From the Guidelines
Parotidectomy is indicated for high-grade or advanced-stage parotid cancer, as well as for benign tumors, malignant tumors, chronic sialadenitis, facial nerve schwannomas, and suspicious lesions identified on imaging or fine-needle aspiration biopsy. The main indications for parotidectomy include:
- Benign tumors: Most commonly pleomorphic adenomas and Warthin's tumors
- Malignant tumors: Such as mucoepidermoid carcinoma, adenoid cystic carcinoma, and acinic cell carcinoma
- Chronic sialadenitis refractory to conservative treatment
- Facial nerve schwannomas within the parotid gland
- Suspicious lesions identified on imaging or fine-needle aspiration biopsy According to the ASCO guideline 1, surgeons should perform at least a superficial parotidectomy with consideration of a total or subtotal parotidectomy for any high-grade or advanced (T3-T4) parotid cancer. The decision to perform a parotidectomy is based on clinical examination, imaging studies (CT or MRI), and fine-needle aspiration cytology results. The extent of surgery (superficial vs. total parotidectomy) depends on the location and nature of the lesion. It's crucial to perform parotidectomy for benign tumors to prevent potential malignant transformation and for malignant tumors to achieve complete resection with clear margins, as achieving negative surgical margins has been shown to improve overall survival (OS) 1. The procedure requires meticulous dissection to preserve the facial nerve, which runs through the parotid gland. Patients should be counseled about potential complications, including temporary or permanent facial nerve weakness, Frey's syndrome (gustatory sweating), and salivary fistula. Post-operative care typically involves wound care, facial exercises if indicated, and regular follow-up to monitor for recurrence. In cases where facial nerve resection is considered, it is recommended to resect facial nerve branches only when this will allow for complete margin clearance or when the nerve is grossly infiltrated or encased by malignancy 1, as the oncologic benefit of nerve resection is not clear, and facial nerve preservation is important for maintaining quality of life.
From the Research
Indications for Parotidectomy
The indications for parotidectomy, or the surgical removal of the parotid gland, include:
- Benign tumors, such as pleomorphic adenoma and Warthin's tumor 2, 3, 4, 5, 6
- Malignant tumors, including metastatic cutaneous squamous cell carcinoma (SCC) 5
- Inflammatory parotid disease 5
- Miscellaneous conditions, such as recurrent parotid tumors or tumors arising in the deep lobe of the parotid gland 5, 6
Types of Parotidectomy
Different types of parotidectomy can be performed, including:
- Superficial parotidectomy (SP) 2, 3, 4
- Partial superficial parotidectomy (PSP) 2, 4
- Total conservative parotidectomy (TCP) 2
- Enucleation (E) 2
- Extracapsular dissection (ECD) 2, 3, 6
- Lateral parotid lobectomy 6
- Total parotidectomy 6
Factors Influencing the Choice of Parotidectomy
The choice of parotidectomy depends on several factors, including: