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, butin daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. Thisclinical 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 completehistory is collected from the patients with the duration and the site of the tumor, the facial nerve examined and itsassociations, a medical consultation done for opinion and management. Clinical examination with facial nerve wasmandatory to avoid any mistakes that may occur. The most significant single parameter in this series of malignanciesregarding disease specific survival was the clinical involvement of the facial nerve. Also for this reason, as there is noevidence that the facial nerve sacrifice improves prognosis, when it is not clinically involved, every attempt is madeto dissect and preserve it. A treatment plan was contemplated regarding nerve preservation for malignancy or withnerve 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 oneand a malignancy affected females more than males. Pleomorphic adenomas are the most frequent benign tumorswhile the adenocarcinoma most frequent malignant tumors.Conclusion: The most complicated situation concerning nerve preservation may be the recurrence of a benigntumor, in particular pleomorphic adenoma, which, in our series, has a higher incidence (62.5%) of permanent facialdysfunction, than surgery with nerve preservation for malignancy (37.5%) and to resects the nerve when is clinicallyinvolved and when is totally embedded in a clearly malignant neoplasm with attempt to preserve it in all other