Farzad Borumandi1, Katherine S George, Luke Cascarini. 1. Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK. f.borumandi@web.de
Abstract
PURPOSE: The majority of parotid tumours are benign, making parotid surgery a compromise between adequate tumour excision and preservation of function and facial harmony. Besides the traditional superficial or total parotidectomy, less invasive techniques have been described with similar recurrent rates. The aim of this review is to assess the evidence in the published literature and to summarise the advantages and disadvantages of the available techniques. METHODS: A systematic search in Pubmed for studies on surgery of benign parotid tumours (BPTs) published between January 2000 and January 2012 was conducted. Case series with a clear description of the surgical technique and a minimum number of 10 patients were included. RESULTS: Four hundred sixty-three articles were found, 49 abstracts reviewed and 37 case series were selected for this review. The surgical techniques for benign parotid tumours can largely be grouped into facial nerve dissecting (superficial parotidectomy, partial superficial parotidectomy and total parotidectomy) and non-nerve dissecting techniques (extracapsular dissection). With all of the currently used techniques, a low recurrence (<3 %) with a low incidence of permanent facial nerve morbidity (0.2-4 %) can be achieved. The tumour-facial nerve interface and pseudopodia are areas at risk for positive margins. CONCLUSION: There is currently no agreement in the literature about the extent of surgery for BPTs to obtain an adequate margin. The tumour nerve interface is the predetermined area at risk for tumour spillage and positive margin. A prolonged follow-up is recommended. Further long-term randomised clinical trials are required to address the question of the extent of the excision in benign parotid surgery.
PURPOSE: The majority of parotid tumours are benign, making parotid surgery a compromise between adequate tumour excision and preservation of function and facial harmony. Besides the traditional superficial or total parotidectomy, less invasive techniques have been described with similar recurrent rates. The aim of this review is to assess the evidence in the published literature and to summarise the advantages and disadvantages of the available techniques. METHODS: A systematic search in Pubmed for studies on surgery of benign parotid tumours (BPTs) published between January 2000 and January 2012 was conducted. Case series with a clear description of the surgical technique and a minimum number of 10 patients were included. RESULTS: Four hundred sixty-three articles were found, 49 abstracts reviewed and 37 case series were selected for this review. The surgical techniques for benign parotid tumours can largely be grouped into facial nerve dissecting (superficial parotidectomy, partial superficial parotidectomy and total parotidectomy) and non-nerve dissecting techniques (extracapsular dissection). With all of the currently used techniques, a low recurrence (<3 %) with a low incidence of permanent facial nerve morbidity (0.2-4 %) can be achieved. The tumour-facial nerve interface and pseudopodia are areas at risk for positive margins. CONCLUSION: There is currently no agreement in the literature about the extent of surgery for BPTs to obtain an adequate margin. The tumour nerve interface is the predetermined area at risk for tumour spillage and positive margin. A prolonged follow-up is recommended. Further long-term randomised clinical trials are required to address the question of the extent of the excision in benign parotid surgery.