Introduction The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors. Objective The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors. Methods A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow [BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs], Warthin's tumor [WT] and pleomorphic adenomas [PA]). Results The mean age of the patients was 55.9 ± 14.1 (26–77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62 ± 7.5 years; 52 ± 14.2 for patients with Pas, and 55.2 ± 17.2 for those with MTs (p = 0.32). The mean MIP was 122.7 ± 12.2 in WT, while it was 80.5 ± 19.5 in PA, and 76.2 ± 27.1 in MTs (p < 0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher in WTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs. Conclusion Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.
Background: For many years, Canal Wall Down (CWD) tympanomastoidectomy has been the gold standard for treatment of cholesteatoma; however, this method has long-term complications for the patients. The Intact Canal Wall (ICW) tympanomastoidectomy has relatively lower complications, but access to the middle-ear recesses is difficult in this method. Therefore, endoscopy is used to visualize the underexposed recesses. Objective: This study aims to compare the incidence of residual cholesteatoma using the two methods of CWD and endoscopic-assisted ICW. Materials and Methods: In this prospective randomized clinical trial, participants were 40 patients with cholesteatoma in the middle ear and mastoid who were candidates for tympanomastoidectomy. They were randomly divided into two groups. In the first group, ICW was performed with endoscopic assisted visualization, while in the second group, conventional CWD technique was performed without ossicular reconstruction. All the patients were microscopically examined at 3, 6, 9 and 12 months after surgery. Revision middle ear surgery and possible ossicular reconstruction under local anesthesia were performed one year after the surgery. The presence of cholesteatoma pearl in the middle-ear, evaluated by using a 2.7mm 30° endoscope, was recorded as the sign of residual cholesteatoma. Fisher’s exact test and Mann-Whitney U test were used for statistical analysis. Significance level for the tests was set at 5%. Results: The incidence of residual cholesteatoma was not statistically significant between the two groups (P>0.05). In each group, 20% (n=4) had residual cholesteatoma. The difference in time interval from the first to second surgery was not statistically significant between the study groups (P>0.05). Conclusion: Endoscopic-assisted ICW tympanomastoidectomy is comparable with CWD tympanomastoidectomy in eradication of cholesteatoma, having possibly fewer complications. It is recommended that more studies be conducted with a larger sample size and longer follow-up period.
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