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Objectives/hypothesis: To assess long-term results after the treatment of parotid pleomorphic adenomas (PPAs) using different surgical techniques and focusing on recurrence rates and the risk of adverse effects.Study Design: Retrospective analysis.Methods: Retrospective analysis of 182 patients treated exclusively for PPAs at a tertiary referral center between 2000 and 2004. Thorough follow-up examinations over a mean period of 13 years were possible in 53.8% (n = 98/182). Tumors were categorized according to the European Salivary Gland Society (ESGS) system to improve the comparison of outcomes. After different surgical resection strategies, recurrence rates, postoperative facial nerve paresis (FNP), and incidence of Frey's syndrome were assessed. The follow-up period included clinical examinations and imaging of every patient in the treating department.Results: Of 182 patients, extracapsular dissection (ED) was performed in 29.7%, and other surgical modalities (OSMs), including facial nerve dissection, in 70.3%. After the long-term follow-up, 98% of all the patients (n = 96/98) were recurrence free. When recurrence rates were compared, no significant differences were noted (P < .331). ED resulted in significantly lower FNP rates compared to OSMs (P < .001). FNP rates significantly increased with size and location of the tumors according to ESGS categories (temporary and permanent FNP, P = .04). Surgical invasiveness corresponded to a significant increase in the incidence of Frey's syndrome (P < .001).Conclusions: ED was associated with the lowest complication rates, but not with a higher risk of recurrence, when compared with OSM in the long-term course. As ED can be performed in the majority of PPAs, it can be regarded as the treatment of choice whenever possible.Level Of Evidence: 4 Laryngoscope, 131:E445-E451, 2021. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate the demographics, clinical features, management, and prognostic indicators of tracheoesophageal puncture complications in patients undergoing placement of voice prosthesis following cancer treatment. Study Design: Retrospective analysis. Methods: A retrospective analysis was conducted of cases from a tertiary referral center diagnosed between 1996 and 2015. Multivariate logistic regression was used to determine factors associated with tracheoesophageal puncture (TEP) and voice prostheses–complication‐free survival (TEP/VP‐CFS). Results: One hundred fourteen cases were identified. Most patients were males (92.9%) with pT3 (26.8%) or pT4 (58.1%) N+ (53.6%) tumors. All patients received laryngectomy as the primary treatment, with 75% of patients receiving adjuvant radiation therapy or chemoradiotherapy. Complications with TEP were common (65.2%). The most frequent problem was salivary leakage (50.0%), which at the same time was the most common reason for changing the prosthesis. On univariate regression analysis, prosthesis placement time after adjuvant radiotherapy (hazard ratio [HR]: 4.17, 95% confidence interval [CI]: 2‐8.69), secondary prosthesis placement after primary surgery (HR: 3.97, 95% CI: 1.99‐7.9), and laryngectomy with flap reconstruction (HR: 1.96, 95% CI: 0.99‐3.89) were significant prognosticators for complications. Multivariate regression analysis revealed secondary prosthesis placement after adjuvant radiotherapy (HR: 3.66, 95% CI: 1.39‐9.68) or after primary surgery (HR: 2.57, 95% CI: 0.92‐7.2) to be the strongest predictors of reduced TEP/VP‐CFS. Conclusions: Secondary prosthesis placement after primary surgery, placement after previous irradiation, and laryngectomy with flap reconstruction are predictors of poor TEP/VP‐CFS. Planned adjuvant radiotherapy is not a contraindication for TEP with prosthetic placement, but it is very important to place the prosthesis during the primary surgery or at least before scheduled radiotherapy. Level of Evidence: 4 Laryngoscope, 2020 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The ideal extent of surgical intervention for cystadenolymphomas of the parotid gland remains a matter of controversy. The aim of our study was to assess the surgical outcome after extracapsular dissection for cystadenolymphomas of the parotid gland. A further purpose of this study was to examine how the number of primary cystadenolymphomas or the size of the primary lesion influences the possibility of an ipsilateral metachronous tumor occurrence.Study Design: Retrospective clinical study.Methods: A retrospective evaluation of the records was carried out for all patients treated for cystadenolymphomas of the parotid gland by means of extracapsular dissection at a tertiary referral center between 2000 and 2012.Results: Three hundred twenty-seven patients were included in the study. Our analysis detected an overall occurrence rate of ipsilateral metachronous tumors of 3.1% (10/327) with a mean follow-up of 108.4 months. A significant difference in the rate of metachronous lesions between unilocular (1.7%) and multilocular (11.6%) tumors could be detected (χ2 (1) = 7.342, P < .001). Our analysis was not able to find any significant influence of the maximal tumor size on the rate of metachronous tumors (χ2 (1) = 0.634, P = .426).Conclusions: One of the most controversial issues in the treatment of cystadenolymphomas of the parotid gland concerns the question of which is the best therapeutic approach to be taken in such patients. Our analysis was able to demonstrate the benefits of extracapsular dissection in the management of solitary as well as carefully selected multicentric cystadenolymphomas with a consistently acceptable surgical outcome.Level Of Evidence: 4. Laryngoscope, 2521-2524, 2018. [ABSTRACT FROM AUTHOR]

Objectives: To assess results after treatment of difficult/complex sialolithiasis with extracorporeal shock-wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL).Study Design: Retrospective study in a tertiary referral center.Methods: Altogether, 63 stones were diagnosed in 38 patients with difficult/complex sialolithiasis. Forty-nine stones were treated with fragmentation using both ESWL and IPL. Stones accessible with the sialendoscope were treated primarily with IPL in multiple sialolithiasis.Results: Seventy-one ESWL procedures and 57 IPL were performed in our patients. Forty-nine stones were treated by 67 ESWL procedures and 52 IPL. ESWL converted sialoliths from sialendoscopically untreatable into sialendoscopically treatable cases in 94.7%; the treatment then was completed by a total of 52 IPL procedures. ESWL was performed before IPL (81.6%), in combination with IPL (7.9%) and after (10.5%). Complete fragmentation was achieved in 97.9%. Four stones each were treated with ESWL and IPL alone in multiple sialolithiasis. Altogether, 53 stones were treated by 57 IPL procedures. Complete fragmentation was achieved in 98.1% of the 53 stones. ESWL and IPL were the dominant treatment modalities in 84.1% of all 63 stones treated. Of all 38 patients, 92.1% became stone-free and all became symptom-free. All the glands were preserved. Multiple stones were treated in 34.2% of the patients; of these, 92.3% became stone-free.Conclusion: These results show that patients with difficult and complex sialolithiasis can be treated with high success rates of > 90% using a multimodal, minimally invasive, and gland-preserving treatment approach. ESWL and IPL played a key role in this multimodal treatment regime in > 80% of stones.Level Of Evidence: 4. Laryngoscope, 128:E332-E338, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To assess the long-term results after transoral submandibulotomy for stones located in the deep hilar and intraparenchymal submandibular region.Study Design: Retrospective cohort analysis.Methods: Retrospective evaluation including all patients treated with transoral submandibulotomy for sialolithiasis at a tertiary referral center.Results: Complete stone removal at the first transoral surgical treatment was achieved in 185 of 234 patients (79.1%). One hundred seventy-five of the 234 patients were followed up for a mean of 31.2 ( ± 20.5) months. During the follow-up period, 140 of the 175 patients (80.0%) became symptom free after one operation. In patients with residual symptoms, no further treatment was needed in 12 patients (6.9%) due to the mildness of the symptoms; 23 patients (13.1%) received further therapy, which was successful in 15 cases. Submandibulectomy only had to be performed in 3.4% of the patients with follow-up (6/175). In a questionnaire survey, 91.4% of the patients stated that they would be prepared to have the same operation again.Conclusions: These findings show that transoral removal of submandibular sialoliths located in the deep hilum or adjacent intraglandular parenchyma is an effective treatment that can be assisted by additional measures. The techniques described show high success rates, good long-term results, low complication rates, and they avoided the need for submandibulectomy in >95% of cases.Level Of Evidence: 4. Laryngoscope, 127:2038-2044, 2017. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate whether extracapsular dissection of a primarily unsuspected lesion in the parotid gland could be oncologically sufficient for carefully selected cases of parotid gland malignomas.Study Design: Retrospective clinical study.Methods: The records of all patients treated for primary malignant tumors of the parotid gland solely by means of extracapsular dissection between 2006 and 2013 were studied retrospectively. Patients with manifestation of malignant tumors in the parotid gland that were not of primary salivary gland origin (squamous cell carcinomas, lymphomas, melanomas) or who had had revision surgery or other malignant tumors in their history, as well as patients with insufficient data, were excluded from our study sample.Results: Nine patients, all with low-grade parotid malignancies, were detected. Our study showed acceptable oncologic and functional outcomes throughout.Conclusion: Our study was able to show very encouraging preliminary results following primary extracapsular dissection as sole surgical therapy for carefully selected low-stage, low-grade, inferiorly located lesions in patients with high compliance.Level Of Evidence: 4. Laryngoscope, 127:1804-1807, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To provide an extended and treatment-oriented classification of parotid duct stenosis that might be useful in the management of this condition.Study Design: Retrospective study in a tertiary referral center.Methods: A total of 550 symptomatic stenoses of the parotid gland excretory duct in 445 patients were analyzed. Sialendoscopy was performed with semirigid endoscopes. The tissue quality, location, grade of luminal narrowing, and length and number of the stenoses were assessed.Results: Inflammation-dominant stenosis (type 1) was found in 8.9% of the patients, web-associated fibrous stenosis (type 2) in 19.5%, and fibrous (type 3) in 71.6%. Multiple stenoses (≥3) were found in 2.8% of patients, and bilateral stenoses in 11.9%. Type 1 stenoses differed significantly from type 3 stenoses, with lower grades. Type 3 stenoses showed significantly higher grades of luminal narrowing than the other two types (P = .0001). Type 2 stenoses were significantly shorter in comparison with the other two types (P = .0001). Multiple stenoses were observed significantly more often in type 2 than in type 3 stenoses (P = .0001). Due to these differences, the type of stenosis appears to be the most important criterion in the treatment-oriented classification.Conclusions: Significant differences between the different stenoses were observed. Type 1 stenosis may be considered as a precursor of type 3 stenosis, but type 2 stenosis showed significantly different characteristics. The differences prescribed in this classification may be helpful in the management of parotid duct stenoses.Level Of Evidence: 4. Laryngoscope, 2016 127:366-371, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To test the effectiveness of a newly approved pneumatic lithotripter for fragmentation of salivary stones.Study Design: Retrospective study in a tertiary referral center.Methods: In 44 patients, 49 stones were primarily treated with direct endoscopic guidance using the StoneBreaker. Twenty-three stones were located in the parotid gland and 26 in the submandibular gland.Results: Complete fragmentation was achieved combined extracorporeal in 97.7% of the stones. All of the patients became symptom free, and 97.7% were stone free. Three patients underwent lithotripsy procedures. Altogether additional treatment was necessary in five cases to achieve stone clearance. The reason for residual sialolithiasis was intraparenchymal repulsion of a residual fragment (n = 1). The glands were preserved in all cases.Conclusions: Endoscopically guided intraductal pneumatic lithotripsy using the StoneBreaker is an effective and promising procedure for the treatment of sialolithiasis.Level Of Evidence: 4 Laryngoscope, 126:1545-1550, 2016. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To investigate epidemiological features and symptoms of sialolithiasis and their implications for diagnosis and management. Study Design Retrospective cohort study. Methods Retrospective analysis on 2,322 patients with sialolithiasis, between 1987 and 2009. The statistical significance between two sample distributions was computed using analysis of variance Student t test for two-tailed distribution. Results A total of 2,959 calculi were identified by means of ultrasound. Of those, 80.4% were located in the submandibular duct system (53% hilar/proximal, 37% distal, 10% intraparenchymal) and 19.6% were parotid stones (83% in Stensen's duct, 17% intraparenchymal). Sialoliths had been discovered beforehand in the submandibular gland ( P = 0.00024; t test). Symptoms, measured from first visit, lasted on average 26 months (range: 1 day-30 years). The main group suffered from swelling (50.3%), followed by painful swelling (41.6%) and pain (3.1%). Multiple stones were found in 16.9% of patients (18.1% in the submandibular gland; 14.3% in the parotid). Average stone diameter in the submandibular gland was 8.3 mm (range 1-35 mm), and the stones were in Lustmann group II (46%). In the parotid gland, the average diameter was 6.4 mm (range 1-31 mm), and 51% were in Lustmann group I. Conclusion Nowadays, epidemiologic features and clinical manifestations of sialolithiasis play an important role, assisting not only in diagnosis but also in determining appropriate treatment. Due to their location and smaller diameter, parotid stones in some cases can only be treated using a mini-invasive endoscopic technique. Submandibular stones more often require a combined approach. Level of Evidence 4 Laryngoscope, 125:1879-1882, 2015 [ABSTRACT FROM AUTHOR]

Objective/Hypothesis The ideal extent of surgical intervention for benign parotid tumors remains a matter of controversy. The aim of the study was to trace the development of surgical therapy in a large cohort, explore its changes in a single institution specializing in salivary gland pathologies over the last 12 years, and determine the extent to which a possible shift in the surgical therapy of parotid benign tumors toward less radical methods was correlated with a change in the incidence of facial palsy and Frey's syndrome. Study Design Retrospective clinical study. Methods A retrospective evaluation of the records for all patients treated for benign parotid tumors between 2000 and 2012 at a tertiary referral center was carried out. Surgical methods were classified into four groups: extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy, and complete parotidectomy. Results A total of 1,624 patients were included in the study. Our analysis demonstrated an increase in the total number of parotidectomies for benign lesions from 71 (2000) to 184 (2012), mostly due to the increase in extracapsular dissections (from 9 to 123). Increased performance of less radical surgery was associated with a significantly decreased incidence of temporary and permanent facial palsies (from 22.8% to 9% and 9.8% to 5.9%, respectively) and Frey's syndrome (from 11.3% to 1.6%). Conclusions One of the most controversial issues in the treatment of benign parotid tumors is the best therapeutic approach to be taken in such patients. Our study showed that increased performance of less radical surgery was associated with better functional outcomes. Level of Evidence 2b. Laryngoscope, 125:122-127, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To assess the objective long-term results and subjective outcome after treatment of Stensen's duct stenosis. Study Design: Retrospective study at a tertiary center. Methods: The long-term results after treatment with a minimally invasive regimen focusing on sialendoscopy were assessed in 82 patients with 98 parotid duct stenoses after primary gland-preserving treatment. A questionnaire was used to assess the patients' perception of success, including clinical parameters and a visual analogue scale (VAS) assessing pain, symptoms, and salivary gland-related quality of life (QOL). Patients were invited to present for clinical and ultrasound examinations and sialendoscopy. Results: The average follow-up period was 98.48 months. Fifty percent of the patients reported having recurrent gland swelling; but only 19.5% reported recurrent pain and the VAS scores for current symptoms and pain were low. Independent of the type of stenosis, the VAS scores showed a significant reduction in symptoms and improvement in the perceived QOL after the treatment (P50.0001 each). Follow-up examinations were carried out in 20.73% of the patients, and sialendoscopy was performed in 12.1% of the patients. After diagnosis, recurrent stenoses (n58, 9.75%) were successfully reopened in all cases. The glands were preserved in all of the patients. Conclusion: Long-term evaluation after minimally invasive treatment of stenoses of the parotid duct indicates that high success rates, high rates of gland preservation, and an acceptable subjective patient outcome can be achieved. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis There are several therapeutic approaches to treat juvenile recurrent parotitis. The aim of this study was to compare sialendoscopy, including prophylactic cortisone irrigation, with observation and a conservative approach of antibiotic therapy alone. Study Design Retrospective study, tertiary clinical center. Methods The charts of patients treated for juvenile recurrent parotitis between November 2004 and June 2011 were reviewed. Initial acute flares were always treated with a course of antibiotics. Subsequent treatment consisted of either salivary gland endoscopy including cortisone irrigation or additional pure antibiotic therapy. Patients treated with salivary endoscopy were compared to patients treated with antibiotics alone with regard to the number of inflammatory episodes and pain intensity pre- and posttreatment. Results Thirty-six patients were treated during the period of study, 15 with salivary endoscopy with cortisone irrigation and 21 with antibiotic therapy alone. A significant reduction in recurrent episodes and pain intensity following therapy was found in both groups. With respect to these two outcomes, the comparison showed two therapeutic options of equal merit. Conclusions Salivary gland endoscopy is an option in the management of juvenile recurrent parotitis that helps in confirming the diagnosis and that also provides therapeutic intervention. However, although there are further advantages, the definitive value of salivary gland endoscopy requires ongoing evaluation in further prospective studies. Level of Evidence 4. Laryngoscope, 124:451-455, 2014 [ABSTRACT FROM AUTHOR]

Sialendoscopy is established in the diagnostics and treatment of obstructive salivary gland diseases, but has not previously been reported in patients with injuries to Stensen's duct. Sialendoscopy assisted repair of a transected Stensen's duct in zone B is reported. The duct injury itself, its location, and its severity could be visualized and precisely assessed and allowed intraductal assessment of the ductal tissue. Rapid atraumatic dissection and also postoperative endoscopic follow-up examination with assessment of the anastomosis was provided by using the sialendoscope, which appears to be valuable for several reasons in the management of Stensen's duct trauma. Laryngoscope, 123:3074-3077, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Treatment for jugulotympanic paragangliomas (JTPs) is shifting from radical toward function-preserving surgery. Alternative primary treatments are available, such as stereotactic radiotherapy (SRT) and radiosurgery. The aim of this study was to analyze the results after primary function-preserving surgery with or without adjuvant radiotherapy, or primary SRT, in the treatment of JTPs. Study Design: Retrospective analysis. Methods: From 2000 to 2010, 45 patients (mean age, 62.5 years) received function-preserving treatment for JTPs-four type A paragangliomas (8.9%), 19 type B (42.2%), 13 type C (28.9%), and nine type D (20%) in the Fisch classification. The patients were retrospectively assigned to three groups: primary function-preserving surgery, primary stereotactic radiotherapy, and close follow-up. The end points for analysis were long-term tumor control, cranial nerve function, and hearing. Results: A total of 64.4% of the patients (n = 29) received primary surgery, with complete resection in 18. Eleven patients had surgical tumor reduction, with fractionated postoperative radiotherapy (mean 53.5 Gy; range, 50-56 Gy) in five cases and radiosurgery (18 Gy) in one case; five patients received close follow-up. Twelve patients (26.7%) underwent primary radiotherapy (11 with SRT [mean, 50 Gy]; one with radiosurgery [16 Gy]). Four patients (8.9%) received a wait-and-scan strategy. The mean follow-up was 46.8 months. The overall tumor control rate was 97.2%. Conclusions: With these high tumor control rates, consistent with the literature, function-preserving therapy for JTPs currently appears to offer the greatest benefit for patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to review the advantages, limitations, and international interdisciplinary expert perspectives and contrasts of salivary gland endoscopy and transoral techniques in the diagnosis and management of salivary gland calculi and their adaptation in North America. The transition from transcervical approaches to strictly sialendoscopic approaches is a broad chasm and often not feasible. Sialendoscopy, sialendoscopy-assisted, intraoral, and transcervical approaches all have surgical value. Diagnostic sialendoscopy, interventional sialendoscopy, sialendoscopy-assisted, and transoral techniques have been a major step forward, not only in providing an accurate means of diagnosing and locating intraductal obstructions, but also in permitting minimally invasive surgical treatment that can successfully manage blockages precluding sialoadenectomy in most cases. A flexible methodology is required. Multiple or combined measured may prove effective. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The management of stenoses of Wharton's duct has so far been little investigated or systematized. The development of minimally invasive treatment methods, including sialendoscopy, has made preservation of gland function possible. Study Design: Retrospective study in a tertiary referral center. Methods: A total of 153 stenoses of the submandibular duct were diagnosed and treated in 138 patients. Ultrasound and sialendoscopy were the first-choice diagnostic measures. A total of 62.7% of the stenoses were located in the distal, 11.1% in the middle segment, and 18.3% in the proximal to posthilar duct. Diffuse stenoses were observed in 7.8% of the cases. Sialendoscopy-assisted intraductal cortisone administration, interventional sialendoscopy, and transoral ductal surgery were the treatment options. The mean period between treatment and data collection was 52.5 months. Results: Fibrotic stenoses were diagnosed in 88.3% and bilateral involvement in 8.6% of the cases. Distal stenoses were treated predominantly by ductal incision (79.2%). Stenoses of the midsubmandibular duct were treated conservatively in 29.4% or with sialendoscopy or ductal incision in 35.3% of cases each. Proximal up to posthilar stenoses could be dilated by interventional sialendoscopy in 82.2%. In 25% of all diffuse stenoses, glandular resection was carried out, representing 2.6% of all stenoses. Glandular function was preserved in 97.8% of cases. Conclusions: Stenoses of the submandibular duct can be treated using minimally invasive procedures and with preservation of glandular function with a high success rate. Ductal incision procedures are the most important measure, but sialendoscopy becomes more important the more centrally the stenosis is located. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: This study aimed to evaluate the results of endoscopic laser-assisted diverticulotomy and the transcervical approach in treating Zenker's diverticulum. Study Design: Retrospective clinical study. Methods: Results of 155 cases after endoscopic laser-assisted diverticulotomy and the transcervical approach were retrospectively compared. Results: Primary treatment consisted of endoscopic laser-assisted diverticulotomy in 65.2%, and 34.8% were treated by a transcervical approach. Average follow-up time was 61.8 months. Surgical time, duration of hospitalization, and occurrence of minor complications were significantly lower after endoscopic approach. Recurrence rate showed a statistically significant difference in favor of open approach. Including the recurrences, 38.7% could be cured only by transcervical techniques. Patient perception of success was found to be similar for the compared treatment modalities. Conclusions: Endoscopic approach proved to be the treatment of first choice. However, the fact that open techniques were necessary in nearly 40% of our cases suggests that this operative technique retains a substantial role in treatment of this disease. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To determine the incidence of major and minor complications and their impact on patients' comfort after parotid surgery in benign disease. Study Design: Retrospective. Methods: Four hundred ninety-two patients were included. Total parotidectomy (TP) was performed in 65.8%, superficial parotidectomy (SP) in 27.2%, and partial superficial parotidectomy (PSP) in 7.0%. Patients were interviewed using a self-designed questionnaire. Incidence of complications was evaluated depending on the extent of surgery and intensity of complaints. To ascertain the impact of morbidity on their daily lives, patients were asked to estimate it according to a visual analog scale. Results: Frey's syndrome occurred in 63.4%, and temporary facial nerve palsy in 32.7% of all cases. Both rates were significantly reduced after PSP. Permanent facial nerve paresis was observed in 2.3% of the cases, but in no case after PSP. Perception of patients and their scores reflected these results. Scores regarding Frey's syndrome and facial nerve paresis showed a significant positive correlation with extent of surgery. The recurrence rate was 2.2%; no recurrences were noted after PSP. Scores of perceived general condition indicated an excellent state. Conclusions: The incidence of complications was reduced after PSP compared to SP or TP. Patient scores, which represent their perception of these complications, reflected these data and may be an additional instrument to measure outcome. These data suggest that less invasive operative techniques should be considered in case of a benign disease. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The desirable extent of surgical intervention for benign parotid tumors remains a matter of controversy. Superficial or total parotidectomy as a standard procedure is often said to be the gold standard; however, with it the risk of intraoperative damage to the facial nerve cannot be ignored. For some time now, extracapsular dissection without exposure of the main trunk of the facial nerve has been favored as an alternative for the treatment of discrete parotid tumors. Data on the incidence of facial nerve lesions and other acute postoperative complications of extracapsular dissection have been lacking until now. Study Design: Retrospective analysis. Methods: We performed a retrospective analysis of the data from patients in whom extracapsular dissection of a benign parotid tumor had been performed under facial nerve monitoring and as a primary intervention in our department between 2000 and 2008. Results: A total of 934 patients were operated on for a newly diagnosed benign tumor of the parotid gland. Three hundred seventy-seven patients (40%) underwent extracapsular dissection as a primary intervention. The most common postoperative complication was hypoesthesia of the cheek or the earlobe, as reported by 38 patients (10%). Eighteen patients (5%) developed a seroma and 13 patients (3%) a hematoma. A salivary fistula formed in eight patients (2%). Secondary bleeding occurred in three patients (0.8%). In 346 patients (92%) facial nerve function was normal (House-Brackmann grade I) in the immediate postoperative period, whereas 23 patients (6%) showed temporary facial nerve paresis (House-Brackmann grade II or III) and eight patients (2%) developed permanent facial nerve paresis (seven patients House-Brackmann grade II, one patient House-Brackmann grade III). Conclusions: Extracapsular dissection of benign parotid tumors is associated with a low rate of postoperative complications, a fact that is confirmed by the available literature. We therefore recommend that use of this technique always be considered as a means of treating benign parotid tumors as conservatively, that is, as uninvasively, as possible. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To assess stenoses of Stensen's duct considering findings provided by sialendoscopy-based direct visualization. A practical classification scheme based on different parameters is presented. Methods: Ultrasonography and sialendoscopy were used to diagnose and analyze symptomatic stenoses of the parotid gland excretory duct in 93 patients. Sialendoscopy was performed with semirigid endoscopes that enabled direct evaluation and classification of those stenoses in terms of tissue quality, luminal narrowing, extend, number, location, and in consideration of possible etiologic diseases or conditions. Results: A total of 111 stenoses were diagnosed in 93 patients. Three types could be distinguished. Stenoses were inflammation-dominated with various narrowing of the lumen (type I) in 16.1% of patients, fibrous and web-associated, predominant incomplete (luminal narrowing <50%, type II) in 18.3%, and fibrous, predominant high-grade (luminal narrowing >50%, type III) in 66.6%. A length of more than 1 cm or diffuse involvement of the duct system was observed in 12.9% of cases. Together 70.1% of all stenoses were found in middle and distal regions of the duct. Multiple stenoses were found in 12.9% of patients, bilateral in 6.5%. Of all patients, 45.2% had diseases possibly implicated in the etiogenesis. Type III stenoses were associated with these comorbidities in up to 100%. Conclusions: Minimally invasive techniques play a central role in the diagnosis and treatment of Stensen's duct stenoses. Sialendoscopy is the diagnostic method of first choice. It enables an exact and direct classification of stenoses and provides additional information for planning effective treatment. Laryngoscope, 2009 [ABSTRACT FROM AUTHOR]