Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors

Abstract

Purpose Surgical treatment of benign parotid tumors has developed in the direction of less invasive procedures in recent years and has raised great debate about the best surgical approach. Aim of this article is to analyse anatomical and other factors that are important in selection of the appropriate surgical technique in treatment of benign parotid tumors. Furthermore, to discuss the risk of complications and recurrent disease according to selected operation. Finally, to define patient selection criteria to facilitate decision making in parotid surgery and become a guide for younger surgeons. Methods Literature review and authors' personal opinions based on their surgical experience. Results All possible surgical techniques for benign parotid surgery with advantages and disadvantages are being described. An algorithm with anatomical and other criteria influencing decision making in benign parotid surgery is presented. Conclusion Surgeons nowadays have many options to choose from for benign parotid surgery. ECD is one of the many surgical techniques available in parotid surgery and can achieve excellent results with proper training and if used for proper indications. PSP is mainly indicated in large tumors of the caudal part of the PG (ESGS level II). SP represents a universal solution in parotid surgery and should be the first technique young surgeons learn. TP has only few but important indications in benign parotid surgery. Surgeons need to carefully consider the patient and his/her preoperative imaging as well as her or his own special expertise to select the most appropriate surgical technique.

Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

“…Surgery currently remains the primary recommended treatment of WTs. The extent of the surgery depends on the size and location of the tumor [28,29]. Based on our evaluation of the literature and personal experience, there are four clear indications for upfront surgery (Table 1): (1) no reliable or no conclusive diagnosis of WT; (2) cosmetic concerns; (3) clinical complaints such as pain, infection, or ulceration [30] and (4) the patient's wishes to have the tumor removed.…”

“…Other clinical issues, mainly pain, recurrent infection, or ulceration (Figure 5) may also require surgical treatment. On occasion, the patient may present with urgency at the emergency department with acute swelling and fever suggesting an infection or abscess formation, which requires aspiration diagnosis and a course of antibiotics [29,31]. Pain can be present in some WT patients, especially when the tumor is compressed.…”

“…Extent of resection, varying from minimal surgeries to reduce postoperative complications and sequelae, to more extensive surgical procedures to lower the possibility of recurrences or metachronous WTs, is still controversial. Attempts have been made at the classification of parotid tumors in terms of size and location to aid with determining the extent of surgical excision [28,29], but there is no consensus on this matter. In Table 2, a general guideline for surgical approach in various clinical settings is proposed.…”

The use of Personal Protective Equipment during the COVID-19 pandemic: The effects on surgical wounds healing after parotid gland surgery

“…Preauricolar surgical approach to the parotid gland is a very common for the removal of parotid lesions. This approach involves a skin incision in the preauricular region with extension to the ear lobe and continues in the mastoid region according to the type of flap needed for the various types of surgery [ 3 ]. This means that both the superior and inferior loop of Personal Protective Equipment (PPE) are in contact with the wound.…”

Preoperative Multiparametric Ultrasound and Fine Needle Aspiration Cytology evaluation of parotid gland tumors: which is the best technique?

“…Surgical treatment of parotid tumors ranges from extracapsular dissection to total parotidectomy with or without neck dissection [5][6][7][8][9][10][11]. Characterization of parotid tumors is relevant in planning surgery and in predicting possible complications or recurrencies.…”