The Clinical Approach and Treatment of Benign and Malignant Parotid Masses

Abstract

Background: Parotid gland tumors account for 80% of all salivary gland neoplasms, 20% of these are malignant, but in daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve. Materials and methods: 45 patients underwent parotidectomy for benign and malignant neoplasms. A complete history is collected from the patients with the duration and the site of the tumor, the facial nerve examined and its associations, a medical consultation done for opinion and management. Clinical examination with facial nerve was mandatory to avoid any mistakes that may occur. The most significant single parameter in this series of malignancies regarding disease specific survival was the clinical involvement of the facial nerve. Also for this reason, as there is no evidence that the facial nerve sacrifice improves prognosis, when it is not clinically involved, every attempt is made to dissect and preserve it. A treatment plan was contemplated regarding nerve preservation for malignancy or with nerve sacrifice.
Result: This study showed that females (62%) are more affected than males (38%),tumors occur at left parotid gland (65%) more than right parotid gland (35%), a malignancy affected the left parotid gland more than the right one and a malignancy affected females more than males. Pleomorphic adenomas are the most frequent benign tumors while the adenocarcinoma most frequent malignant tumors.
Conclusion: The most complicated situation concerning nerve preservation may be the recurrence of a benign tumor, in particular pleomorphic adenoma, which, in our series, has a higher incidence (62.5%) of permanent facial dysfunction, than surgery with nerve preservation for malignancy (37.5%) and to resects the nerve when is clinically involved and when is totally embedded in a clearly malignant neoplasm with attempt to preserve it in all other.