Management of midcheek masses and tumors of the accessory parotid gland

doi:10.1016/j.tripleo.2011.01.005

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 111, Issue 5, May 2011, Pages e5-e11

https://doi.org/10.1016/j.tripleo.2011.01.005 Get rights and content

Tumors of the lateral wall of the mouth have different origins and behaviors. These lesions often arise from salivary tissues, such as the accessory parotid gland, but tumors can also originate from the muscles, buccal fat pad, or other structures. Surgical approaches are limited in this region by the presence of the facial nerve and the Stensen's duct. In this article, we present 9 cases of midcheek masses that were operated on via extra- or intraoral approaches. We discuss the problems related to the diagnosis of such tumors, as well as the indications and rationales for different treatment approaches.

Section snippets

Patients and Methods

In a 3-year period, 9 patients (5 men, 4 women; aged 42-71 years) were referred to the Maxillofacial Surgery Department for surgical treatment of masses arising in the wall of the mouth. All patients presented with an asymptomatic enlarging cheek mass; none complained of pain, tenderness, or difficulty chewing. A careful neck examination disclosed no enlarged node in any patient. Sensation and facial nerve function were intact, and clear saliva flowed from the parotid duct in all cases. There

Discussion and Conclusions

A cheek mass is usually first diagnosed on physical examination. An APG tumor or Stensen's duct tumor is often suspected when the mass is localized along the Stensen's duct, even if the salivary origin can be confirmed only by pathologic examination.

A careful examination is required when evaluating midcheek lesions. Rare tumors of the accessory parotid lobe can easily mimic more common diagnoses, and failure to consider a salivary origin may result in a disastrous outcome if a direct approach

References (10)

J. Frommer
The human accessory parotid gland: its incidence, nature, and significance
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1977)
F.E. Johnson et al.
Tumors arising in accessory parotid tissue
Am J Surg
(1979)
S.L. Perzik et al.
Surgical management of preauricular tumors of the accessory parotid apparatus
Am J Surg
(1966)
A. Lewkowicz et al.
Accessory parotid gland masses
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2000)
H. Toh et al.
Incidence and histology of human accessory parotid glands
Anat Rec
(1993)

There are more references available in the full text version of this article.

Cited by (26)

Spontaneous percutaneous extrusion of an accessory parotid gland lithiasis
2021, Brazilian Journal of Otorhinolaryngology
The main objective of this report is to reveal the chronic obstructive pathology in the accessory parotid gland. The common misunderstanding about its location and pathology may lead to major complications. Chronic obstructive sialadenitis in the accessory parotid gland may involve the main parotid gland and its duct.
We present the first case of sialolithiasis of an accessory parotid gland resulting in a percutaneous extrusion of the stone through a cutaneous fistula. The origin of lithiasis in the accessory parotid gland was confirmed by ultrasound and resonance with sialography protocol. Complete closure of the fistula and the resolution of the episodes of sialadenitis were achieved after cleaning and debridement of the abscess.
The accessory parotid gland may suffer chronic obstructive sialadenitis related to sialolithiasis. Knowledge of the presence of the accessory parotid gland should be shared in order to perform an early diagnosis, treatment and to avoid associated complications such as facial skin ulceration and lithiasis extrusion.
Effective surgical management of anterior tumors of the parotid gland: Main trunk method vs. peripheral Smethod
2021, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Several surgical procedures have been proposed for tumors in the anterior parotid gland. Although the standard approach to other parotid tumors is generally also used for anterior tumors, handling of the facial nerve has not been addressed in any previous reports.
A total of 654 patients with benign parotid tumors who underwent surgery in our department were classified into anterior (AT), middle (MT), and posterior tumor (PT) groups according to tumor location. Clinical characteristics, histopathological types, and frequency of postoperative transient facial palsy were examined. In the AT group, two surgical methods were compared, which were the main trunk method (MTM) and the peripheral method (PM).
172 patients were included in the AT group, 175 in the MT group, and 307 in the PT group. The AT group showed significant female predominance and a higher percentage of deep lobe tumors than the PT group. There was no significant difference in the rate of postoperative transient facial palsy among the AT (MTM), MT, and PT groups. The PM had a significantly shorter operating time and lower rate of transient facial palsy than the MTM.
The PM for AT was considered a useful surgical method from the standpoints of postoperative complications and operating time. In the PM, a wide operating field made identification of the facial nerve easier.
Outcomes and surgical tips in the management of accessory parotid lobe tumours
2021, Advances in Oral and Maxillofacial Surgery
The tumours of the parotid accessory lobe may present with significant challenges to the clinicians due to their rarity, presenting with diagnostic difficulties as well as difficult decision-making in terms of surgical approach.
We retrospectively analysed 8 cases of accessory parotid lobe tumours treated in our unit. The presenting symptom was a mass in all cases present in the peri-parotid region with duration ranging from 6 weeks to 2 years. All cases were investigated with ultrasound-guided fine needle aspiration cytology (FNAC). Various surgical approaches were adopted that included standard cervico-facial (n = 4), trans-oral (n = 3) and cervical (n = 1) incision approach. The rate of early post-operative facial nerve weakness was 37.5% (n = 3). There were no cases of tumour recurrence.
Any lump not typical of a parotid lump but close to the parotid region should be treated with a high degree of suspicion to exclude an accessory lobe tumour. A full work up with US-guided FNAC is recommended prior to definitive treatment. Although a standard cervico-facial incision approach is recommended in most cases, other direct approaches may also be considered depending on the location of the tumour. We present our experience of these tumours providing practical tips on diagnosis and surgical management.
Buccal Space Tumors
2021, Surgery of the Salivary Glands
Adenoid cystic carcinoma of accessory parotid gland: A case report and review of the literature
2020, Oral and Maxillofacial Surgery Cases
Citation Excerpt :
Differential diagnoses of this area includes parotid gland cyst, accessory parotid gland tumors (APGTs) Arteriovenous malformation, neural tumors, adenopathy, and metastasis. APGTs should be suspected in any patient presenting with a midcheek mass [8], that most often present as indolent, progressively enlarging cheek mass [9]. Despite APG is a relatively common anatomical variant, whit a frequency in autopsy studies, from 21% to 56% [3,4]; APGTs are rare, accounting for only 1%–7.7% of all parotid gland tumors.
Accessory parotid gland (APG) is a small salivary gland tissue ranging from 0.5 to 1 cm diameter in size, located almost 7 mm anterior to the main parotid gland. APG is a common anatomical variant, but accessory parotid gland tumors are very rare, accounting for only 1%–7.7% of all parotid gland tumors. We present a case of adenoid cystic carcinoma involving accessory parotid gland, a very rare condition with only, to the best of our knowledge, other 7 cases described in literature. Surgical excision was performed and eventful postoperative recovery, without severe surgical complications and no signs of recurrence at 12 months of follow-up was obtained, with a good cosmetic result. An extensive review of the literature has been performed and the results are presented in order to establish a correct diagnostic-therapeutic protocol for these oncologic patients.
Review of publications on the possible advantages of a direct cheek incision for accessory parotid gland masses
2020, British Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
As the surgery is less traumatic, and postoperative recovery is shorter, the cheek incision can be used during a minimal hospital stay, reducing operating time, time spent in hospital, and costs. Additionally, when the incision is made in skin creases, aesthetic complaints are minimised, especially in older patients.15,18,26 The largest drawback of the direct cheek incision is its visibility.
Lesions of the accessory parotid gland (APG) are rare and surgical management is generally under-discussed. The surgical approach should provide complete resection, while minimising complications and aesthetic complaints. The current study reviews recent publications on the surgical management of APG masses, and discusses the advantages, and limitations of, and our experience with, direct cheek incision. Papers on the surgical management of APG masses published in the last 10 years were systematically searched. Information was obtained regarding the surgical approach, type of excision, and postoperative complications. In the included studies, 253 APG masses were selected for analysis, whereof six were treated with the direct cheek incision. Although no local recurrence or postoperative complications were observed after this, the approach was usually not recommended due to a higher reported risk of recurrence and complications in older papers. More recent studies, however, indicate that the direct cheek incision should be considered as a valuable alternative to standard approaches in selected patients.

View all citing articles on Scopus

View full text

Oral and maxillofacial surgeryOnline only articleManagement of midcheek masses and tumors of the accessory parotid gland

Section snippets

Patients and Methods

Discussion and Conclusions

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Am J Surg

Am J Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Incidence and histology of human accessory parotid glands

Anat Rec

Oral and maxillofacial surgery
Online only article
Management of midcheek masses and tumors of the accessory parotid gland