and pelvis. Here we reported a case of 14-year female patient present with painless swelling of the right cheek over the parotid region since 5 years.

Introduction Giant cell reparative granuloma is a rare, locally benign tumor with an aggressive behavior resembling malignant neoplasm, originating mainly from the mandible and maxilla; however, it can originate from other sites, such as zygomatic and temporal bones, with a young adult female predilection. Case presentation A 28-year-old female presented to the Department of Otolaryngology and Head and Neck Surgery with a history of a slowly enlarging swelling over the left parotid region for four months. Physical examination revealed a non-erythematous, non-tender, firm mass with no overlying skin changes. Fine needle aspiration cytology of the lesion revealed a multinucleated giant cell-rich tumor and the histopathological examination of an incisional biopsy from the mass confirmed giant cell reparative granuloma. Therefore, a total surgical excision of the mass with curating of the zygomatic and temporal bones was performed with uneventful postoperative course and regular follow ups for one year. Conclusion A growing mass in the parotid region in a young adult female with no history of trauma should raise the suspicion of giant cell reparative granuloma. Histopathological examination is the definitive tool for diagnosis, and surgical excision is the treatment modality of choice in such cases., Highlights • Similar GCRG case has been only reported once in the literature. • This is the second case reporting a GCRG. • Young females with no history of trauma should raise suspicion of GCRG. • We must give more thoughts into etiologies causing such reported cases.

The article presents a clinical example of a case of accidental diagnosis of human immunodeficiency virus in a child at the age of 1 year 10 months with an abscess in the parotid region on the left and the newly diagnosed lymphoproliferative syndrome. The expression of lymphoproliferative syndrome did not correspond to the clinical picture of the underlying disease, therefore differential diagnosis was made between such diseases as histiocytosis, haemoblastosis, primary immunodeficiency disorders, salmonellosis, yersiniosis, tuberculosis. As a result, a human immunodeficiency virus was diagnosed in a child of young age who does not have an apparently burdened history. As a result, the child was timely sent to a specialized hospital for in-depth examination and treatment.

To perform an anatomical study to analyze the size, weight, and the relationships of the parotid levels proposed by the European Salivary Gland Society (ESGS). Anatomical dissections of the parotid region in 19 human specimens were performed. All dissections were systematically carried out to study the dimensions and weight of each level. We also studied the facial nerve distribution between the different levels and the relative position of the facial nerve main trunk and parotid duct in regard to the Frankfort line plane. The facial nerve trunk and the parotid duct were identified in all the 19 specimens, which made it feasible to define the 4 principal levels of the parotid gland body (levels I–IV). Level V was identified in 9 out of 19 dissections (47.5%). For the whole gland, the mean for the height and width dimensions were 66.37 mm and 46.84 mm, respectively, and it weighted 18.13 g. In terms of relative weight regarding the whole gland, level II was always the heaviest, representing from 41 to 47% of the gland's weight, depending on the presence of level V. Levels I and III represent almost the same amount of relative weight as they range from 20 to 22% for each one. Level IV was the lightest body level representing 8–10% of the whole, and when present, level V represented less than 5% of the whole parotid weight. The temporal and zygomatic terminal branches were always found between the cranial levels, whereas the cervical and marginal nerves lie in all cases between the caudal levels. The buccal branches had multiple ramifications that lie between both cranial and caudal levels in 47% of the cases, being found exclusively between cranial levels in 21% and between the caudal levels in the remaining 32%. As traditionally reported, the caudal superficial portion of the gland represents the most voluminous portion of the gland, being labeled in our classification as level II. Levels I and III represent similar amounts of gland, though presenting a significantly different morphological disposition. Level IV is the smallest portion of the body gland and level V, when present represents a scarce 5% of the whole body gland weight. The ESGS levels have a clear anatomical basis and the basic references needed to define them are always present.

The new three-dimensional (3D) high-definition (HD) exoscope enables surgeons to perform a precise surgical dissection of the parotid region with a real 3D magnification of the anatomical structures, with low risk for iatrogenic lesions of the facial nerve, without delay in the surgical time. The 3D-HD exoscope is a light instrument, smaller than the operative microscope, that can be easily integrated into the surgical theater. Furthermore, it shows high potential for training and educational purposes as the surgical staff can easily follow the procedure on 3D monitors and better perceive the surgeon's fine gestures. The 3D-HD exoscope is a valid alternative to the surgical loupes and the operative microscope in the parotid surgery.

Arteriovenous malformation (AVM) results from errors in vascular development during embryogenesis; absent capillary beds lead to shunting directly from the arterial to venous circulation. Although it is common in the head and neck region, AVMs located in the parotid gland are quite rare. Here, we report two cases of arteriovenous malformation of the parotid gland that presented to our out-patient setup with swelling in the parotid region and were diagnosed as arteriovenous malformation on histopathological study after surgical resection.

Swelling of the parotid region is a frequent reason for consultation and the first clinical sign of both benign and malignant parotid tumors. These parotid tumors represent 80 % of tumors of the main salivary glands. They present a highly variable clinical and radiological picture and are known to have a wide histological diversity. Some histological types are rare entities found in the parotid gland, such as Ewing's sarcoma and lymphoepithelial cyst, the latter of which is often associated with HIV co-morbidity, and therefore requires careful and adequate therapeutic attitudes and strategies. We report two cases of parotid swelling revealing unusual pathologies: HIV and Ewing's sarcoma., Highlights • Swelling of the parotid region is a frequent reason for consultation. • Some histological types are rare entities found in the parotid gland. • The pathological examination of the surgical specimen provides a definitive diagnosis. • Age can be a concealing element, therefore a careful medical attitude is the key.

Patients presenting with a parotid region lump may occasionally have a lesion arising from the spaces around, rather than from within, the parotid space. These lesions, referred to in this article as the Parotid Imposters, in most of the cases will require alternative diagnostic and therapeutic pathways and hence it is important to know beforehand what the nature of such a lesion could be before assuming that we are dealing with a parotid space lesion. In this article, we will discuss some of these lesions and review their imaging features.

This report describes the rare complication of first-bite syndrome (FBS) after carotid endarterectomy (CEA). Although FBS is well known in otolaryngologic literature, it is rarely discussed in relation to vascular surgery. FBS is most commonly a postoperative pain syndrome that is thought to be the result of selective parotid gland sympathetic denervation. The resultant facial pain is centered around the parotid region and triggered by initiation of mastication. The pain is severe, but short in duration, and quite specific in pattern. We present a case of FBS after CEA with complex anatomy. The patient developed typical symptoms of ipsilateral parotid, mandibular pain during the postoperative course. Workup excluded other diagnoses. The symptoms were self-limiting but did not resolve completely. Vascular surgeons, who are universally aware of the presentation of Horner’s syndrome, should also be aware of this rare complication with similar pathophysiology.

Hydatidosis (Echinococcosis) is a disease caused by infestation of hydatid cysts in any organ of body but mainly liver (70% of cases). Hydatidosis of salivary glands is rare and necessitate computerized tomography for diagnosis while fine needle aspiration remains controversial procedure. Materials and methods: 6 patients diagnosed with hydatid cysts of parotid glands. These cases were admitted and treated at the maxillofacial surgery Clinic of the “AL-Ramadi” Hospital in Iraq. 5 patients were female and 1 male with age group was between 30–50 years. The patients complained of painless unilateral swelling in parotid region and who were diagnosed hydatid cysts using CT. All cases were treated by superficial parotidectomy with cystectomy and preservation of facial nerve. Results: All hydatid cysts are CE1- type with no recurrences were reported in any of these cases. The postoperative edema was the most common complication. Other complications were not seen. Conclusion: parotid hydatid cyst should be included in differential diagnosis of persistent parotid swelling especially those with history of hepatic hydatid cysts. Computerized tomography is the gold imaging that aid in diagnosis and classification of hydatid cysts. Most cases are CE1 type and Eosinophilia is a sign of concern in some patients. Surgical treatment remains the “gold standard” in therapy. Highlights: Hydatidosis of parotid glands is rare but must be included in differential diagnosis of cystic swelling of salivary glands especially those with history of hepatic hydatid cysts. The hydatid cysts are classified according to morphology on imaging into 5 types Total serum bilirubin, eosinophilia and leukocytosis are seen Superficial parotidectomy with removal of hydatid cysts is the treatment of choice in parotid hydatid cysts

Multifocal adenomatous oncocytic hyperplasia (MAOH) is a rare non-neoplastic condition of the parotid gland. It is also referred to as “Oncocytosis.” It accounts for approximately 0.1% of all the salivary gland lesions. The existence of this entity needs more understanding compared to its counterpart oncocytoma due to limited identification and studies. Here, we report a case series of two cases of MAOH in a 63-year-old man and in a 54-year-old woman over the left and right parotid region, respectively, both clinically operated for malignant parotid tumors. Fine-needle aspiration of both the lesions was reported with differentials of oncocytic rich lesions oncocytoma, Warthin’s tumor, and an oncocytic variant of mucoepidermoid carcinoma. Histology was proven as MAOH as it showed multiple unencapsulated nodules composed of oncocytes. Cytology alone is not sufficient for its diagnosis as they overlap withother oncocytic rich lesions. Awareness of this entity is essential for surgeons and practicing pathologists as it is a benign condition, thereby avoiding extended surgeries.

Periauricular sensory deficit occurs frequently after parotidectomy even in cases with preservation of the greater auricular nerve (GAN). This study was performed to evaluate the effects of antiadhesive agent in functional recovery of the GAN after parotidectomy. Ninety-eight patients undergoing partial parotidectomy for benign parotid tumors were prospectively enrolled in this multicenter, double-blind randomized controlled study and randomly assigned to either the study or control group. Antiadhesive agent was applied in the study group. The results of sensory tests (tactile, heat, and cold sensitivity) and a questionnaire on quality of life (QoL) were acquired at postoperative 1, 8, and 24 weeks after surgery. Clinical parameters, and the results of the sensory tests and the questionnaire, were compared between the two groups. A total of 80 patients were finally enrolled. On sensory evaluation, tactile sensation and warm sensation in the ear lobule, and warm sensation in the mastoid area, showed significant improvement at 24 weeks postoperatively in the study group. There were no significant differences between the two groups on any questions in the QoL questionnaire, at any follow-up time point. Antiadhesive agents have some positive effects on functional recovery of the GAN after parotidectomy. Therefore, applying antiadhesive agents after parotidectomy can reduce discomfort in patients.

We present a case of a woman operated 20 years ago of bilateral parotidectomy that developed Frey's syndrome (FS). We try to explain the causes of the delay request for therapy in FS. We got the disappearance of symptoms even after 20 years from surgery thanks to botulinum toxin injection. Frey's syndrome, also named auriculotemporal syndrome, is described as facial sweating and redness during meals following traumas or surgeries in the region of the parotid gland.1 Injury to the auriculotemporal nerve resulting from parotidectomy or parotid region trauma might damage parasympathetic and sympathetic fibers, and the parotid gland. The FS appears to be secondary to the abnormal reinnervation of the sweat glands and cutaneous vessels of the auricular‐temporal and large auricular nerve distribution territories by parasympathetic fibers, normally destined for the parotid and injured by the surgical intervention.2 Botulinum toxins, produced by Clostridium botulinum, are a family of neurotoxins that includes several subtypes. Botulinum toxin type A (BTXA) is the most common subtype, which causes blockage of neurotransmission by preventing the release of acetylcholine to nerve endings.3, 4

Although tuberculosis is a common health problem in developing countries such as India, tuberculous parotitis (tubercular involvement of parotid gland) is rarely encountered. Because of very low incidence and nonspecific symptoms, it is often misdiagnosed as parotid neoplasm. Ultrasonographic and computed tomographic findings are also noncontributory for this entity. Hence, to increase awareness about this rare entity, here, we report a series of eight cases of tuberculous parotitis which were diagnosed on fine-needle aspiration cytology (FNAC) and successfully treated with antitubercular drugs. Majority of our cases (five cases) presented as asymptomatic unilateral swelling or acute tender painful swelling (two cases) in the parotid region. FNAC smears showed caseous necrosis, epithelioid granulomas along with variable amount of mixed inflammatory exudates, and few benign ductal or acinar cell clusters. One case had unilateral recurrent swelling in the preauricular region with fistula. Superficial parotidectomy was done and histological examination revealed the diagnosis of tubercular parotitis. Following diagnosis, all patients were kept on antitubercular treatment and responded well to treatment with no evidence of recurrence on 9-month regular follow-up.

Highlights • The parotid region is a very rare site with few published case reports, shares the common features of trunk DFSP. • Radiotherapy or chemoradiotherapy can be applied to large and recurrent cases, but with unclear benefit. • Dermatofibrosarcoma protuberans is a rare tumor, with infiltrative margins, high local recurrence rate, and rare distant metastasis. • CD34 immunohistochemistry is a reliable marker for difficult diagnostic cases., Introduction Dermatofibrosarcoma protuberans (DFSP) is a cutaneous malignancy that arises from the dermis and invades deeper tissue. The cellular origin of DFSP is not clear. Evidence supports the cellular origin being fibroblastic, histiocytic, or neuroectodermal. Presentation of case A 38 years old, women presented with slow-growing large right parotid mass. A total parotidectomy performed with auriculectomy and reconstruction using ALT flap. Diagnosis confirmed by pathology and immunohistochemistry. Tumor recurred in 10 months, the second surgery with subsequent chemoradiotherapy performed. Patient initially treated with wide resection, 4 cycles of chemotherapy and postoperative radiotherapy 40 Gy, with the recurrence in 10 months. We performed a second surgery followed by radiotherapy. She is disease-free for more than two years under follow-up. Discussion The main treatment of DFSP is surgical resection with wide negative margins or Moh’s surgery. Advanced cases treated with addition of radiotherapy or chemoradiotherapy, but with unclear benefits. In our case, huge tumor located in the parotid region recurred after initial surgery and adjuvant treatment. Conclusion Clinically, DFSP usually manifest as well circumscribed, slow-growing, smooth, and painless masses. In cases with advanced tumor in parotid region, recurrence may occur despite aggressive initial treatment with wide resection and chemoradiotherapy.

Infezioni del sito chirurgico dopo parotidectomia: la gestione e i vantaggi dell’antibioticoprofilassi.L’uso dell’antibioticoprofilassi perioperatoria nella chirurgia della testa e del collo non contaminati è ancora oggetto di dibattito. La valutazione dell’efficacia del protocollo istituzionale di antibioticoprofilassi per la prevenzione dell’infezione del sito chirurgico dopo parotidectomia è l’obiettivo del nostro studio. Per tale scopo sono state rivalutate le cartelle cliniche di 448 pazienti sottoposti a parotidectomia. I pazienti sono stati divisi in due gruppi in base all’uso della somministrazione endovenosa perioperatoria di cefazolina oppure di ciclo settimanale di antibioticoterapia post-operatoria. L’infezione del sito chirurgico è stata registrata in 29 casi (6,5%) di cui 16 (5,7%) all’interno del gruppo prima dell’applicazione del protocollo perioperatorio e 13 (7,9%) all’interno del gruppo dell’antibioticoprofilassi. Le analisi di regressione logistica univariata e multivariata hanno mostrato che i fattori predittivi per l’infezione del sito chirurgico erano la quantità di raccolta nel drenaggio ≥ 50 ml nelle prime 24 ore postoperatorie (OR: 4,86; 1,59-14,82 95% CI; p0,01) e l’anamnesi positiva per una precedente infezione acuta parotidea (OR: 13,83; 5,31-36 95% CI; p0,01). La maggior parte delle infezioni post-chirurgiche (82%) sono state trattate con terapia antibiotica endovenosa. Le restanti hanno richiesto un intervento chirurgico. L’antibioticoprofilassi è raccomandata per i pazienti sottoposti a chirurgia parotidea mentre la terapia antibiotica nel decorso post-operatorio è fortemente consigliata in caso di storia di precedenti infezioni acute parotidee e di quantità di materiale raccolto nel drenaggio ≥ 50 ml nelle prime 24 ore.The use of perioperative prophylactic antibiotics in uncontaminated head and neck surgery is still controversial. The aim of this study was to assess the efficacy of an institutional antibiotic prophylactic protocol in preventing surgical site infection after parotidectomy. The medical charts of 448 patients who underwent parotidectomy were reviewed. Patients were divided in two groups according the use of perioperative administration of intravenous cefazolin or post-operative week course of antibiotics. Surgical site infection was registered in 29 (6.5%) cases, 16 (5.7%) within the group before the application of the perioperative protocol and 13 (7.9%) within the antibiotic prophylaxis protocol group. The univariate and multivariate logistic regression analyses showed that predictors for surgical site infection were the amount of drain output ≥ 50 ml in the first post-operative 24 hours (OR: 4.86; 1.59-14.82 95% CI; p0.01) and history of a previous parotid acute infection (OR: 13.83; 5.31-36 95% CI; p0.01). The majority of post-surgical infections (82%) were treated with intravenous antibiotic therapy. The remnants were treated surgically. Perioperative antibiotic treatment is recommended for patients undergoing parotid gland surgery and intravenous antibiotics during the post-operative course are highly suggested in case of history of previous acute parotid infection and drain output ≥ 50 ml in first 24 hours.

Two cases of lipomatosis of the parotid salivary gland in two dogs are reported. Both dogs were presented with a slow growing unilateral non-painful mass in the parotid region. The mass measured 12 and 15 cm on the longest axis for case 1 and 2 respectively. Initial incisional biopsies were suggestive of infiltrative lipoma or salivary gland adenocarcinoma. Case 2 underwent head radiographs that showed a soft tissue opacity on the area of the right parotid gland followed by a computed tomography that showed a multi-lobulated infiltrative mass occupying the right parotid gland. Both cases underwent total parotidectomy with an excisional biopsy intent. Surgery on case 1 included total ear canal ablation (TECA). Histology revealed lipomatosis of the parotid gland with a similar admixture of adipocytes and well-differentiated salivary acini on both cases. No recurrence was reported by 4 years for case 1 and by 3 years for case 2. Case 1 developed long-term right-sided facial paralysis and palpebral reflex deficit due to damage of the facial and trigeminal nerve during surgery. The cases are described and the veterinary literature is reviewed in view of the most updated information available in human medicine on fat-containing salivary gland lesions. Considering this literature review, authors recommended these two cases to be classified as lipomatosis of the salivary gland. In conclusion, fat-containing salivary gland lesions should be considered in the list of differential diagnoses in dogs with an enlarged salivary gland and seem to be associated with an excellent prognosis after surgical excision. Keywords: Dog, Lipomatosis, Parotid, Salivary gland, Sialoadenectomy, Sialolipoma

This study aims to investigate how the appetite as perceived by subjects may be estimated by physiological responses such as saliva secretion or pupillary response when they are presented visual stimuli. We recruited nine healthy male and female subjects to observe the changes in saliva secretion and pupil diameter before and after visual stimuli that arouse appetite. We also examined the relationship between these changes and subjects' evaluations of appetite. We found a significant difference in blood flow in the parotid region between the low-rating group and the high-rating group concerning their own appetite. Our findings suggest that salivary secretion may be useful in estimating and assessing appetite.

Angiosarcoma of the scalp is an aggressive tumor with a high rate of local recurrence and distant metastasis. We present two cases of metastasis in parotid region at the time of one year after radical surgery of scalp angiosarcoma. It is suggested that regional lymph nodes should be treated more aggressively at the first treatment, which may achieve better results or, at least, prolong the time to local recurrence and distant metastasis.