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Routine use of CFNM during RPA surgery improves the surgical outcome. The facial nerve deficit can be reduced, and the recovery of facial nerve function is faster.

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Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%). Nevertheless, a definitive facial paralysis ≥ grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.

Purpose:The main goal of sentinel lymph node (SLN) detection in head and neck squamous cell carcinomas is to limit neck dissections to pN+ cases only. However, intraoperative + diagnosis cannot be routinely done using the current gold standard, serial step sectioning with immunohistochemistry. Real-time quantitative reverse transcription-PCR (RT-PCR) is potentially compatible with intraoperative use, proving highly sensitive in detecting molecular markers. This study postoperatively assessed the accuracy of quantitative RT-PCR in staging patients from their SLN. Experimental Design: A combined analysis on the same SLN by serial step sectioning with immunohistochemistry and quantitative RT-PCR targeting cytokeratins 5, 14, and 17 was done in 18 consecutive patients with oral or oropharyngeal squamous cell carcinoma and 10 control subjects. Results: From 71lymph nodes examined, mRNA levels (KRT) were linked to metastasis size for the three cytokeratins studied (Pearson correlation coefficient, r = 0.89, 0.73, and 0.77 for KRT 5, 14, and 17 respectively; P < 0.05). Histopathology-positive SLNs (macro-and micrometastases) showed higher mRNA values than negative SLNs for KRT 17 (P < 10 À4) and KRT 14 (P < 10 À2 ). KRT 5 showed nonsignificant results. KRT17 seemed to be the most accurate marker for the diagnosis of micrometastases of a size >450 Am. Smaller micrometastases and isolated tumor cells did not provide results above the background level. Receiver operating characteristic curve analysis for KRT17 identified a cutoff value where patient staging reached 100% specificity and sensitivity for macro-and micrometastases. Conclusion: Quantitative RT-PCR for SLN staging in cN 0 patients with oral and oropharyngeal squamous cell carcinoma seems to be a promising approach.The extent of lymph node involvement in clinically and computed tomography scan N 0 (cN 0 ) oral and oropharyngeal squamous cell carcinomas is f30% to 40% and is one of the main prognostic factors (1). Until recently, a neck dissection was advocated routinely both to assess nodal involvement and to remove occult minimal residual cancer (2). A more recent approach consists of limiting lymph node surgery to a staging procedure by taking only the sentinel lymph nodes (SLN) which are representative of the whole neck node system (3). Such a strategy aims to permit more thorough analysis of only a few lymph nodes to enhance the sensitivity and the specificity of the diagnosis of lymph node invasion and thus select only pN+ patients on whom to perform a neck dissection. Intraoperative diagnosis must therefore have a predictive negative value close to 100%. At present, many methods of SLN analysis are used. The reference method for pathologic analysis is histopathologic examination by serial step sectioning with immunohistochemistry, staining with anticytokeratin antibodies in cases of squamous cell carcinoma (4, 5). Such analysis is able to diagnose three levels of nodal invasion (6): isolated tumor cells <0.2 mm, micrometastases V2 mm, and macromet...