title: High risk for bilateral Warthin tumor in heavy smokers--review of 185 cases.
abstract: CONCLUSIONS
  We identified smoking as a significant risk factor for multilocular Warthin tumor development. Therefore, we recommend taking history of smoking into account when making the decisions for surgical strategy.
  
  
  OBJECTIVE
  Warthin tumor is a common benign neoplasm of the parotid gland. Risk factors for multilocular development have not been defined.
  
  
  METHODS
  A total of 185 consecutive patients treated for Warthin tumor were included. Charts were reviewed for symptoms, risk factors, and diagnostic and surgical procedures. Patients were followed for facial function and recurrence. Risk factors were evaluated.
  
  
  RESULTS
  Overall, in 203 parotid operations, a lateral parotidectomy (77%) was performed in most cases; 94% were primary surgery and 6% were revision surgery. In 89% of patients swelling was the only symptom. Bilateral Warthin tumor was seen in 17% of patients. Of these cases synchronous and metachronous bilateral tumors were observed in 61% and 39%, respectively. The median time period for second contralateral tumor development was 7 years. Postoperative transient facial dysfunction was observed in 31%, which recovered within 3 months in all cases. Evaluation of risk factors revealed that 89% of the subjects were smokers and 66% were heavy smokers. The risk for bilateral Warthin tumors correlated significantly with the amount of nicotine intake (p=0.003).
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Peter Klussmann
authors.forename: Claus
authors.initials: C
authors.lastname: Wittekindt
authors.forename: Simon
authors.initials: S
authors.lastname: Florian Preuss
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Al Attab
authors.forename: Ursula
authors.initials: U
authors.lastname: Schroeder
authors.forename: Orlando
authors.initials: O
authors.lastname: Guntinas-Lichius
mesh_terms: D000235:Adenolymphoma / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D010306:Parotid Gland / Q000601:surgery; D010307:Parotid Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D013223:Statistics as Topic