Clinical treatment and prognosis of 52 cases of neurinoma in parotid region

doi:10.19439/j.sjos.2018.04.015

Abstract

Abstract: PURPOSE: To investigate the clinical features, diagnosis, and treatment, as well as prognosis of neurinoma in parotid region, in order to provide references for clinical treatment. METHODS: Fifty-two cases of neurinoma in parotid region treated between June 2000 to December 2013 were retrospectively investigated, including their clinical characteristics, imaging examination, diagnosis, therapies and prognosis. SPSS13.0 software package was used for Fisher's exact test. RESULTS: Nine cases (17.31%) in all had facial paralysis, discomfort and other neural symptoms before operation. Eleven cases(21.15%) was preoperatively diagnosed. All patients were treated with surgery, pathologically diagnosed and followed up for 42 months to 206 months. No recurrence and malignant transformation were found. Twenty-eight cases (53.85%) had symptoms of facial nerve injury postoperatively, but 18 cases (64.29%) were improved functionally. When there was no obvious correlation between the tumor and facial nerve, no facial nerve paralysis was found. When the tumor was located on the facial nerve, the rate of preserving facial nerve function was 22.22%, the rate of intracapsular enucleation of the neurinoma was 85.71%, and the effective rate of excision followed by facial nerve reconstruction was 85.71%. CONCLUSIONS: The diagnosis of neurinoma in parotid region is difficult and needed to be confirmed by postoperative pathology. The preservation of facial nerve function should be the utmost procedure during operation while intracapsular enucleation is the first choice. However, in order to restore the function of facial nerve, nerve reconstruction should be performed as soon as possible.

Key words: Parotid gland, Neurinoma, Facial nerve injury

CLC Number:

R739.8

GAO Ming-hua, YIN Xue-lai, HU Yong-jie, SHENG Mei-chun, WANG Zhong-hua, ZHENG Chong-yang, ZHANG Xin-yu, WU Hai-wei. Clinical treatment and prognosis of 52 cases of neurinoma in parotid region[J]. Shanghai Journal of Stomatology, 2018, 27(4): 411-414.

References

[1] 邱蔚六, 张震康, 张志愿, 等. 口腔颌面外科学 [M]. 第6版. 北京: 人民卫生出版社, 2008: 2-270.
[2] Rajabi MT, Riazi H, Hosseini SS, et al.Malignant peripheral nerve sheath tumor of lacrimal nerve: a case report[J]. Orbit (Amsterdam, Netherlands), 2015, 34(1): 41-44.
[3] Chong KW, Chung YF, Khoo ML, et al.Management of intraparotid facial nerve schwannomas[J]. Aust N Z J Surg, 2000, 70(10): 732-734.
[4] Ibartz PL.Rare kinds of parotid tumors[J]. An Fac Med (Montevideo),1927,12: 546.
[5] O'Keefe JJ.Neurinoma of the facial nerve in the parotid gland[J]. Ann Otol Rhinol Laryngol, 1949, 58(1): 220-225.
[6] Merker VL, Esparza S, Smith MJ, et al.Clinical features of schwannomatosis: a retrospective analysis of 87 patients[J]. Oncologist, 2012, 17(10): 1317-1322.
[7] Oberman HA, Sullenger G.Neurogenous tumors of the head and neck[J]. Cancer, 1967, 20(11): 1992-2001.
[8] Terasaki K, Mera Y, Uchimiya H, et al.Plexiform schwannoma[J]. Clin Exper Dermatol, 2003, 28(4): 372-374.
[9] Marchioni D, Alicandri Ciufelli M, Presutti L.Intraparotid facial nerve schwannoma: literature review and classification proposal[J]. J Laryngol Otol, 2007, 121(8): 707-712.
[10] 柏宁野, 戴光华, 郑辉. 外周神经源肿瘤的声像图诊断与鉴别诊断分析[J].中国超声医学杂志, 2001, 17(4): 309-311.
[11] 曾炜, 王弘士, 朱世亮, 等.颈部颈丛和臂丛神经鞘瘤的彩色多普勒超声定位诊断[J].中国超声医学杂志, 2000, 16(11): 819-822.
[12] Lee YYP, Wong KT, King AD, et al.Imaging of salivary gland tumors[J]. Eur J Radiol, 2008, 66(3): 419-436.
[13] Martin N, Sterkers O, Mompoint D, et al.Facial nerve neuromas: MR imaging. Report of four cases[J]. Neuroradiology, 1992, 34(1): 62-67.
[14] Suh JS, Abenoza P, Galloway HR, et al.Peripheral (extracranial) nerve tumors: correlation of MR imaging and histologic findings[J]. Radiology, 1992, 183(2): 341-346.
[15] Henrys CE, Grigg R.Use of fine-needle aspiration cytology in the diagnosis of parotid neoplasms[J]. ANZ J Surg, 2015, 85(11): 838-842.
[16] Gross BC, Carlson ML, Moore EJ, et al.The intraparotid facial nerve schwannoma: a diagnostic and management conundrum[J]. Am J Otolaryngol, 2012, 33(5): 497-504.
[17] Chung JW, Ahn JH, Kim JH, et al.Facial nerve Schwannomas: different manifestations and outcome[J]. Surg Neurol, 2004, 62(3): 245-252.
[18] Richmon JD, Wahl CE, Chia S.Coexisting facial nerve Schwannoma and monomorphic adenoma of the parotid gland[J]. Ear Nose Throat J, 2004, 83(3): 166-169.
[19] Gupta RK, Dowle CS.A case of neurilemoma (schwannoma) that mimicked a pleomorphic adenoma (an example of potential pitfall in aspiration cytodiagnosis)[J]. Diagn Cytopathol, 1991, 7(6): 622-624.
[20] Maly B, Maly A, Doviner V, et al.Fine needle aspiration biopsy of intraparotid schwannoma. A case report[J]. Acta Cytol, 2003, 47(6): 1131-1134.
[21] Guzzo M, Ferraro L, Ibba T, et al.Schwannoma in the parotid gland. Experience at our institute and review of the literature[J]. Tumori, 2009, 95(6): 846-851.
[22] Liu R, Fagan P.Facial nerve schwannoma: surgical excision versus conservative management[J]. Ann Otol Rhinol Laryngol, 2001, 110(11): 1025-1029.
[23] Sarela AI, Bapat VN, Supe AN.Intra-parotid neurilemmomas of the facial nerve[J]. Br J Oral Maxillofac Surg, 1997, 35(1): 71.
[24] Ulku CH, Uyar Y, Acar O, et al.Facial nerve schwannomas: a report of four cases and a review of the literature[J]. Am J Otolaryngol, 2004, 25(6): 426-431.
[25] House JW, Brackmann DE.Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985, 93(2): 146-147.