Superficial Parotidectomy

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Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

Superficial parotidectomy remains the most efficient technique yet available allowing surgeons through complete facial nerve dissection with better chances of preserving its function. 34 It is quite intuitive to relate the increase of tumor dimensions to higher incidence of complications. In our study, we have demonstrated that tumors with 4.0 cm or more in length and 2.0 cm or more in depth have a significantly higher risk of developing facial paralysis. This should be taken into account in pre- operative evaluation and much more care should be taken during nerve dissection. It is still inconclusive whether the incidence of facial nerve dysfunction is higher after malignant tumor resection due to more aggressive surgical approach, or after benign lesions of longer duration of disease associated with tumor adherence and adjacent inflammatory process. 31,35 In our study, we did not find any statistically significant correlation with higher risk of facial nerve injury.
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Functioning of Deep Lobe of the Parotid Gland after  Superficial Parotidectomy

Functioning of Deep Lobe of the Parotid Gland after Superficial Parotidectomy

has fourth order ductules and the buccal branches are superficial to the main duct. Nerve branches of the temporo-facial ramus (temporal, zygomatic and upper buccal) occupy a superficial position in the primordium whereas branches of the cervicofacial ramus (lower buccal, marginal mandibular and cervical) are deeper. A similar arrangement is evident at 56-80 mm (11.5- 13.5w) when the complex primordium has connections with its superficial and deep portions between many nerve branches. Tumors that occur in the human parotid gland often require removal by partial or total parotidectomy. Such an operation is hazardous because of the intimate relationship the gland has with the facial nerve that supplies the muscles of expression. In order to define this relationship, many authors have reported studies on dissected adult and infant specimens. (e.g., Gregoire, 18 ; McWhorter, 19 ; Mc-Cormack Cauldwell and Anson, 20 ; Mc-Kenzie, 21 ; Davis et al., 26 ; Patey and Ranger, 27 ; Youssef, Talaat and El-Malt 28) . However, these studies summarize the
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Anomalies of the branchial arch apparatus in children: case series and review of literature

Anomalies of the branchial arch apparatus in children: case series and review of literature

Early diagnosis and treatment are needed to avoid recurrent infection and secondary development of fistulous tracts. 20 Complete surgical excision with wide exposure of the lesion is the only treatment for FBCA. 16 The course of the tract varies and has variable relationship with the facial nerve-superficial, deep to the nerve or between the branches of the nerve. 19, 20, 21 Thus, facial nerve is always at risk during the surgical removal of FBCA. 25 The risk of facial nerve palsy is higher in patients having recurrent infections and inadequate treatment (incision, drainage or incomplete excision). 26 Hence, it is advisable to perform a superficial parotidectomy in cases of FBCA while identifying the tract in relation to the facial nerve. 17
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A Case of Pleomorphic Adenoma of the Parotid Gland with Multiple Local Recurrences through Facial to Cervical Regions

A Case of Pleomorphic Adenoma of the Parotid Gland with Multiple Local Recurrences through Facial to Cervical Regions

The standard treatment of pleomorphic adenomas in the parotid gland is a surgical procedure. However, adverse outcomes of the surgical procedures are common. As noted in the Introduction, the recurrence rate of pleomorphic adenoma after surgery has been reported to be 1% - 45% [1]. The wide range of the rate depends on the type of surgical procedures. The recurrence rate after tumor enucleation has been reported to be 20% to 45% [1]. The high rate of recurrence is considered to be associated with positive margins consisting of in- complete tumor capsules. Other suggested causes of pleomorphic adenoma recurrence are the perforating pseu- dopodia of the tumor, capsule rupture by the surgical procedure, and the proximity of the tumor to facial nerves [2]. In this case, although tumor was removed along with the surrounding tissue of the membrane in the primary surgical procedure, the size of tumor was not small, therefore capsule rupture might have occurred in this pro- cedure and have led the tumor recurrences. More comprehensive dissection methods, extracapsular dissection or superficial parotidectomy are considered more effective to prevent tumor recurrence compared to enucleation when a pleomorphic adenoma is limited to the superficial lobe of the parotid gland. After extracapsular dissec- tion or superficial parotidectomy, recurrence rates are reduced to less than 5% [1].
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Parotid Lipoma: A Case Report

Parotid Lipoma: A Case Report

gions. The surgical procedure reported in English literature consisted of superficial parotidectomy, partial exci- sion of the inferior part of the parotid gland, extrcapsular dissection, near total parotidectomy in the case with parapharyngeal extension [10]. In 83% of cases, surgery was performed for esthetic and/or functional discomfort caused by increased tumor volume. The average time between the discovery of lipoma and surgical excision is about 1 - 3 years in literature such as in our case. During operation most surgeons recommend superficial paro- tidectomy with dissection of the facial nerve before removal of lesions in the deep lobe [1]. Debnath, S.C., et al. exposed all the branches from the main trunk of the facial nerve by meticulous dissection and superficial paroti- dectomy [1].
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Parotidectomy using the Harmonic scalpel: ten years of experience at a rural academic health center

Parotidectomy using the Harmonic scalpel: ten years of experience at a rural academic health center

For both the superficial and total parotidectomy groups, there was a significant difference in operative time between the use of the HS and SB dissection. For the superficial group, the amount of time saved using the HS equated to 18 min, while this difference in- creased to 48 min in the total parotidectomy group. At our institution the amount of operating room time saved, even in the superficial parotidectomy group, translates into a cost reduction greater than the cost of the HS, resulting in a $1381 (5.6%) and a $4530 (15%) decrease in cost of performing superficial and total par- otidectomy respectively. We expect the percentage of cost reduction to be relatively consistent across institu- tions, whereas the monetary value could be highly variable depending on operating room utilization cost per institution. These data are compelling as health- care costs continue to soar in the United States and cost reduction efforts become increasingly important. In 2014, 17.1% of the gross domestic product was allo- cated for health-care, and the Congressional Budget Office estimates this figure to increase to 25% by 2025 should the rate of increasing expenditures remain constant [17]. Being at the forefront of health-care
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Parotidectomy, complications and management: our experience

Parotidectomy, complications and management: our experience

Meticulous preoperative investigations were done like USG neck, USG guided FNAC and radio-imaging in the form of MRI whenever indicated. USG was done routinely in all the cases followed by USG guided FNAC to identify the pathology. MRI was done in three conditions specifically: first, when pathology was clinically suspected to involve the deep lobe, second when there were cases suspected to have facial nerve involvement and thirdly prior to operative planning in cases of revision surgery. Three types of surgical procedures were defined viz superficial parotidectomy, total conservative parotidectomy and total parotidec- tomy (Figure 2).
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Basal Cell Adenoma of the Parotid Gland: A Case Report and Review of the Literature

Basal Cell Adenoma of the Parotid Gland: A Case Report and Review of the Literature

duced for the BCA: superficial parotidectomy, total parotidectomy, and partial parotidectomy or extra-capsular dissection. Some complications may occur after parotidectomy due to the inju- ry of the seventh Cranial Nerve (CN VII=facial nerve). Other disadvantages include sunken de- fect due to loss of soft tissue volume and Frey’s syndrome (10% after superficial and 30% after total parotidectomy).

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Assessment of functional outcome after parotidectomy reconstruction

Assessment of functional outcome after parotidectomy reconstruction

Background: Total or superficial parotidectomy, when a reconstructive technique is not used, usually leads to Frey’s syndrome, preauricular and retromandibular depression. These together with the scar from a classic or modified Blair incision limit the final aesthetic outcome. The superiorly based sternocleidomastoid muscle (SCM) flap or superficial musculo-aponeurotic system (SMAS) flap can be used for reconstruction of the defect to achieve better facial contour restoration. The aim and objective of the study was to evaluate the functional and cosmetic outcome of patients after reconstruction in parotid surgeries.
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Pleomorphic adenoma of head and neck region: our institutional review

Pleomorphic adenoma of head and neck region: our institutional review

All patients underwent surgical excision under general anesthesia. Patients with pleomorphic adenoma in the parotid gland underwent superficial parotidectomy or total conservative parotidectomy through standard parotidectomy approach. In case of submandibular gland, standard submandibular approach and for parapharyngeal caeses standard transcervical approach was followed. The cases of pleomorphic adenoma on palate, nose and lip were undergone for wide local excision, whereas case of base of tongue underwent radiotherapy due to inoperability.
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Diffusion Weighted Imaging of Hyperacute Cerebral Hypoglycemia

Diffusion Weighted Imaging of Hyperacute Cerebral Hypoglycemia

by a consultant in internal medicine. After an overnight fast, the par- ticipants were placed in the MR imaging scanner. An indwelling can- nula for infusion of regular human insulin and glucose was placed in a superficial vein of the dorsum of 1 hand and a second cannula for collection of blood glucose samples, on the contralateral side. On-site testing of venous blood glucose was performed every 5 minutes to monitor hypoglycemia by using a quality-controlled glucometer (OneTouch; LifeScan, Milpitas, California). Venous blood samples were collected every 5 minutes in containers with fluoride to prevent glucose metabolism. Blood glucose was measured in these samples within 3 hours after collection with a quality-controlled laboratory Table 1: Reported location of hypoglycemic lesions based on DWI imaging of the cerebrum
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Case Report Myxoid dermatofibroma on a great toe : a case report

Case Report Myxoid dermatofibroma on a great toe : a case report

and does not have alternating zones of fibrotic and myxoid stroma. Most importantly, whereas superficial acral fibromyxoma commonly ex- press CD34, this antigen is rarely found in der- matofibroma [2, 8]. Even though there may occasionally be an increase of CD34 expres- sion at the periphery of the lesion, which derives from the intrinsic reactivity of the sur- rounding stromal tissue response, this finding is in sharp contrast to superficial acral fibro- myxoma and dermatofibrosarcoma protuber- ans, which are usually diffusely and strongly positive for CD34. The fibrohistiocytic origin of myxoid dermatofibroma is indicated by several characteristics shared with classic dermatofi- bromas: predilection for the lower legs of young to adult women, preservation of storiform pat- tern in the periphery, immunoreactivity for his- tiocytic marker CD68 and a benign clinical course with no recurrence. CD68-positive/ CD34-negative immunophenotype, together with the presence of histopathologic features of classic dermatofibroma, is useful in the dif- ferential diagnosis.
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Neuroimaging in Superficial Siderosis: An In Depth Look

Neuroimaging in Superficial Siderosis: An In Depth Look

E1, Dynamic CT myelogram shows leakage of contrast (arrow); the dotted arrow points to the intrathecal contrast. E2, Dynamic CT myelogram shows calcified disk protrusion immediately caudal to the dural defect shown in E; the dotted arrow points to intrathecal contrast. This patient (E1 and E2) had diffuse pachymeningeal enhancement, a cervicothoracic epidural fluid collection, and CSF RBCs and xanthochromia, all of which resolved after repair of a dural defect identified at T7– 8. F1, Reformatted sagittal cuts from a dynamic CT myelogram obtained in a patient with low-pressure headache without SS show a high-flow CSF leak (arrow) through a ventral midline defect located on the right side of a bilobed spiculated midline osteophyte at T2–3. F2, The osteophyte is shown on an axial thoracic spine CT. This patient also had a ventral epidural fluid-filled collection into which the contrast leaked through the dural defect (dotted arrow). C reprinted with permission from Kumar N. Superficial siderosis: associations and therapeutic implications. Arch Neurol 2007;64:491–96 (Copyright 2007, American Medical Association) and Kumar N, Lindell EP, Wilden JA, et al. Role of dynamic CT myelography in identifying the etiology of superficial siderosis. Neurology 2005;65:486 – 88 (Copyright 2005, Wolters Kluwer Health). E1 and E2 reprinted with permission from Kumar N, Lane JI, Piepgras DG. Superficial siderosis: sealing the defect. Neurology 2009;72:671–73 (Copyright 2009, Wolters Kluwer Health).
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The hydrodynamic behavior of an inverse liquid-solid circulating fluidized bed

The hydrodynamic behavior of an inverse liquid-solid circulating fluidized bed

When the total liquid velocity in the downer reaches the minimum fluidization velocity, particles move away from each other and the bed of the particles from the fix bed expands slowly in a downward direction. With a further increase of the superficial liquid velocity over the terminal velocity, particles begin to move out of the bed. Under this condition, particles are carried by the downward liquid flow and then at the bottom of the downer are separated from the liquid in a cylindrical liquid–solid separator. Liquid is returned to the liquid tank through the pipe which was designed as a Π - shape. The maximum height of this pipe is at the highest level of the reactor to ensure that the entire system is filled with water during the experiments. On the other hand, particles move from the separator to the upcomer through the pipe which connects the separator and upcomer. Particles move up in the upcomer because of their buoyancy and are stored at
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Acute compartment syndrome of the lower leg causing cardiac arrest after resection of the right external iliac vein for autologous graft: a case report

Acute compartment syndrome of the lower leg causing cardiac arrest after resection of the right external iliac vein for autologous graft: a case report

To our knowledge, this is the first report of a fatal compli- cation after REIV resection for autologous grafts. Terasaki et al. reported that an interposition graft using the REIV for portal vein reconstruction following pancreatoduode- nectomy was safe and effective [6]. However, in another study, moderate to severe outflow obstruction in the lower limbs was observed on air plethysmography in all patients after harvesting of the REIV, and such outflow obstruction in the lower limbs persisted for a long time causing symp- toms such as pain upon long-duration standing [5]. After resection of the REIV, venous blood from the lower limb returns to the systemic circulation mainly through the in- ferior epigastric vein and great saphenous vein. Therefore, harvesting of the REIV does not usually cause the acute phase of complications, while harvesting of the deep thigh veins such as the superficial femoral vein and superficial femoropopliteal vein, which are distal to the junction of the inferior epigastric vein and the REIV, sometimes cause acute extremity compartment syndrome [7]. Initially, we were scheduled to harvest the left internal jugular vein. However, we were concerned that brain congestion might occur after internal jugular vein resection, because cardio- pulmonary resuscitation was needed during the first
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Superficial Mycoses in Relation to Age and Gender

Superficial Mycoses in Relation to Age and Gender

The populations of female and male pupils in the study by Enemuor et al. were 969 and 1215, respectively. The respective prevalence rates of superficial mycoses were 1.5% and 10.6%. Comparison of the prevalence rates of females and males pupils showed a significantly higher (P = 0.0005) prevalence rate in male pupils [28]. A lower prevalent rates of T. capitis was found in girls than boys in this study . Other reports by Mirmirani et al. [27], Enemuor et al. [28] and Adefemi et al. [29] showed greater affectation of boys by dermatophyte infections, and most especially, tinea capitis. However, Anosike et al. [30] found that girls were affected more though this was not significant. The higher prevalence in male in this environment may be as a result of increased contact between boys during play, sharing of combs and cutting of hair at local barber shops, and possibly more contact with pets during play.
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Case Report Porokeratosis with follicular involvement: report of three cases and review of literatures

Case Report Porokeratosis with follicular involvement: report of three cases and review of literatures

Porokeratosis can be classified into six classi- cal subtypes: porokeratosis of Mibelli (PM), dis- seminated superficial actinic porokeratosis (DSAP), superficial disseminated porokeratosis (SDP), porokeratosis punctata palmaris et plan- taris, linear porokeratosis (LP), and localized porokeratosis. [1] Follicular involvement of porokeratosis is rare. To date, there have been 12 well-documented cases in the literatures. Five cases of them involve in the trunk and extremities [3-6]. Five cases are in the face [4, 7-10], and the other two cases are in the gluteal area [11, 12]. According to the descriptions of lesions, 12 cases can be classified as the fol- lowing: 5 cases are diagnosed PM [3, 4, 8, 9, 11], 3 are DSAP [3, 5, 7], 2 are SDP [4, 12], 1 is LP [6] and 1 is localized porokeratosis [10]. Figure 3. A. multiple disseminated small elevated black-brown keratotic eruptions on the face. B. On the histopatho- logical examination of case 3, three cornoid lamella, all of them involved in the hair follicles (HE, original magnifica- tion ×200). C. A close view of the cornoid lamella involvement in the hair follicles (HE, original magnification ×400).
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Study of Branching Pattern and Surgical Anatomy of Femoral Artery.

Study of Branching Pattern and Surgical Anatomy of Femoral Artery.

Clinical significance: The clinical significance of the relationship between the superficial external pudendal artery and the great saphenous vein is that it is important in ensuring that the saphenofemoral junction is managed safely and adequately in patients with varicose veins. Failure to appreciate these variations may account for a significant proportion of inadequate primary varicose vein surgery. So knowing and taking the variations into account are essential to prevent recurrences after surgical treatment of varies of pelvic limbs.

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Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

A study by Bruggeman et al. [39] examined 164 patients with Achilles tendon repair. More than 10% of the patients experienced wound healing problems [39]. Among others, smoking and female gender were identified as risk factors, whereas BMI and age did not play a considerable role [39]. In the current study, we confirmed the negative influence of smoking. Women also exhibited reduced perfusion compared to men. We found both negative and positive correlations between BMI and superficial dermal perfu- sion. Thus, the results are consistent with those of Bruggeman et al. [39].

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The topography of the superficial veins of the hind leg in the baboon Papio anubis in comparison with the superficial veins of the lower limb in humans

The topography of the superficial veins of the hind leg in the baboon Papio anubis in comparison with the superficial veins of the lower limb in humans

anubis. The vessels of the hind leg were filled with coloured latex. Afterwards we prepared the deep and the superficial veins and their accompanying arte- ries in the traditional manner using microsurgical tools. We exposed the course of the long and short saphenous veins and also the saphenofemoral and the saphenopopliteal junctions. We then photo- graphed the specimens.

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