The morbidity rate following 112 operations on the parotid gland is reported. Facial nerve palsy (temporary, 38 per cent; permanent, 9 per cent) and Frey's syndrome (11 per cent) were common following superficial parotidectomy. For pleomorphic adenoma and malignant lesions this procedure is justified. Benign conditions, which can be diagnosed preoperatively, should be treated by more limited surgery which has a lower complication rate.

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Over a 14-year period 34 patients were referred for surgical treatment of insulinoma. The diagnosis was confirmed by demonstrating hypoglycaemia with inappropriate hyperinsulinaemia during prolonged fasting. Selective visceral angiography localized 30 solitary benign insulinomas and two carcinomas. In two patients with islet cell hyperplasia, angiography demonstrated a single lesion only. Ultrasonography had a sensitivity of 15 per cent and computed tomography a sensitivity of 24 per cent in the localization of tumours. All patients but one were treated by operation. Eighteen tumours were enucleated and 13 (including both patients with islet cell hyperplasia) were treated by distal pancreatectomy. Two patients underwent negative primary exploration; both had single adenomas removed at re-exploration. There were no operative deaths but nine patients (predominantly those undergoing pancreatic resection) had complications. Thirty-one patients were symptom-free following operation at a mean follow-up of 16 months.

A seriously ill patient was found to have megaloblastic changes in his bone marrow after a nitrous oxide anaesthesia which lasted for 105 min. After an interval of 7 h a second nitrous oxide anaesthetic was administered, during which the patient received 30 mg of folinic acid. His marrow was normal when assessed 4 h later.

Operations on the parotid gland present a considerable surgical challenge because the anatomy is delicate and the pathology diversel. Formal parotidectomy has become the preferred treatment for space-occupying lesions' ; this approach has evolved because pleomorphic adenoma is the commonest lesion. This operation can be technically demanding and the residual disabilities are serious in a significant number of patients. Facial nerve palsy is the single greatest problem, and can be temporary (1 1-82 per cent) or permanent (&17 per centI3. Masses of benign origin on the other hand require only enucleation and this has a lower morbidity4. Therefore, an accurate preoperative diagnosis would allow less radical surgery in some patients and should reduce complications. Patients and methodsThe case notes of 84 patients presenting with a lump in the parotid region over an 8-year period (1981-88) have been reviewed. Following clinical diagnosis of a lump in or related to the parotid gland two additional diagnostic methods have been used.Forty-four patients (34 men) were investigated by fine needle aspiration cytology (FNAC) using a standard technique. The age range was 17-8 1 years. The preoperative cytological diagnosis was compared with the final histopathological one after examination of the surgical specimen. In addition, the last 18 patients had a computed tomographic (CT) scan of the parotid region. ResultsThe results and accuracy of fine needle aspiration are shown in T a b l e l . The accuracy was 100percent with pleomorphic adenoma and 75 per cent with adenolymphoma with no false positive or false negative diagnoses of malignancy. Follow-up ranged from 4 to 96 months with a mean of 30, and there have been no local recurrences to date. Three patients had