Salivary Gland Pathology. Группа авторов

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Название Salivary Gland Pathology
Автор произведения Группа авторов
Жанр Медицина
Серия
Издательство Медицина
Год выпуска 0
isbn 9781119730224



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      With a preoperative clinical diagnosis of synchronous, multicentric bilateral Warthin tumors, the patient underwent staged superficial parotidectomies beginning with the larger tumors in the left parotid gland. With a modified Blair incision (Figure 2.85h), the patient underwent left superficial parotidectomy that began with the identification of the parotid capsule (Figure 2.85i). The main trunk of the facial nerve was identified and preserved with superficial elevation of the specimen (Figure 2.85j). The specimen was delivered (Figure 2.85k and l). Two Warthin tumors were later diagnosed in the specimen on permanent sections (Figure 2.85m). The resultant tissue bed and facial nerve dissection is appreciated (Figure 2.85n). At five months following left superficial parotidectomy, the patient was prepared for right superficial parotidectomy (Figure 2.85o–q). His facial nerve was intact bilaterally. He underwent repeat CT scanning (Figure 2.85g) that demonstrated one tumor in the superficial lobe of the right parotid gland (Figure 2.85r–t) that was larger than that noted on the initial CT scan obtained five months earlier. He underwent right superficial parotidectomy with identification and preservation of the facial nerve (Figure 2.85u–x). Final pathology confirmed the presence of one Warthin tumor (Figure 2.85y). The patient's postoperative course was unremarkable and he sustained no morbidity with either surgical procedure.

      TAKE‐HOME POINTS

      1 Warthin tumors should be suspected when patients present with multicentric unilateral and/or bilateral tumors of the parotid glands.

      2 Staging the performance of the bilateral superficial parotidectomies is prudent to avoid the possibility of bilateral facial nerve palsies if bilateral surgery was performed synchronously and postoperative facial nerve weaknesses were noted bilaterally.

      3 Repeat CT scanning in staged parotid surgeries permits the assessment of interval growth of masses prior to the second parotid surgery. The increased growth of the mass in this case increased the pretest probability of a neoplastic process, and specifically a Warthin tumor.

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