Tumors of accessory parotid gland are considered in the differential diagnosis of a mid cheek mass. Parotidectomy is the procedure of choice. All pathological types of parotid main gland tumors occur in the accessory parotid gland also. Presenting as a mid cheek or infrazygomatic mass, the tumors of this accessory parotid gland are notorious for recurrences, if adequate margins are not achieved. We describe two such cases of such a tumor. 40-year-old male with a slowly progressive mid cheek mass was operated by a mid cheek incision. Histopathology of the tumor was pleomorphic adenoma. Facial nerve paresis recovered complelety in 6 months. A 52-year-old female with progressive mid cheek mass who underwent parotidectomy and neck dissection by a modified Blair's incision was diagnosed with extranodal marginal zone lymphoma with focal transformation to a diffuse large B-cell lymphoma. Chemotherapy with CHOP regime was initiated. There was no recurrence at 6 months of follow-up. Lymphoma of accessory parotid gland is a very rare tumor. Standard parotidectomy incision is advocated to prevent damage to facial nerve branches.

IntroductionOptimization of postoperative care is often contingent upon the risk stratification tools such as surgical scores that are used to prognosticate potential complications.AimThis study evaluates the utility of surgical Apgar score (SAS) as a tool to predict morbidity and 30-day mortality among patients post general surgical procedures.Material and methodsThe study cohort comprised of 400 patients aged between 15 to 75 years, and prospectively undergoing emergency or elective general surgery. SAS of patients were extracted from the anesthesiologist’s records on estimated blood loss, lowest heart rate and lowest mean arterial pressure. Post-operative outcomes such as major complications and mortality within 30 days of surgery were monitored.Results and DiscussionOut of the 297 elective procedures, 22 (7.41%) cases had major complications. While among those undergoing emergency surgeries (103), 38 (36.86%) patients developed major complications. The odds of developing major complications in patients with the high-risk SAS scores (31; 51.67%) was 5.42 (CI: 3.03–9.70) times greater than in patients with low-risk SAS scores (29; 48.33%). The odds of expiring after a general surgery was 11.92 times higher in high-risk patients (9; 75%) when contrasted with low-risk patients (3; 25%). The sensitivity and specificity of SAS in predicting major complications is 51.67% and 83.53%, respectively. The sensitivity and specificity of SAS in predicting mortality are 75% and 79.9%, respectively.ConclusionsSAS serves as a simple and dependable tool to predict morbidity and 30-day mortality in patients undergoing surgical procedures under anesthesia other than local, requiring intensive perioperative monitoring.