title: Three-dimensional imaging and navigated sentinel node biopsy for primary parotid malignancy: new application in parotid cancer management.
abstract: BACKGROUND
  Applications for sentinel node biopsy (SNB) in the head and neck are increasing with new lymphatic tracers and imaging techniques allowing previously inaccessible tumor sites to benefit from the procedure. We show that lymphatic drainage from a primary parotid malignancy can be accurately mapped using navigational surgery.
  
  
  METHODS
  A patient with radiologically classified N0 intraparotid malignancy underwent peritumoral injection of 99mTc-nanocolloid. Planar imaging and single photon emission CT (SPECT)/CT identified the sentinel node. At surgery, real-time video combined with 3 dimensional (3D) images of intraoperative radioisotope hot spots directed the surgeon to the sentinel node.
  
  
  RESULTS
  Lymphoscintographic images demonstrated the hot nodes, which were easily retrieved intraoperatively by 3D navigation. Three lymph nodes were removed, all were free of metastasis.
  
  
  CONCLUSIONS
  The morbidity associated with total parotidectomy and elective neck dissection in low-risk malignancies may be avoided with SNB. This technique is applicable to other sites within the head and neck.
authors: Department of Oral and Maxillofacial Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors: Clare
authors: C
authors: Schilling
authors: Gopinath
authors: G
authors: Gnanasegaran
authors: Mark
authors: M
authors: McGurk
mesh_terms: D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000473:pathology*; D010307:Parotid Neoplasms / Q000473:pathology* / Q000601:surgery*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon
keywords: 3D navigation; neck dissection; parotid malignancy; sentinel node; single photon emission CT (SPECT)/CT