From the Guidelines
Parotidectomy involves the surgical removal of part or all of the parotid gland, with several types defined by the extent of tissue excised, and the choice of procedure depends on tumor characteristics, location, histology, and the surgeon's assessment of facial nerve involvement, with the goal of complete tumor removal while minimizing morbidity, particularly facial nerve dysfunction, as recommended by the ASCO guideline 1.
Types of Parotidectomy
- Superficial parotidectomy: removes only the superficial lobe of the parotid gland (about 80% of the gland) while preserving the facial nerve, and is indicated for benign tumors confined to the superficial lobe such as pleomorphic adenomas and Warthin's tumors.
- Deep lobe parotidectomy: removes the portion of the gland deep to the facial nerve and is performed for tumors in this location.
- Total parotidectomy: involves removal of both superficial and deep lobes while preserving the facial nerve, and is indicated for extensive benign disease or low-grade malignancies.
- Radical parotidectomy: includes removal of the entire gland along with the facial nerve and is reserved for malignant tumors with facial nerve involvement.
- Extended radical parotidectomy: includes additional structures like skin, mandible, or temporal bone for advanced malignancies with extensive local invasion.
- Partial superficial parotidectomy (extracapsular dissection): removes the tumor with a margin of normal tissue and is suitable for small, superficial, clearly benign lesions, as recommended by the ASCO guideline 1.
Indications for Each Type
- For high-grade or advanced-stage parotid cancer, at least a superficial parotidectomy with consideration of a total or subtotal parotidectomy is recommended, as stated in the ASCO guideline 1.
- For low-grade salivary gland cancers, partial superficial parotidectomy may be performed, as recommended by the ASCO guideline 1.
- Facial nerve resection should only be performed when necessary for complete margin clearance or when the nerve is grossly infiltrated or encased by malignancy, as recommended by the ASCO guideline 1.
Key Considerations
- The goal of parotidectomy is to achieve complete tumor removal while minimizing morbidity, particularly facial nerve dysfunction.
- The choice of procedure depends on tumor characteristics, location, histology, and the surgeon's assessment of facial nerve involvement.
- Adjuvant radiation therapy may be considered for high-grade or advanced-stage parotid cancer, as stated in the ASCO guideline 1.
From the Research
Types of Parotidectomy
The types of parotidectomy include:
- Superficial parotidectomy: This procedure involves the removal of the superficial lobe of the parotid gland, and is often used to treat benign tumors confined to this area 2, 3.
- Total parotidectomy: This procedure involves the removal of both the superficial and deep lobes of the parotid gland, and is often used to treat more extensive or malignant tumors 4, 5.
- Partial superficial parotidectomy: This procedure involves the removal of a portion of the superficial lobe, and is often used to treat smaller benign tumors 2, 4.
- Extracapsular dissection: This procedure involves the removal of the tumor with a margin of normal tissue, without dissecting the facial nerve 4, 5.
- Deep lobe parotidectomy: This procedure involves the removal of the deep lobe of the parotid gland, and is often used to treat tumors that originate in or have spread to this area 6.
Structures Excised
The structures excised during parotidectomy vary depending on the type of procedure:
- Superficial parotidectomy: The superficial lobe of the parotid gland is removed, while the facial nerve and deep lobe are preserved 2, 3.
- Total parotidectomy: Both the superficial and deep lobes of the parotid gland are removed, and the facial nerve is dissected and preserved 4, 5.
- Partial superficial parotidectomy: A portion of the superficial lobe is removed, while the facial nerve and remaining parotid tissue are preserved 2, 4.
- Extracapsular dissection: The tumor is removed with a margin of normal tissue, without dissecting the facial nerve 4, 5.
- Deep lobe parotidectomy: The deep lobe of the parotid gland is removed, and the facial nerve is dissected and preserved 6.
Indications for Each Type
The indications for each type of parotidectomy vary:
- Superficial parotidectomy: Benign tumors confined to the superficial lobe, such as pleomorphic adenomas 2, 3.
- Total parotidectomy: Malignant tumors, or benign tumors that involve both the superficial and deep lobes 4, 5.
- Partial superficial parotidectomy: Smaller benign tumors confined to the superficial lobe 2, 4.
- Extracapsular dissection: Benign tumors that can be removed with a margin of normal tissue, without dissecting the facial nerve 4, 5.
- Deep lobe parotidectomy: Tumors that originate in or have spread to the deep lobe, such as malignant tumors 6.