I discovered a lump in my parotid gland; where should I go for evaluation?

Where to Seek Evaluation for a Parotid Mass

You should go to an otolaryngologist (ENT/head and neck surgeon) for evaluation of your parotid mass, as this requires specialized assessment and should never be biopsied by a general practitioner or through open incisional biopsy. 1, 2

Why Specialist Referral is Essential

• Any lump in the parotid region must be assumed to originate in the parotid gland and requires specialized management to avoid complications such as tumor seeding or facial nerve damage that can occur with improper biopsy techniques 2
• The presence of a parotid lump is a definite indication for referral to a head and neck surgeon, as treatment is always performed under general anesthesia with specialized expertise 2
• Open incisional biopsy should never be performed in the parotid region due to the danger of tumor seeding and potential facial nerve injury 2

What the Specialist Will Do

Initial Clinical Assessment

The ENT surgeon will immediately evaluate several critical features:

• Facial nerve function - Any facial weakness or palsy indicates either malignancy or serious complication requiring emergency evaluation 3
• Pain characteristics - Painful swelling typically suggests infection or inflammation, while painless masses raise concern for malignancy 3
• Bilateral versus unilateral involvement - Bilateral swelling suggests Sjögren's syndrome or systemic autoimmune process 3
• Associated symptoms such as difficulty swallowing, trismus, or regional dysesthesia that may indicate deep lobe involvement 1

Imaging Workup

The specialist will order appropriate imaging studies:

• High-frequency ultrasound (≥12 MHz) with color Doppler is the recommended first-line imaging study to distinguish parotid from extraparotid masses and characterize suspicious features 1, 3
• MRI with and without IV contrast is the preferred comprehensive imaging modality and should be obtained if deep lobe involvement is suspected, facial nerve dysfunction is present, or ultrasound findings are indeterminate 1, 3, 4
• Ultrasound has significant limitations for deep lobe parotid lesions, which is why MRI may be necessary for complete evaluation 1

Tissue Diagnosis

The specialist will perform appropriate biopsy when needed:

• Fine needle aspiration biopsy (FNAB) is the primary method for tissue diagnosis, not open biopsy 1
• Ultrasound-guided FNA is specifically recommended over palpation-guided FNA as it increases specimen adequacy rates, allows targeting of solid components, and reduces inadequacy rates 1, 3
• FNAC shows no false malignant findings in research studies, though it can occasionally be false benign (2.6% of cases) 5

Critical Pitfalls to Avoid

• Never allow a general practitioner or non-specialist to perform an open biopsy of a parotid mass, as this can cause tumor seeding and facial nerve damage 2
• Do not assume a mobile, superficial-appearing lesion is just beneath the skin - all parotid region lumps must be assumed to originate in the parotid gland 2
• Imaging alone cannot definitively distinguish benign from malignant parotid masses - histologic confirmation through FNA is essential for definitive diagnosis 1, 4

When to Seek Urgent Evaluation

Seek immediate ENT consultation if you develop:

• Facial nerve palsy or facial weakness 3
• Rapidly enlarging mass 3
• Fever and constitutional symptoms suggesting severe infection or lymphoma 3
• Difficulty swallowing or trismus 1