Letters to Editor Parotid duct cyst in a child Sir, Cystic lesions localised in salivary gland are commonly of neoplastic origin, whereas non-neoplastic cysts are quite rare, and constitute approximately 2-5% of all salivary gland lesions. Salivary gland duct cysts in non-neoplastic group are mass lesions with an epithelium lining inside, and these are also named as mucous retention cyst or mucous duct cyst. These are true cysts that can be congenital or acquired. The most common type is the acquired type, which develops due to obstruction of the duct. Salivary gland duct cysts are generally observed in minor salivary glands. They are rarely seen in major salivary glands and are commonly localised in the superficial lobe. Cystic lesions of the salivary gland are commonly seen between the ages of 30 and 40. They are rarely observed in childhood.[1-5] In this case, a 6-year-old child was admitted to the polyclinic due to painless swelling on the right side of the face, which had been present since birth and gradually increased in size in the last year. Upon physical examination, an immobile, uniformly consistent , soft mass that was approximately 6 cm × 7 cm in size and painless on palpation was detected in the preauricular region [Figure 1]. A cystic mass was observed in the superficial lobe of the right parotid gland of the patient on ultrasonographic examination. The magnetic resonance imaging revealed a multiloculated, sharplycircumscribed cystic mass of 5.5 cm × 5 cm × 4 cm in size that partially extend from the superficial lobe to the deep lobe was detected and a second cystic lesion of 2.5 cm × 2 cm × 2 cm in size extending to retroauricular region was detected in the deep lobe [Figure 2]. In the fine needle aspiration biopsy, the lesion was considered to have benign cyst content. Exploration was done, and a superficial parotidectomy was performed, preserving the facial nerve,. The removed cystic tissue was examined using frozen section . It was found to be benign, and the cyst extending to the deep lobe was totally excised, and the deep lobe was preserved [Figure 3]. No postoperative complications developed. No Indian Journal of Plastic Surgery January-April 2015 Vol 48 Issue 1
Figure 1: Preoperative photograph
Figure 2: Preoperative magnetic resonance imaging
Figure 3: Intraoperative view of the facial nerve
recurrence was detected during the postoperative 1-year follow-up of the patient. The current case is 92
Letters to Editor
presented as a rare case, as the patient was a child and as the lesion was large and present in both lobes of the unilateral parotid gland. Although rarely observed, non-neoplastic cystic lesions of the parotid gland should be kept in mind when considering parotid gland masses.
Mehmet Dadaci1, Gökhan Tuncbilek2, Bilsev İnce1, Fatma Bilgen3 Department of Plastic, Meram Faculty of Medicine, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Konya, 2Department of Plastic, Faculty of Medicine, Reconstructive and Aesthetic Surgery, Hacettepe University, Ankara, 3Clinic of Plastic, Reconstructive and Aesthetic Surgery, Necip Fazıl State Hospital, Kahramanmaras, Turkey 1
Address for correspondence: Dr. Mehmet Dadaci, Department of Plastic, Meram Medical Faculty, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Meram 42080, Konya, Turkey. E-mail: [email protected]
a bloodless surgical field and to assess the chordee by artificial erection.[1] Despite a number of popular tourniquets used in penile surgery, there are no clear guidelines for the safe use of tourniquets. Different types of material are used for a penile tourniquet such as a red rubber catheter, soft latex catheter, a Penrose drain clipped around the base of the penis using artery forceps, rubber band, and the rolled rubber glove, or twisting a silicon vascular band around the base of degloved penis by using a clip [Figure 1]. To minimise the risk of excessive tourniquet pressure, current recommendations advise the use of the lowest pressure necessary to maintain haemostasis. According to data the Penrose drain and rolled glove with clamp methods exerted high pressures in excess of 300 mmHg.[2-4] Thus the clamp (artery forceps) to tighten the tourniquet should be avoided.
REFERENCES
DESIGN OF THE TOURNIQUET
1.
One mm thick flat, soft silicone sheet is taken. Depending upon the size of the penis, 5-10 mm wide strips are cut from the silicone sheet with 1 mm increments and 10-15 cm in length.
Rajendran R. Tumors of the salivary glands. In: Rajendran R, editor. Shafer’s Textbook of Oral Pathology. 5thed. Amsterdam: Elseiver; 2007. p. 309-56. 2. Vinayachandran D, Sankarapandian S. Salivary duct cyst: Histo-pathologic correlation. J Clin Imaging Sci2013;3:3. 3. Jerzy K, Philippe V. Salivary Gland Tumors. Switzerland: Karger; 2000. p. 125-6. 4. Ellies M, Laskawi R. Diseases of the salivary glands in infants and adolescents. Head Face Med 2010;6:1. 5. Riffat F, Mahrous AK, Buchanan MA, Fish BM, Jani P. Safety of extracapsular dissection in benign superficial parotid lesions. J Maxillofac Oral Surg2012;11:407-10. Access this article online Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.155279
A total of 2 tubectomy rings are threaded over the silicone strip with the help of straight artery forceps to make the tourniquet [Figure 2]. The haemorrhoids rubber rings cannot be used because of its being oversized. The threading of the tubectomy rings is facilitated over the strips after lubricating with sterile jelly or distilled water. The first ring exerts the needed pressure to check bleeding, and the second one retains the position of the first ring and does not allow it to slip out. Our penile tourniquets can be sterilised by any conventional method without any damage.
APPLICATION OF THE TOURNIQUET
A simple and safe penile tourniquet Sir, Tourniquets have been widely used in penile surgery, especially for hypospadias surgery, for the last five decades. The purpose of these tourniquets is to obtain 93
The tourniquet is passed through the tip of the penis to the base of the penis. The assistant squeezes out the penis after applying the gauge sponge, and tubectomy rings are advanced over the silicone strip toward the base of the penis to fasten the tourniquet. Now the surgeon makes a small cut at the proposed site of the incision. If bleeding is present, the ring is further advanced over silicone strip just to stop bleeding. If there is no bleeding, the ring is just Indian Journal of Plastic Surgery January-April 2015 Vol 48 Issue 1
Copyright of Indian Journal of Plastic Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Figure 1: Preoperative photograph
Figure 2: Preoperative magnetic resonance imaging
Figure 3: Intraoperative view of the facial nerve
recurrence was detected during the postoperative 1-year follow-up of the patient. The current case is 92
Letters to Editor
presented as a rare case, as the patient was a child and as the lesion was large and present in both lobes of the unilateral parotid gland. Although rarely observed, non-neoplastic cystic lesions of the parotid gland should be kept in mind when considering parotid gland masses.
Mehmet Dadaci1, Gökhan Tuncbilek2, Bilsev İnce1, Fatma Bilgen3 Department of Plastic, Meram Faculty of Medicine, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Konya, 2Department of Plastic, Faculty of Medicine, Reconstructive and Aesthetic Surgery, Hacettepe University, Ankara, 3Clinic of Plastic, Reconstructive and Aesthetic Surgery, Necip Fazıl State Hospital, Kahramanmaras, Turkey 1
Address for correspondence: Dr. Mehmet Dadaci, Department of Plastic, Meram Medical Faculty, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Meram 42080, Konya, Turkey. E-mail: [email protected]
a bloodless surgical field and to assess the chordee by artificial erection.[1] Despite a number of popular tourniquets used in penile surgery, there are no clear guidelines for the safe use of tourniquets. Different types of material are used for a penile tourniquet such as a red rubber catheter, soft latex catheter, a Penrose drain clipped around the base of the penis using artery forceps, rubber band, and the rolled rubber glove, or twisting a silicon vascular band around the base of degloved penis by using a clip [Figure 1]. To minimise the risk of excessive tourniquet pressure, current recommendations advise the use of the lowest pressure necessary to maintain haemostasis. According to data the Penrose drain and rolled glove with clamp methods exerted high pressures in excess of 300 mmHg.[2-4] Thus the clamp (artery forceps) to tighten the tourniquet should be avoided.
REFERENCES
DESIGN OF THE TOURNIQUET
1.
One mm thick flat, soft silicone sheet is taken. Depending upon the size of the penis, 5-10 mm wide strips are cut from the silicone sheet with 1 mm increments and 10-15 cm in length.
Rajendran R. Tumors of the salivary glands. In: Rajendran R, editor. Shafer’s Textbook of Oral Pathology. 5thed. Amsterdam: Elseiver; 2007. p. 309-56. 2. Vinayachandran D, Sankarapandian S. Salivary duct cyst: Histo-pathologic correlation. J Clin Imaging Sci2013;3:3. 3. Jerzy K, Philippe V. Salivary Gland Tumors. Switzerland: Karger; 2000. p. 125-6. 4. Ellies M, Laskawi R. Diseases of the salivary glands in infants and adolescents. Head Face Med 2010;6:1. 5. Riffat F, Mahrous AK, Buchanan MA, Fish BM, Jani P. Safety of extracapsular dissection in benign superficial parotid lesions. J Maxillofac Oral Surg2012;11:407-10. Access this article online Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.155279
A total of 2 tubectomy rings are threaded over the silicone strip with the help of straight artery forceps to make the tourniquet [Figure 2]. The haemorrhoids rubber rings cannot be used because of its being oversized. The threading of the tubectomy rings is facilitated over the strips after lubricating with sterile jelly or distilled water. The first ring exerts the needed pressure to check bleeding, and the second one retains the position of the first ring and does not allow it to slip out. Our penile tourniquets can be sterilised by any conventional method without any damage.
APPLICATION OF THE TOURNIQUET
A simple and safe penile tourniquet Sir, Tourniquets have been widely used in penile surgery, especially for hypospadias surgery, for the last five decades. The purpose of these tourniquets is to obtain 93
The tourniquet is passed through the tip of the penis to the base of the penis. The assistant squeezes out the penis after applying the gauge sponge, and tubectomy rings are advanced over the silicone strip toward the base of the penis to fasten the tourniquet. Now the surgeon makes a small cut at the proposed site of the incision. If bleeding is present, the ring is further advanced over silicone strip just to stop bleeding. If there is no bleeding, the ring is just Indian Journal of Plastic Surgery January-April 2015 Vol 48 Issue 1
Copyright of Indian Journal of Plastic Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
