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Purpose: Sublingual gland tumors are rare. We sought to define the general features of sublingual gland tumors for clinical reference. In addition, we evaluated whether it would be safe to speculate that ∼90% sublingual gland tumors will be malignant and that ∼90% of those malignant tumors will be adenoid cystic carcinoma., Materials and Methods: In the present study, we have reported data from a pleomorphic adenoma case of the sublingual gland and a case series of sublingual gland tumors. Global data of sublingual gland tumors were retrieved. The cases pathologically identified as either benign or malignant tumors of the sublingual gland were included. The demographic, pathologic, and treatment features were analyzed., Results: Data from 1 recent case of pleomorphic adenoma of the sublingual gland and a 21-case series of sublingual gland tumors were retrieved. A total of 839 cases of sublingual gland tumors were analyzed in the present study. The most commonly encountered age group was 40 to 59 years (47.6%). Of the 367 patients with gender specified, 178 were men (48.5%) and 189 were women (51.5%). Malignant tumors predominated (n = 722 cases; 86.1% of 839). Most malignant tumors were adenoid cystic carcinoma (n = 376), just greater than one half (52.1%) of all malignant tumors. Surgery was the only reported treatment method for the benign tumors. The most common treatment methods for the 164 explicit malignant tumors were surgery plus radiotherapy for 82 patients (50%), followed by surgery alone for 70 patients (42.7%)., Conclusions: To date and to the best of our knowledge, the present study is the most comprehensive study on the demographic, pathologic, and treatment features of global sublingual gland tumors. These findings have shown that ∼90% of sublingual gland tumors will be malignant. However, the assumption that ∼90% malignant sublingual gland tumors will be adenoid cystic carcinoma is incorrect, which could be a new critical clinical reference., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This study evaluated salivary function after extracapsular dissection (ECD) compared with partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP) of benign parotid gland tumors. The authors hypothesized that ECD would be superior to PSP and CSP in preserving postoperative salivary function., Materials and Methods: Retrospective analyses were performed for 43 consecutive patients who underwent parotidectomies of benign parotid tumors performed by a single experienced surgeon. Clinical data and pre- and postoperative whole salivary flow rates were compared among the operative procedures. Pearson χ 2 and Fisher exact tests were used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. A P value less than .05 was considered significant throughout the study., Results: Tumor sizes did not differ among groups. Operative times, amounts of drainage, and hospital days for ECD were markedly decreased compared with CSP and tended to be decreased compared with PSP. Resection margins were exposed in 0, 12.5, and 6.7% of patients who underwent ECD, PSP, and CSP, respectively. Postoperative complications occurred less often (but not meaningfully) after ECD. Postoperative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14 mL/minute, respectively (P = .05). Stimulated salivary flow rates remained stable for the ECD and PSP groups but decreased in the CSP group., Conclusion: ECD is a safe and time-efficient surgical approach, offering early recovery from parotid tumors and better preservation of salivary function. ECD should be considered a surgical approach for parotid tumors, especially those in the parotid tail region, such as Warthin tumors., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Pleomorphic adenoma (PA) of the submandibular gland is known to have a very low recurrence rate. The aim of this study was to investigate the histopathological and capsular characteristics of submandibular gland PA, looking for any differences between submandibular PA and the reported data for PA of the parotid gland as possible explanation for its low recurrence rate. We reviewed 72 submandibular gland PAs resected at our center between 2000 and 2016. Patient age ranged from 14 to 77 years (mean, 47.2). At least follow (range, 12 to 170 months; mean, 82), none of the 72 patients developed a local recurrence. Histologically, all of the tumors were encased by a complete and intact anatomical capsule (100%). Pseudopodia were detected in 11 (15.3%) and satellite nodules in 3 (4.2%) cases. The histological subtype (according to Seifert et al.) was classic (mixed) in 39 (54.2%), stroma-rich/myxoid in 18/72 (25%) and cellular in 15 (20.8%) cases. A complete rim of healthy pericapsular tissue encasing the tumor and its capsule was observed in only 23/72 (31.9%) cases. In conclusion, submandibular PAs are characterized by consistent presence of an intact anatomical capsule, infrequent occurrence of pseudopodia, a remarkably infrequent occurrence lower frequency of secondary satellite tumor nodules and a comparatively lower proportion of the fragile risky myxoid subtype. Despite the fact that surgery of the submandibular gland can frequently lead to focal capsular exposure, the aforementioned capsular characteristics of submandibular gland PA are probably responsible for the excellent oncologic results., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To determine whether clinicopathologic or surgical features are risk factors for recurrence and facial nerve dysfunction in pleomorphic adenoma (PA) of the parotid gland., Patients and Methods: The records of 198 patients surgically treated for a PA of the parotid gland from 1999 through 2013 were retrospectively reviewed to identify patients who developed a tumor recurrence. The Fisher exact test and Mann-Whitney U test were used to analyze patient characteristics between recurrent and non-recurrent PAs. Logistic regression was used to determine the risks of recurrence and facial nerve dysfunction., Results: Twenty-three patients (11.6%) developed a recurrence. Patients with tumor recurrence were notably younger than patients without recurrence. Of the 14 patients who underwent enucleation, 11 (78.6%) developed residual disease, as did 10 of 165 patients (6%) managed by a superficial parotidectomy (P < .0005). Furthermore, the risk of residual disease was 9.3 to 21.6 times higher in patients who underwent enucleation than in those who underwent a total or superficial parotidectomy. For tumor histology, recurrence was observed in 3 (15.8%) of the 19 cellular types, 18 (11.5%) of 157 classic cases, and 1 (4.8%) of 21 myxoid cases (P = .5). The risk of recurrence with positive resection margins was 49 times higher than with negative margins (P = .001)., Conclusion: Young age, enucleation, and positive margins are risk factors for residual pleomorphic adenoma, and surgical technique and histomorphologic features are associated with increased facial nerve dysfunction., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

There are no established protocols for the optimum surgical margin required for salivary gland malignancies. Factors including histologic diagnosis and TNM stage have been shown to be important in prognosis and survival outcome and mandate special consideration of margin size. Salivary cancers are treated differently at different anatomic sites, and different histologic types show a propensity for major or minor glands. Low-grade malignancies are treated with soft tissue margins of 1 cm or less. The facial nerve is preserved unless infiltrated and encased. Adenoid cystic carcinoma and carcinoma ex pleomorphic adenoma require more complex planning to obtain negative margins., (Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.)

Pleomorphic adenoma is the most common tumor of the major and minor salivary glands. Rarely is it found evolving from an ectopic location of major salivary glandular tissue in the mid cheek. A healthy 56-year-old woman presented to our institution with a 20-year duration of a slowly growing right cheek soft tissue mass that was causing facial asymmetry. No significant functional or neurosensory dysfunction was appreciated. Radiologic examination showed a heterogeneous, hyperintense, well-delineated mass within the region of the right buccal fat pad. Fine-needle aspiration biopsy showed benign salivary gland elements consistent with pleomorphic adenoma. The decision was made to perform intraoral extracapsular dissection for removal. Discussion of the clinical assessment and magnetic resonance imaging evaluation with an emphasis on intraoral extracapsular dissection for definitive surgical therapy of longstanding benign salivary gland tumors is emphasized., (Published by Elsevier Inc.)

Purpose: Postoncologic reconstruction of the palate represents a major surgical challenge with respect to the thin intraoral and intranasal lining. Current reconstructive methods have ranged from obturative closure of the defect to microsurgical free tissue transfer. The final choice of treatment will be influenced by the size and location of the defect and surgeon experience. The goals of palate repair include optimizing palatal function for speech and eating, and avoiding dehiscence or postoperative fistulas. This study assessed the reliability of locoregional flaps for reconstructing maxillary defects., Patients and Methods: The present study described the surgical outcome of locoregional reconstruction of the hard and soft palate of 5 patients who had previously undergone tumor ablative surgery. They ranged in age from 19 to 64 years. None had received postoperative radiotherapy. The resultant surgical defects ranged in size from 2.5 to 12 cm(2). One patient experienced velopharyngeal insufficiency., Results: In all cases, the palate was closed at the first attempt without complications. All flaps survived, and complete closure was obtained in these 4 patients. The patient with the velopharyngeal insufficiency experienced a significant improvement in articulation and swallowing function., Conclusions: The results of these 5 cases indicate that secondary locoregional flaps are a suitable alternative for palatal defect management. They have a high success rate and functional outcome. These secondary techniques can be reliably used to reconstruct small- to moderate-size palatal defects and represent a reliable reconstructive option with minimal morbidity., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Pleomorphic adenoma (PA) is one of the most common benign tumors of the parotid gland. PA usually grows slowly and is painless. Surgery is necessary for treating PA. Facial palsy, salivary fistula, and Frey syndrome have been reported as complications of tumor resection. PA can transform into a carcinoma ex pleomorphic adenoma (CXPA) over time and as it enlarges. This report describes a case of a large CXPA that transformed from a PA that had developed over 17 years and caused withdrawal from social contact because fear of surgery made the patient refuse treatment. The tumor gradually enlarged without any pain for a decade, but rapid growth and bleeding began a year before admission. Postoperative facial function and local control of the tumor were excellent, but the patient required adjuvant chemotherapy for lung and mediastinum lymph node metastasis leading to dyspnea from tracheal stenosis. This case indicates the importance of adequate explanation and advice when choosing therapy for PA, especially given the risk of a PA transforming to a CXPA., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The utility of fine needle aspiration (FNA) for parotid tumors is limited owing to its low diagnostic accuracy. In this study, the authors sought to analyze and interpret FNA results for parotid tumors from a clinical perspective., Materials and Methods: Parotid tumors subjected to preoperative FNA and subsequent complete excision were the subject of this study. Patient demographics, medical records, FNA findings, and final pathology of 158 consecutive cases were analyzed., Results: The accuracy of FNA was 77.8%. The positive predictive value and likelihood ratio for malignancy were 90.0% and 52.8% (95% confidence interval, 7.02-397), respectively. The positive predictive value and likelihood ratio for benign pathology of Warthin tumor plus pleomorphic adenoma were 97.8% and 7.67% (2.03-29.0), respectively., Conclusions: The FNA diagnosis of Warthin tumor or pleomorphic adenoma is reliable and can be safely regarded as a benign tumor. Based on the high positive predictive value and likelihood ratio, FNA of the parotid gland can offer valuable information in surgical planning and patient counseling in many centers., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to retrospectively analyze all cases of benign parotid tumors treated at our institution from 2002 to 2009., Materials and Methods: We carried out a retrospective review of 232 patients with benign primary parotid tumors. Extracapsular dissection or superficial parotidectomy was performed. Clinical and histopathologic data were analyzed, and management was described. The statistical difference between the 2 techniques as concerns evaluated recurrence rate and complications was measured with the log-rank (Cox-Mantel) test. The chosen level of statistical significance was P < .05., Results: A total of 232 patients were enrolled, 107 women and 125 men, whose mean age was 53.2 ± 11.3 years. Extracapsular dissection was performed in 176 cases (76%) (mean age, 52.82 ± 11.55 years), and superficial parotidectomy was performed in 56 cases (24%) (mean age, 54.59 ± 10.56 years). The mean lesion size was 1.89 ± 0.52 cm for extracapsular dissection and 3.49 ± 0.43 cm for superficial parotidectomy (P < .001). Mean follow-up was 52.6 ± 4.5 months for the group of patients treated with superficial parotidectomy and 46 ± 5.2 months for the group treated with extracapsular dissection. No significant differences as concerns capsular rupture and recurrence were observed after extracapsular dissection and superficial parotidectomy (3.4% vs 1.8% [P = .1] and 4.5% vs 3.6% [P = .1], respectively). Transient facial nerve injury, facial paralysis, and Frey syndrome were significantly more frequent after superficial parotidectomy than after extracapsular dissection (26.8% vs 3.9% [P = .001], 8.9% vs 0% [P < .001], and 5.3% vs 0% [P < .001], respectively)., Conclusions: Extracapsular dissection showed similar effectiveness and fewer side effects than superficial parotidectomy and could be considered as the treatment of choice for tumors located in the superficial portion of the parotid gland., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed., Patient and Methods: From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant., Results: No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically (P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant (P = .3467)., Conclusion: Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Of all benign salivary gland tumors of the parotid gland, pleomorphic adenoma (mixed tumor) is the most common. It accounts for 60% to 70% of all benign tumors of the parotid gland. This neoplasm arises in patients in the fourth to sixth decade of life, with a female predominance. The surgical excision of this lesion continues to be the subject of major debate. The goal is to avoid facial disability yet attain complete resection without perforation of the capsule/pseudocapsule. The purpose of our study is to compare 2 surgical techniques performed at the Ear, Nose, and Throat and Maxillofacial Departments, Rambam Medical Center, Haifa, Israel, and determine which is preferable in treating this lesion., Patients and Methods: We reviewed 48 patients who underwent excision of pleomorphic adenoma of the parotid gland between 1996 and 2005 at Rambam Medical Center: 18 were treated surgically with the classical superficial parotidectomy (SP) technique, using an anterograde approach, and 30 were treated with retrograde partial superficial parotidectomy (PSP). We compared the 2 surgical techniques in terms of surgical time, histopathologic size of the lesion, amount of excised healthy parotid tissue, histologic margin, and the preservation of the capsule/pseudocapsule. We also made clinical records of temporary or definitive injury to the facial nerve, which branches of the facial nerve were temporarily or definitively injured, the occurrence of Frey syndrome, esthetic satisfaction, and the amount of recurrence or infection after surgery., Results: Of the 48 patients, 19 (39.6%) were male and 29 (60.4%) were female, with a mean age (+/- SD) of 43.8 +/- 16.97 years (median, 50 years; range, 12-79 years). We found a significant difference (P = .029) in mean surgical time (+/- SD): 171 +/- 49.7 minutes (median, 165 minutes) when performing the classical SP and 145 +/- 42.7 minutes (median, 130 minutes) when performing the retrograde PSP. Much more healthy parotid tissue was taken out with the classical procedure (mean, 51.4 +/- 13.6 mm; median, 50 mm) than with the retrograde PSP technique (mean, 39.2 +/- 11.8; median, 35 mm) (P = .01). There was a significant difference (P = .0003) in facial nerve injuries: 39% of patients did not report any facial deficit in the SP group compared with 90% in the PSP group. In the SP group, only 3 patients reported a permanent deficit, and in the PSP group, only 3 patients had a temporary deficit (compared with 8 in the SP group). The main injuries occurred in the mandibular branch with both techniques: 6 SP and 2 PSP. There was no difference in esthetic satisfaction: 72.2% of patients in the SP group and 80% in the PSP group had no esthetic complaints. In the SP group, patients mainly complained about swelling (3 patients), and in the retrograde PSP group, the main complaint was depression (4 patients). Frey syndrome was found in 9 patients in the retrograde PSP group and 4 in the classical SP group (with an overall rate of 27.7%). The lesion recurred in only 2 patients--1 in each group., Conclusion: With both of the techniques, we found satisfactory results. In the majority of cases, retrograde PSP is a superior technique to the classical SP, although Frey syndrome is more often observed with the former., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This study evaluated parapharyngeal-space (PPS) tumors in regard to clinical pathological features, preoperative assessment, surgical approaches, perioperative complications, and patterns of recurrence., Patients and Methods: We performed a retrospective review of patients with PPS tumors referred to the stomatological hospitals of Sichuan University and Xi'an Jiaotong University between 1990 and 2004., Results: Beginning in 1990 and ending in 2004, 162 patients with PPS tumors were evaluated in our unit. The gender distribution was 94 (58.08%) males and 68 (41.98%) females. The median age was 36.4 years. The main presenting symptom was neck swelling. All cases were evaluated with at least a computed tomography scan. The most common class of lesion was salivary-gland neoplasm, accounting for 74 cases (45.68%). The next most common group of tumors was neurogenic, representing 68 cases (41.98%). Only 22 patients (13.58%) presented with malignant disease. Three surgical approaches were commonly used in the management of these lesions: transcervical-transparotid in 93 patients (57.41%), transcervical in 51 patients (31.48%), and transcervical-transmandibular in 18 patients (11.11%). Twenty patients with malignant disease underwent adjuvant chemotherapy and/or radiotherapy. All cases were followed for a mean of 36 months. There was no perioperative mortality. Two patients suffered local failure, and 4 patients developed distant metastasis during the observation period., Conclusions: Surgery is the mainstay treatment for PPS tumors. Surgical approaches were dictated by size of the tumor, its location, its relationship to the great vessels, and suspicion of malignancy. The most common approach was transcervical-transparotid for benign tumors.

Neck manifestations from salivary gland tissue are most commonly related to inflammation and obstruction of the glands. However, various benign and malignant processes are also seen along a continuum of clinical presentation and behavior. Preoperative diagnostics, including imaging and fine needle aspiration, are key elements in treatment planning, even in the absence of absolute histologic confirmation of tumors. Benign tumor implants in the neck can be managed with conservative surgery, whereas aggressive surgical management, including neck dissection and adjuvant therapy, is generally advocated for malignancy.

Purpose: To assess the additional value of magnetic resonance imaging (MRI) and ultrasound (US) to physical examination (PE) and fine needle aspiration cytology (FNAC) in the preoperative determination of the location and histology of parotid gland tumors., Patients and Methods: Prospectively, 99 patients with 77 benign and 22 malignant lesions were included; 82 underwent parotidectomy. FNAC was performed in 88 patients. On PE, the location of the tumor was predicted. Eighty-nine patients had MRI and 47 US. Various characteristics and the presumed diagnosis were assessed. Furthermore, the location of the tumor in relation to the facial nerve was predicted. The results were compared with the definite histology and the location during surgery., Results: Of the MRI characteristics, incomplete demarcation from normal parotid gland tissue showed the highest positive predictive value (PPV) for malignancy of 0.48. Of the US characteristics, enlarged lymph nodes yielded the highest PPV for malignancy of 0.5. Cytology correctly predicted the benign or malignant nature of the tumor in all cases. Superficial location was well predicted on PE with a PPV of 0.8, slightly better on MRI (PPV of 0.87), and worse on US (PPV of 0.7)., Conclusion: FNAC is the only accurate investigation for classifying a parotid gland tumor as benign or malignant. Palpation and MRI are superior to US in predicting tumor location. Because the results for palpation and MRI are almost equal, MRI should only be reserved for specific cases, and not routinely requested.

Purpose: To describe an endoscopic technique for submandibular sialoadenectomy in humans, as well as the equipment, instrumentation, and pertinent anatomy., Materials and Methods: Six submandibular sialoadenectomies were carried out in 5 patients (3 women, 2 men; mean age, 26.6 years; range, 16 to 42 years) via a 15 to 20 mm neck incision for insertion of the endoscopic camera and surgical instruments., Results: All operations were successful without conversion to an open surgery. Operative time was 20 to 120 minutes (mean, 65 minutes). All patients were discharged the day after surgery. There were no postoperative complications (hematoma, nerve injury, infection). All patients experienced a mild degree of edema, which had resolved totally at the 6-month follow-up visit. All patients were satisfied with the outcome and especially the cosmetic result., Conclusions: Absence of extensive scars, nontraumatic dissection, and magnification of anatomic structures are the most obvious advantages of this innovative technique.

Purpose: Current opinion that extracapsular dissection is in fact a euphemism for enucleation prompted us to retrospectively identify all patients in whom the extracapsular dissection technique was used and to critically assess the value of this technique., Patients and Methods: The study includes all patients who underwent extracapsular dissection of parotid pleomorphic adenoma from 1979 to 2002 in our department (Department of Surgical Oncology, Medical University of Lodz, Poland). Ninety-eight cases were evaluated. Mean tumor diameter was 3.6 cm (range, 1.5 to 10 cm; median, 3 cm)., Results: In 8 cases (8/98; 8.2%) local recurrence was observed. For the entire group, the probability of living 10 years without the recurrence of the disease was 0.58. The lowest probability of local recurrence was found in patients with tumors larger than 4 to 6 cm in diameter. In these cases, the extensiveness of resection was similar to superficial parotidectomy, which could explain the result. In 13 cases (13/98; 13.3%) capsular exposure was found and consequently microscopic disease was present at the excision margins. In 7 cases (7/98; 7.1%) capsular rupture took place during surgery. The persistent paresis of facial nerve was observed in 8 cases (8/98; 8.2%)., Conclusion: Extracapsular dissection of pleomorphic adenoma is a very demanding technique. Inevitable eventual clinical errors (eg, incomplete resection) lead to unacceptably high incidences of recurrences and complications. We do not advise this technique for the treatment of pleomorphic adenoma.

Primary sebaceous carcinoma of salivary glands is a rare entity with approximately 22 de novo documented cases. Similar tumor arising in a benign mixed tumor has only been reported once. We report a second case of sebaceous carcinoma in a pleomorphic adenoma and discuss the clinicopathologic features, histogenesis, and the differential diagnosis of this unusual tumor.

Malignant transformation of pleomorphic adenomas often occurs in long-standing tumors or tumors with multiple local recurrences. The malignant component is usually a carcinoma. The case reported herein concerns a 60-year-old man who had a malignant rhabdoid tumor arising in a painless parotid mass that remained untreated for 25 years. Malignant rhabdoid tumors are clinically aggressive neoplasms with phenotypic features that resemble rhabdomyomatous differentiation but lack genuine skeletal muscle differentiation. The salient features of rhabdoid tumor cell include large, pleomorphic, and eccentric nucleus and a solitary and prominent intracytoplasmic inclusion that is strongly immunoreactive for vimentin. It is our understanding that this is the first reported case of malignant rhabdoid tumor arising in the parotid gland in the English literature. The pathologic features of our case will be discussed in context with malignant rhabdoid tumors from other parts of the body.

Purpose: This retrospective study evaluated data pertaining to history, symptoms, diagnosis, and mode of therapy of patients treated for pleomorphic adenoma of the parotid gland., Patients and Methods: The records of 475 patients were reviewed. Follow-up was done by questionnaires sent to the referring doctor., Results: The total rate of recurrence was 0.9% after 475 operations for pleomorphic adenoma of the parotid gland. One recurrence (0.7%) was reported for the group with superficial parotidectomy and none for the group with total parotidectomy. The rate of postoperative side effects was also low. The facial nerve was affected in 1.4% after superficial parotidectomy, and in 3.3% after total parotidectomy., Conclusion: The results of this follow-up study show that superficial parotidectomy for pleomorphic adenoma located in the superficial lobe of the parotid gland provides adequate therapy and generally avoids recurrence and side effects.

Purpose: This article reports the results of treatment of 7 histologic types of minor salivary gland carcinoma., Patients and Methods: Of 256 cases, local excision was used in 194, extended excision in 62, excision accompanied by neck dissection in 98, and surgery with adjunctive radiation therapy or chemotherapy in 101. Forty-five of the 98 neck dissection cases had cervical node metastases., Results: Survival rates were analyzed for 233 patients. The 3-year survival rate was (167 of 215) (77.67%), the 5-year survival rate was 134 of 187 (71.76%), and the 10-year survival rate was 79 of 113 (69.91%)., Conclusions: These data confirm that surgery is still the mode of choice in the treatment of minor salivary gland carcinoma, but a combination with radiation therapy or chemotherapy is advisable in some patients.

Purpose: This retrospective study evaluated data pertaining to history, symptoms, diagnosis, and mode of therapy of patients treated for benign tumors of the submandibular gland., Patients and Methods: The records of 38 patients were reviewed. The patients were divided into three groups: pleomorphic adenoma (first operation), pleomorphic adenoma (second operation for recurrence), and other tumors. Follow-up was done by questionnaires sent to the patient and referring doctor., Results: The vast majority of patients treated (92%) had had either a first or second operation for pleomorphic adenoma. Follow-up revealed that recurrence did not develop in the group of patients with primary surgery. However, one patient undergoing surgery for recurrent pleomorphic adenoma developed two recurrences. Two patients suffered from slight weakness of the lower lip., Conclusion: Tumor recurrence was found only in the cases of second operation after previous surgery for pleomorphic adenoma. Therefore, the first operation should extirpate the entire gland to minimize the risk of recurrence.

Purpose: A review of 121 parotid gland tumors over a 10-year period was carried out., Methods: The clinical records were retrieved to analyze treatment modalities, history, pathology reports, and sex and age distribution., Results: Pleomorphic adenoma was the most common benign tumor (88.2%), with adenoid cystic carcinoma being the most common malignant tumor (7.4%). Pleomorphic adenoma was more common in women than in men. Clinical signs and symptoms were of no value in distinguishing between malignant and benign tumors. Malignant tumors tended to be more common in the elderly. Subtotal or total parotidectomy was used as the method of treatment.

Purpose: To clinically test a new type of parotid surgery termed functional superficial parotidectomy (FSP) to preserve the function of the residual gland., Patients and Methods: Sixteen human parotid specimens were dissected, and 19 patients underwent FSP., Results: It was shown that 91.4% of the main parotid ducts were found deep to the surface of the facial nerve. Physical examination, sialography, and scintigraphy showed that function of the residual gland was well preserved by FSP., Conclusion: A comparison of the main complications between FSP and conservative superficial parotidectomy showed a significant decrease (P < .01) of Frey's syndrome with FSP.

A study of 22 consecutive patients with palatal salivary gland tumors treated in a structured fashion with primary surgery followed by postoperative radiation therapy, where indicated, and followed for a mean of 7.6 years, showed excellent results clinically, esthetically, and functionally, with no recurrence or metastatic deposits to date. Depending on the type of tumor, the surgery consisted of local enucleation, wide local excision with localized flap closure, or inferior maxillectomy with reconstruction by means of an obturator.

In 1984, Attia et al described the double mandibular osteotomy as a more direct approach for tumors of the ptergomaxillary and parapharyngeal space. The procedure incorporates the traditional parasymphyseal osteotomy of the mandible with a horizontal osteotomy of the ascending ramus. Several modifications of this technique are described that increase the surgical exposure, while requiring less surgical dissection. The incorporation of rigid fixation with miniplates has improved postoperative recovery by avoiding maxillomandibular fixation and improving oral nutrition.

A modified centripetal approach to parotidectomy is reported. A total of 422 benign parotid tumors, 383 of which were primary and 39 of which were recurrent, were treated by this technique. The pleomorphic adenoma was the most common type (94.79%) in the series. Superficial parotidectomy was done in 178 cases, and total parotidectomy, in 244 cases. No permanent facial paralysis occurred after parotidectomy in the primary tumor group. Seven recurrences were observed after surgery in the recurrent tumor group.

One hundred benign and ten malignant pleomorphic adenomas of the parotid gland were analyzed. Follow up ranged from two to 20 years. Of 54 cases of benign pleomorphic adenoma of the parotid gland, recurrence was noted in five cases (9.2%). The five-year recurrence rate was 17.2%. Of the six malignant pleomorphic adenoma, recurrence within the first ten years took place in four patients (66.6%).