Contemporary management of benign parotid tumours – the increasing evidence for extracapsular dissection

Abstract

Benign parotid tumours have historically often been managed surgically by superficial parotidectomy. While this approach usually gives a generous cuff of surrounding normal parotid tissue to increase tumour margins, it requires a much larger incision than the increasingly used extracapsular dissection (ECD) technique. Furthermore, superficial parotidectomy can result in marked facial hollowing, Frey syndrome and an increased risk of both temporary and permanent facial nerve weakness. ECD has been popularised as a safe alternative to parotidectomy primarily for the removal of mobile, benign parotid tumours with safe outcomes and reduced risk to the facial nerve. In this article, we review the growing body of evidence for ECD and include our own experience confirming the move away from superficial parotidectomy in contemporary practice for the treatment of benign parotid tumours.

Contemporary treatment of salivary gland tumors. A review of the literature

“…In the second half of the 20th century enucleation was replaced with superficial parotidectomy (SP), especially in cases of parotid neoplasms deriving from the superficial layer of the glands been taught and practiced as the standard management for most parotid tumors arising in the superficial part of the gland (4). Although this therapeutic approach led in less than 5% recurrence rate, it was inculpated for a number of adverse events, including facial hollowing, Frey's syndrome, damage of the great auricular nerve and branches of the facial nerve itself [4].…”

“…Although this therapeutic approach led in less than 5% recurrence rate, it was inculpated for a number of adverse events, including facial hollowing, Frey's syndrome, damage of the great auricular nerve and branches of the facial nerve itself [4]. Meanwhile, a number of surgeons gradually started to recommend less invasive surgical approach for the excision of non malignant neoplasms as a way to decrease not only morbidity but also complication rates (4).…”

“…In late 1990s extracapsular dissection (ECD) was introduced as an alternative technique, instead of SP in presence of mobile, non malignant parotid swellings, followed by a lower risk of facial nerve damage or Frey's syndrome presence (4). As a result, SP is now conducted in a very limited range of cases (4).…”

“…Nerve monitor has been suggested for decreasing risk of damaging facial nerve without success (4). No adverse events are reported (including permanent nerve weakness) except for temporary weakness in less than 7% of cases (4).…”

“…Although ECD is supported to result in a lower risk of facial nerve injury compared to SP, some authors claim that narrow surgical margins after ECD have been related to recurrence (4,9). In such cases, a combined use of chemotherapy and radiotherapy could be an alternative as long as these patients are systematically healthy (9).…”