End results in parotid tumors.

Management of parotid tumors can be based on a clinical classification of these lesions as being either "encapsulated" or infiltrating. The Warthin tumor (papillary cystadenolymphomatosum) is a benign encapsulated tumor, often occurring multicentrically or bilaterally especially in the lower pole area of the parotid. It is characterized clinically by its softness and fluctuation in size and a high incidence in elderly men. The so-called "capsule" of well demarcated mixed and mucoepidermoid tumors is represented by a condensation of host fibrous stroma, in the interstices of which tumor cells may be present. The "encapsulated" tumors should be excised with a "shell" of uninvolved parotid tissue. To do this safely, the facial nerve should first be isolated. Total parotidectomy is necessary only if the size of the tumor, the multiplicity of recurrences, or the infiltrating nature of the tumor are such that complete eradication of the primary site must be done. Radical neck dissection is never performed electively except in the small group of nonencapsulated infiltrating primary lesions. In a series of cases of previously untreated parotid tumors treated by the method outlined, the local parotid recurrence rate was less than 1 per cent.