Drainless Day Case Superficial Parotidectomy with ARTISS [Solutions for Sealant]

Aims: Superficial parotidectomy (SP) is a commonly performed procedure which traditionally requires a drain and overnight hospital stay. This series aimed to show the safety and efficacy of drainless day case parotidectomy using ARTISS [Solution for Sealant] fibrin glue. Materials and Methods: Patients with a superficial parotid lump with benign preoperative sampling underwent an SP. We initially used both ARTISS and a drain, which was removed when output was <40 mls. ARTISS without drain was then introduced and once confident patients were sent home the same day. Objectives: We prospectively collected data and divided groups into ARTISS alone and ARTISS with a drain to compare patients’ length of stay and complication rates. Results: 88 patients were included;52 ARTISS alone, 22 as a day case. 42.3% of patients where ARTISS alone was used were discharged within 24 hours, with the remainder between 24 - 48 hours. Comparatively, no ARTISS and drain patients were discharged within 24 hours and 86.1% were discharged between 24 - 48 hours with the remainder over 48 hours. There were 3 postoperative haematomas and none in the drainless group;a statistically significant difference (p = 0.034). Of the 6 recorded salivary leaks, 4 were in the drain group and 2 in the ARTISS alone group (p > 0.05). Conclusions: Comparable complication rates and reduced length of stay suggest that ARTISS in SP is safe and effective. These findings stand to benefit both patients and the NHS by improving the patient journey and reducing overall costs.

Advanced Stage Stuck Gland Adenocarcinoma:Case Report

Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in September 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.

The distribution of parotid gland neoplasms in a veteran population

Objective:Salivary gland tumors account for 6%-8%of head and neck neoplasms with the parotid gland as the most common primary site.Pleomorphic adenomas(PA)are considered the most common benign parotid gland neoplasms,followed by Warthin tumors(WT).The goal of this study was to investigate the distribution of parotid gland neoplasms among a United States veteran population.Design:Retrospective chart review.Setting:Washington DC Veterans Affairs Medical Center.Participants:Veterans who underwent fine needle aspiration(FNA)for a parotid gland mass from 2000 to 2018 were included.Medical records were reviewed for gender,age,tobacco use,surgery date,and pathology results.Main outcome measures:Changes in the distribution of parotid neoplasms and tobacco use over an 18-year period.Results:Of 141 patients with parotid gland masses,86.5%(n=122)were benign,9.9%(n=14)were malignant,and 3.5%(n=5)were indeterminate.Of benign tumors,WT accounted for the majority at 51.6%,followed by PA at 40.2%.When stratified by decade(2000-2009 and 2010-2018),the proportion of WT compared to all other benign and malignant neoplasms increased from 31.6%to 53.6%,whereas the proportion of PA decreased from 36.8%to 33.3%.The rate of tobacco use was unchanged at approximately 32.0%among our cohort from 2000 to 2018.Conclusion:Among our cohort of veteran patients,WT was the most common benign parotid tumor and has increased in incidence over the last two decades despite an unchanged smoking rate.