From the Guidelines
Parotidectomy surgery should be tailored to the individual patient's tumor characteristics, with a focus on preserving the facial nerve and minimizing morbidity, as recommended by the most recent guidelines 1, 2, 3. The main types of parotidectomy include:
- Superficial parotidectomy, which removes only the superficial lobe of the parotid gland while preserving the facial nerve, and is typically indicated for benign tumors like pleomorphic adenomas located in the superficial lobe.
- Total parotidectomy, which involves removal of both superficial and deep lobes of the parotid gland with preservation of the facial nerve, and is indicated for deep lobe tumors or more extensive benign disease.
- Partial superficial parotidectomy (or extracapsular dissection), which removes only the tumor with a small margin of normal tissue, and is suitable for small, superficial, clearly benign lesions.
- Radical parotidectomy, which involves removal of the entire parotid gland along with the facial nerve and sometimes adjacent structures, and is reserved for malignant tumors that involve the facial nerve or surrounding tissues. The choice of procedure depends on tumor location, size, histology, and the involvement of surrounding structures, as well as the patient's overall health and quality of life, as emphasized in the guidelines 4, 5. Some key considerations in parotidectomy surgery include:
- Achieving negative surgical margins to improve overall survival, as highlighted in the literature review 3.
- Preserving the facial nerve whenever possible to minimize morbidity and maintain quality of life, as recommended in the guidelines 1, 2.
- Considering adjuvant radiation therapy for advanced or high-grade tumors, as discussed in the evidence 2. Potential complications of parotidectomy surgery include:
- Facial nerve injury leading to facial weakness or paralysis
- Frey's syndrome (gustatory sweating)
- Numbness
- Salivary fistula
- Cosmetic deformity Preoperative assessment typically includes fine needle aspiration cytology and imaging studies like MRI or CT to determine the extent of disease and plan the appropriate surgical approach, as noted in the guidelines 4, 5.
From the Research
Types of Parotidectomy
- Superficial parotidectomy (SP) 6, 7
- Partial superficial parotidectomy (PSP) 7, 8
- Extracapsular dissection (ECD) 6, 8
- Total parotidectomy (TP) 8
- Partial parotidectomy 9, 10
Indications for Parotidectomy
- Benign parotid tumors 6, 9, 7, 8
- Malignant lesions of the parotid gland 10
- Pleomorphic adenomas 6, 9
- Warthin's tumor 9
- Cystic lesions of the parotid gland 9
Surgical Approaches
- Conventional superficial parotidectomy with facial nerve dissection 6
- Retrograde nerve dissection approach under local anesthesia 9
- Partial parotidectomy with a retrograde nerve dissection approach 9
- Superficial parotidectomy versus partial superficial parotidectomy 7