The pathohistological analysis of these tumors revealed the following data: 47 cases (43%) of metastatic tumors were localized in the parenchyma of the parotid gland (37 cases) or of the submandibular gland (10 cases). They often don't cause pain. How long will it take to heal? Parotid neoplasms: analysis of 600 patients attended at a single institution. They might use electrical devices to check on the nerve and make sure it works as expected after surgery. Diagnostic grading of parotid lesions by conventional ultrasound: a pilot study. Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. If the history and physical are suggestive of a tumor, these patients should be referred to the otolaryngologist for workup. Unable to load your collection due to an error, Unable to load your delegates due to an error. Malignant parotid gland neoplasms; Monomorphic adenoma; Parotid gland tumor; Pleomorphic adenoma; Ultrasound. How will you be sure that you've removed all of the tumor? Sethi RKV, Deschler DG. 2010;39:235242. 2009 Apr;123(4):449-52. doi: 10.1017/S0022215108003563. Theme: Parotid gland disease A. Pleomorphic adenoma B. Adenoid cystic carcinoma C. Sarcoid D. Sjogrens syndrome E. Sialolithiasis F. Wharthins tumour Please select the most likely explanation for the following patients with parotid gland 2020 Dec;9(6):2295-2311. doi: 10.21037/gs-20-530. Due to theepithelial and the non-epithelial histology of the affected organ,many histological types of parotid tumors are possible, although some arerare. 2021 Jul 7;11:669542. doi: 10.3389/fonc.2021.669542. 8. Chemotherapy may help relieve pain and other symptoms caused by the cancer. Surgeons can repair the facial nerve using nerves from other areas of the body or from artificial nerves. The predictive values were: PPV 66.8% and NPV 93.6%. If the result of FNA is at variance with other findings, then clinical judgment should prevail. The parotid glands are the most common place that salivary gland tumors happen. The radiation can kill any cancer cells that remain. Muscle movement often gets better over time. StatPearls Publishing, Treasure Island (FL). Squamous cell carcinoma tends towards early extracapsular extension. Pleomorphic adenoma is commonly found in the parotid gland and affects both genders equally. elebi and Mahmutoglu found that with the exception of low grade carcinomas the ES did not improve the sensitivity and specificity of standard ultrasound in differentiation of benign from malignant lesions [ 4 ]. Aktan ZA, Bilge O, Pinar YA, Ikiz AO. The majority of patients first present to the primary care clinician or nurse practitioner with complaints of a painless lump. These procedures should be undertaken by expert surgeons in carefully selected cases, e.g., small tumors confined to the superficial lobe. Bethesda, MD 20894, Web Policies 2002 Aug;57(8):692-701. doi: 10.1053/crad.2001.0865. Diagnosing salivary gland cancer Narrative review of multiparametric ultrasound in parotid gland evaluation. [Updated 2022 Aug 8]. First, you will undergo imaging studies, or scans. A review of 2410 cases with particular reference to histological types, site, age and sex distribution. The .gov means its official. Advanced magnetic resonance imaging findings in salivary gland tumors. The .gov means its official. Salivary gland tumors. In very unusual circumstances, this type of tumor can become cancerous, Eisele says. A prophylactic selective neck dissection (levels I to III) should be performed for patients with high-stage (T3/T4) disease-free clinically high-grade tumors (i.e., high-grade mucoepidermoid carcinoma, carcinoma ex-pleomorphic adenoma, adenocarcinoma, squamous and undifferentiated carcinomas). 2003;76 (904): 271-7. 1 , , , , , , , Careers. Radiation therapy might be recommended after surgery. -, Nagler RM, Laufer D. Tumors of the major and minor salivary glands: review of 25 years of experience. Local recurrences are common, and distant metastases occur in 30% to 40% patients, usually in the lungs, many years later. Our aim was to define typical magnetic resonance (MRI) findings in malignant and benign parotid tumours. Management of a recurrent tumor is difficult. Recurrence will occur if there has been incomplete excision and may occur if there has been tumor spillage. Congenital masses, such as branchial anomalies and thyroglossal duct cysts, must be considered in the differential diagnosis. Insmall, low-grade superficial parotid tumors, a superficial parotidectomy with a margin of at least 1.5 cm may suffice, but otherwise, a total conservative parotidectomy is advised with resection of adjacent neck structures if necessary to achieve an en-bloc resection. Ouatassi N, Elguerch W, Bensalah A, Maaroufi M, Alami MN. Head Neck. A painless swelling on one side of your face may indicate a mass or tumor on your parotid gland. A fibrous capsule surrounds the gland, formed by the superficial (investing) layer of the deep cervical fascia, creating the parotid space. Please enable it to take advantage of the complete set of features! Acinic cell carcinoma (ACC) is a rare malignant tumor, arising almost exclusively in the salivary glands in which it accounts for 11% of malignant neoplasms. About 20% of parotid tumors are malignant, with higher percentages for children, for the submandibular gland, and for intraoral minor salivary glands. Your surgeon and team remove the parotid tumor along with some normal tissue surrounding the mass so it can be removed completely. 1732. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Epub 2021 Sep 30. 2013 Oct;41(8):501-8. doi: 10.1002/jcu.22054. Our aim was to define typical magnetic resonance (MRI) findings in malignant and benign parotid tumours. The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice Eur Arch Otorhinolaryngol. The surgeons take care to identify the facial nerve, the nerve that controls the face, and trace out its branches. Pommier A, Lerat J, Orsel S, Bessede JP, Aubry K. Bull Cancer. Current update on established and novel biomarkers in salivary gland carcinoma pathology and the molecular pathways involved. If the tumor is cancerous, you might need more treatment. Some agents include: Viral Adenovirus Coxsackie Epstein Barr virus Influenza Parainfluenza Other respiratory viruses Bacterial Staphlococcus aureus Streptococcus, group A beta-hemolytic Bartonella henselae Haemophilus influenzae The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The tumor is more common in men than women and is known to be bilateral in 10%-15% of cases. (2011) Page 22-24. Front Oncol. Sometimes patients notice a fullness or swelling of the cheek or an asymmetry in the mouth. This is the third most common cancer of the parotid gland. Patients may have blood tests or imaging tests as part of regular follow-up care. It is less common for a cancer arising in a location below the collarbone to spread to the gland.. JAMA Otolaryngology-Head & Neck Surgery. What should I expect during recovery? About 1.5% of the tumors become malignant in the first five years, rising to 9.5% after 15 years. 2015 May-Jun;81(3):301-6. doi: 10.1016/j.bjorl.2015.03.007. The major salivary glands are the submandibular (below the jaw), the sublingual (under the tongue) and the parotid glands, which are located by the angle of your jaw in front of the ear. 6. Adenoid cystic carcinoma. Histology results were available for all tumours. A broad differential diagnosis must always be considered. stata effettuata un'analisi statistica per identificare le caratteristiche RM pi indicative di malignit e per definire l'aspetto tipico degli istotipi pi comuni. MECAs account for less than 2% of all salivary gland cancers and 0.1-0.45% of all salivary gland tumors [10,11,12,13 . 2015 Nov;25(11):3247-54. doi: 10.1007/s00330-015-3755-7. The pathologist also might test nearby lymph nodes and other tissue for signs of cancer. Dentomaxillofac Radiol. Overall ~80% of all parotid masses are benign and the majority of these are pleomorphic adenomas. Differential diagnosis includes chronic sialoadenitis, necrotizing sialometaplasia, and other carcinomas. The patient should be discussed in the team for the suitability of postoperative RT to reduce recurrence. It is important to be aware that false-positive results can occur, leading to misdiagnosis of malignant lesions. Imaging allows your surgeon to better visualize the extent of the tumor. 2. Bookshelf Accessibility Disclaimer, National Library of Medicine In this procedure, the doctor gives you numbing medication and then collects a very small amount of tissue from the tumor with a needle under ultrasound guidance. The role of imaging in the evaluation of parotid disease. Approximately 300 cases per year of primary salivary gland malignancy are registered in the United Kingdom, of which fewer than ten occur in children. Front Oncol. See this image and copyright information in PMC. If your doctor suspects a tumor in this area, he or she is likely to recommend several steps to diagnose and evaluate it. Head and neck cancers. [Clinical pathologic analysis on 3 724 cases of salivary gland tumors]. [2]It is not surprising that with such a wealth of pathology, clinical features, investigation issues, and contentious treatment options that salivary gland neoplasms are regularly used in clinical examinations. A comprehensive history and physical examination, in conjunction with judicious use of radiographic imaging (MRI, computed tomography, ultrasonography, nuclear medicine studies), laboratory studies, and pathologic analysis (fine-needle aspiration, core biopsy, incisional biopsy), facilitates making an accurate diagnosis. 7. Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. It is a relatively painless procedure, has few complications (seeding of the tumor does not seemto occur), and may prevent an ill-advised and often ill-fated incisional or excisional biopsy of a parotid mass. calculus Bilateral mumps sarcoidosis lymphoma Mikulicz syndrome (early Sjogrens, bilateral, painless) alcohol-associated parotitis The parotid glands are two salivary glands that sit just in front of the ears. Examples of criteria for the description of the echogenicity (slightly hypoechoic, highly hypoechoic) and the homogeneity (slightly heterogenous, highly heterogenous) of the parotid gland tumors: US of malignant parotid glands tumors: SCCpoor defined margins, highly hypoechogenic, slightly heterogenic, and poor vascularity pattern (, US of: PA with irregular shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and no vascularity (. A simplified classification is presented below: Carcinomas can further be classified as high grade, low grade, or mixed, the latter indicating a variable behavior depending on the histological picture. During the follow-up care,the otolaryngologist can give patients personalized information aboutthe risk of recurrence. The head and neck skin should be checked for cancers. Differential diagnosis: IA (Submental) Lymph node, Thyroglossal cyst, Dermoid cyst, Plunging ranula. Please enable it to take advantage of the complete set of features! Primer of Diagnostic Imaging with CD-ROM. 2020 Dec;9(6):2295-2311. doi: 10.21037/gs-20-530. Learning more about the procedure can help you feel more comfortable about your treatment plan. 2013; doi:10.1001/jamaoto.2013.5217. I risultati istologici erano disponibili in tutti i casi; abbiamo analizzato 69 lesioni erano benigne (73%) e 25 maligne (27%): 44 adenomi pleomorfi, 18 tumori di Warthin, 7 tumori benigni di diverso istotipo, 6 carcinomi squamocellulari, 3 carcinomi ex-adenomi pleomorfi, 2 carcinomi mucoepidermoidi, 1 tumore adenoidocistico, 13 tumori maligni di diverso istotipo. In: StatPearls [Internet]. Tumors were divided into 5 histological subtypes, and different MRI features were compared between groups. Would you like email updates of new search results? eCollection 2022. Epub 2008 Sep 30. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Jones J, Chieng R, Hacking C, et al. Contributed by Roger Moukarbel, MD. Salivary gland tumorsare variable in location, origin, and malignant potential. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Just as a benign tumor does, they often present as a painless enlarging mass that may or may not be associated with neck lymph node metastases. But malignant parotid tumors can invade adjacent structures, including the facial nerve, resulting in facial weakness or paralysis.. Salivary gland tumors are characterized by diverse histological appearances and variable biological behavior. Differential diagnosis; Histology; Magnetic Resonance Imaging; Neoplasms; Parotid gland. Comparative diagnostic imaging and pathological analysis of echo color/power Doppler and of magnetic resonance imaging. [4]Patients with malignant lesions typically present in theirsixth decade. Would you like email updates of new search results? Earring lesions of the parotid tail. It can be multifocal, and as the facial nerve may be involved, its sheath may need to be stripped. The lesions have a smooth texture and are surrounded by a capsule. https://www.cancer.gov/types/head-and-neck/patient/adult/salivary-gland-treatment-pdq. They can be confused with Warthin tumor on cytology, and larger tissue samples are usually requested, and immunohistochemistry is required. Because of the possibilityof recurrence and distant metastasis,patients with a history of salivary gland, cancermustbe monitored throughout their lifetime. Thisis overall (for all glands) the most frequent malignant salivary gland tumor and may arise from any salivary tissue, but is more common in the minor (rather than in major) salivary glands. How likely is it that the facial nerve will be hurt? The site is secure. 2006;26 (3): 147-53. However, the relative rarity of these . Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. Salivary gland tumor: a review of 599 cases in a brazilian population. 2012 Jun;33(3):283-8. doi: 10.1055/s-0031-1299130. Treatment usually involves surgery to remove the tumor completely. and transmitted securely. Preoperative identification of benign versus malignant parotid masses: a comparative study including positron emission tomography. The differential diagnosis for this appearance includes chronic bacterial or granulomatous infections and multiple parotid cysts associated with human immunodeficiency virus (HIV) infection. FOIA A doctor who uses blood and body tissue to diagnose diseases, who is called a pathologist, looks at the sample right away. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2016 Apr;49(2):285-312. doi: 10.1016/j.otc.2015.10.003. Bron L, Traynor S, McNeil E, O?? Wang Y, Xie W, Huang S, Feng M, Ke X, Zhong Z, Tang L. J Oncol. Salivary gland neoplasms in oral and maxillofacial regions: a 23-year retrospective study of 6982 cases in an eastern Chinese population. First, you will undergo imaging studies, or scans. Check for errors and try again. Please enable it to take advantage of the complete set of features! Wang K, Pearlstein KA, Moon DH, Mahbooba ZM, Deal AM, Wang Y, Sutton SR, Motley BB, Judy GD, Holmes JA, Sheets NC, Kasibhatla MS, Pacholke HD, Shen CJ, Zagar TM, Marks LB, Chera BS. Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review. However, the only way to provide a definitive diagnosis is to excise the cyst and perform a histopathology examination. The WHO histological classification of salivary gland tumors now includes over 40 variantsas well as tumor-like lesions (e.g., salivary gland cysts). This site needs JavaScript to work properly. Howlett DC, Kesse KW, Hughes DV, Sallomi DF. Cancer or Tuberculosis: A Comprehensive Review of the Clinical and Imaging Features in Diagnosis of the Confusing Mass. Cancers (Basel). The gland usually contains several intraparotid lymph nodes. The Diagnostic Value of Ultrasound-Based Deep Learning in Differentiating Parotid Gland Tumors. Unusual parotid gland lesions: a pictorial review. Another step in evaluating the mass is taking a sample of tissue from it abiopsy which can be examined under a microscope by a pathologist. Would you like email updates of new search results? Elsevier Australia. Salivary glands are a common source of benign pathology; malignant tumors are rare. Differential Diagnosis A clinically relevant approach to differentiating neck masses depends on whether the mass is acute, subacute, or chronic ( Tables 1 and 2). The histopathological diagnosis was confirmed after parotidectomy for each lesion. Most parotid tumors aren't cancerous. Parotid gland enlargement (also known as parotidomegaly) has a wide differential given the significant breadth of pathology that can affect the parotid gland. Careers. It is now generally accepted that an adequate margin in benign tumors, is a cuff of 1 to 2 mm. All patients underwent DCE-MRI examination for pre-surgery evaluation of parotid gland tumors. Clipboard, Search History, and several other advanced features are temporarily unavailable. These patients should be followed by the oncology nurse and/or the primary care clinician for several years as there is a small risk of recurrence. Ultrasound scan (USS) provides invaluable information about the site, size, and nature of salivary gland tumors and the presence of any significant cervical lymphadenopathy. I parametri significativamente predittivi di malignit sono risultati i margini mal-definiti (p < 0,001), le linfoadenopatie (p < 0,001) ed il pattern di crescita infiltrativo (p < 0,001). Salivary gland carcinomas are a remain a heterogeneous group of tumors challenging to both pathologists and clinicians. It generally behaves in an indolent, low-grade fashion, but can be unpredictable with perineural invasion and lymph node metastases. Questo studio retrospettivo si basa sulla valutazione di esami RM pre-chirurgici di 94 pazienti con tumori parotidei. This is a reliable way to help your head and neck surgeon determine characteristics of the tumor. The approach is based on the characteristics of the tumor whether it is benign or malignant. National trends in inpatient parotidectomy: A fourteen-year retrospective analysis. Parotid tumors often cause swelling in the face or jaw. Maahs GS, Oppermann Pde O, Maahs LG, Machado Filho G, Ronchi AD. However, it is far from straightforward with issues regarding aspiration technique, adequacy of the specimen, cytological expertise, and limitations of the interpretation. Usefulness of heavily T(2) weighted magnetic resonance images for the differential diagnosis of parotid tumours. Five-year survival varies between 86% for low-grade and 22% for high-grade tumors. Disclaimer, National Library of Medicine (, Pleomorphic adenoma of the right parotid gland. Results of. Loss of appetite. Accessibility The site is secure. An official website of the United States government. -, Aparecida de Oliveira F, Barroso Duarte EC, Teixeira Taveira C, et al. Parotid gland tumors account for approximately 2% to 10% of head and neck tumors. Zhang W, Zuo Z, Luo N, Liu L, Jin G, Liu J, Su D. Eur Arch Otorhinolaryngol. Imaging allows your surgeon to better visualize the extent of the tumor. Neck dissection should be carried out in patients with clinical or radiological evidence of nodal disease. It may be secondary to: Viral (Mumps), Bacterial (may develop into an abscess), Autoimmune (Sjogren's syndrome), Calculus /obstruction, Parotitis is usually bilateral. Several oncogenes have been implicated in salivary gland tumors. Superficial parotidectomy with identification and exposure of was traditionally the preferred procedure. The classification applies only to carcinomas of the major salivary glands. 2002;57 (8): 692-701. Sonohistology for the computerized differentiation of parotid gland tumors. 2008;66:419436. There are several other aspects of salivary gland tumors that make them interesting. The gender incidence is equal, and they are seen most often in patients in their sixth decade. Most cases of squamous cell carcinoma (SCC) are metastases to the parotid from skin cancers. The parotid gland is the largest of the salivary glands and secretes saliva via the parotid ductinto the oral cavity to facilitate mastication and swallowing. Salivary gland cancer can be prevented by avoiding the possible risk factors namely tobacco and alcohol. Before The differential diagnosis mainly relies on methemoglobin determination, B-type ultrasound and hepatic angiography. Comparison of ultrasonography, computerized tomography, and magnetic resonance in the study of parotid masses. Scheipers U, Siebers S, Gottwald F, Ashfaq M, Bozzato A, Zenk J, Iro H, Ermert H. Ultrasound Med Biol. 2005;27(10):923-926. Bethesda, MD 20894, Web Policies Braz J Otorhinolaryngol. The facial nerve may be encased in scar tissue, so the traditional method of finding it may have to be augmented by exposing it in the mastoid bone, or more hazardously a peripheral branch traced back. McGuirt WF, Keyes JW Jr, Greven KM, Williams DW 3rd, Watson NE Jr, Cappellari JO. The incidence of lymph node metastases is low. You might consider asking: Radiation therapy uses powerful energy beams to kill cancer cells. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Saber M, Knipe H, et al. Elsevier; 2021. https://www.clinicalkey.com. If there are no complications, you will likely be able to return home the same day. If the nerve is sacrificed because of involvement, then primary nerve grafting should be performed. The .gov means its official. 2004;13:716. Dry mouth or dry eyes (usually associated with Sjogren's syndrome ). Typical findings of pleomorphic adenoma included hyperintensity on T2w images (p = 0.02), strong contrast enhancement (p < 0.001) and lobulated shape (p = 0.04). An Overview on the Histogenesis and Morphogenesis of Salivary Gland Neoplasms and Evolving Diagnostic Approaches. Epub 2016 Jun 14. 2021 Feb 1;21(1):19-32. doi: 10.17305/bjbms.2020.5028. The site is secure. contribution of apparent diffusion coefficient histogram analysis findings in differential diagnosis of parotid gland masses. [8][9][Level 5], The t1w axial sequence of face reveals a lobulated hypointense well-defined mass lesion in the right parotid gland of 35-year-old male. This is reflected in excellent survival rates of 90% at 5 years, which drops to 55% at 20 years. Cancer in the parotid gland can arise either from the parotid gland itself or spread (metastasize) to the gland from another place, such as the skin. Chemotherapy uses strong medicines to kill cancer cells. Figure 4: parotid gland and relations on CT neck (annotated), doi:10.1148/radiographics.21.5.g01se171211, superior longitudinal muscle of the tongue, inferior longitudinal muscle of the tongue, levator labii superioris alaeque nasalis muscle, superficial layer of the deep cervical fascia, ostiomeatal narrowing due to variant anatomy. Chemotherapy is sometimes used to treat parotid gland cancers. 1993;86 (3): 268-80. A functioning facial nerve should be preserved unless found to be infiltrated with the tumoritself at the time of resection. (2012) ISBN: 9783642178689. government site. Imaging of salivary gland tumors. There are many salivary glands in the lips, cheeks, mouth and throat. 6Hepatomycosis: The patient has progressive enlargement of the liver, hard texture and nodularity, most of the liver is destroyed in the advanced stage, and the clinical manifestation is very similar to primary liver cancer. HHS Vulnerability Disclosure, Help Parotid Gland MRI Segmentation Based on Swin-Unet and Multimodal Images. How much of the parotid gland do you plan to remove? Epub 2010 Oct 1. Head and Neck Cancer Imaging. Stephanie Ryan, Michelle McNicholas, Stephen J. Eustace. Advertising revenue supports our not-for-profit mission. Federal government websites often end in .gov or .mil. 2009;37 (3): 430-4. T-stage, according to the 8th edition of the UICC/AJCC staging manual (2016) is as follows: * Extraparenchymal extension is clinical or macroscopic evidence of invasion of soft tissues or nerve, except those listed under T4a and 4b. Mayo Clinic is a not-for-profit organization. 2022 Aug 28;14(8):256-271. doi: 10.4329/wjr.v14.i8.256. Eisele notes that the drain is usually removed the day after surgery. Martino M, Fodor D, Fresilli D, Guiban O, Rubini A, Cassoni A, Ralli M, De Vincentiis C, Arduini F, Celletti I, Pacini P, Polti G, Polito E, Greco A, Valentini V, Sorrenti S, D'Andrea V, Masciocchi C, Barile A, Cantisani V. Gland Surg. The tail is not distinct from the rest of the gland, but it has been defined as the inferior 2 cm of the gland 11. 7th ed. Accessed Dec. 2, 2022. 1: digastric muscle 2: main trunk of the facial nerve 3: cervical branch of the facial nerve 4: marginal mandibular branch of the facial nerve 5: great auricular nerve divided distally. Berlin Heidelberg: Springer-Verlag; 2007. pp. Radiol Case Rep. 2021 Nov 27;17(2):344-349. doi: 10.1016/j.radcr.2021.10.043. 2012;16(1):134. Those that are deep in the parapharyngeal space can require a special approach.. Ultrasound-guided core needle biopsy of parotid gland swellings. American journal of neuroradiology. Last's Anatomy. You have hundreds of salivary glands in and around your mouth that create saliva, which helps to keep your mouth moist and aids in swallowing, speaking and eating. An indolent but aggressive tumour. -, Eveson JW, Cawson RA. 2021 Aug 3;13(15):3910. doi: 10.3390/cancers13153910. An extracapsular dissection for benign pathology, away from the main branches of the facial nerve is an option, and even endoscopically-assisted parotidectomy can be effective in selected patients. Contributed (more). Parotid Gland Lesions: Multiparametric Ultrasound and MRI Features. 7. -, Takahama Junior A, Almeida OP, Kowalski LP. Pleomorphic adenoma with squamous metaplasia, Stage II: The 5-year survival rate is 75%, Stage III or IV: The 5-year survival rate varies from 39% to 65%. When this happens, you might experience weakness of your face, or a part of it, on one side.
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