Conservative parotidectomy for the treatment of parotid cancers
Introduction
Malignant tumors of the parotid gland represent 1–3% of all tumors of the head and neck.1 Because of their relative rarity and varied biological behaviors, the optimal treatment of parotid malignancies is still in debate.2, 3 Surgical resection has been the standard treatment for primary parotid cancers.
A parotidectomy can be classified in terms of the extent of resection as conservative, superficial, or total. A conservative parotidectomy is defined as any procedure that is less than a superficial parotidectomy, and where less than a full facial nerve is dissected.4, 5
The determination of the resection margin depends on the facial nerve position and the obtainment of a clear safety margin. Generally, the surgical treatment for most malignant parotid tumors confined to the superficial lobe is the classic superficial parotidectomy, where the entire superficial lobe is resected. One exception is the histologically proven high-grade tumor, for which a total parotidectomy is usually performed.6, 7
Nonetheless, we would like to suggest a different approach. We believe that if the tumor is confined to the superficial lobe and is sufficiently distant from the facial nerve, it is not always necessary to resect the entire superficial lobe. The reason for this belief is that while the deep surgical margin is fixed at the facial plane of the facial nerve, the resection margin that the surgeon must select is associated with the horizontal extent of the tumor, not with its depth.
With these considerations, the goal of this study was to evaluate the oncologic efficacy of conservative parotidectomies in a series of patients with malignant tumors of the parotid gland.
Section snippets
Patients and methods
A retrospective analysis of 112 previously untreated consecutive patients with malignant tumors of the parotid gland was performed. All patients were seen from 1992 through 2002 at Severance Hospital, Yonsei University, Seoul, Korea. Thirty-nine patients who underwent total or radical parotidectomy due to tumor extension to the deep lobe, intraoperative facial nerve invasion, or presence of preoperative facial nerve palsy, were excluded. In addition, 13 patients who underwent superficial
Histopathology
Table 2 shows the number of patients in our series with each histologic tumor type and grade. Sixteen tumors (37%) were high-grade and 27 tumors (63%) were low-grade cancers.
Surgical margin
Six patients (14%) had cancer involvement in a margin of the parotidectomy specimen. These tumors were classified as follows: mucoepidermoid carcinoma (two cases), adenoid cystic carcinoma (one case), squamous cell carcinoma (one case), adenocarcinoma (one case), and carcinoma ex pleomorphic adenoma (one case). Four cases
Discussion
The aim of parotid surgery is to eradicate the pathologic process while preserving the facial nerve. The malignant parotid tumors can be resected without sacrificing the facial nerve, especially if nerve function is normal before surgery. However, facial nerve preservation does not always correlate with normal postoperative function. Even when the nerve is carefully dissected, significant facial weakness can occur. The extent of the surgery, one of the previously described risk factors, is
Acknowledgements
This study was presented at the 10th International Congress on Oral Cancer, Island of Crete, Greece, 19–24 April 2005, and supported by Konkuk University Grant 2004.
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