Conservative Total Parotidectomy (April.2020)

Case presentation

Our patient is a 39-year-old male who presented with a left parotid mass of 2-year duration that was increasing in size over the last 4-months period. Upon examination, there was a 3 × 2 cm firm, painless, mobile mass, and facial nerve function was intact. A 2.5 cm solid lobulated mass lesion with a soft edge property in the left parotid gland was identified on MRI (fat-suppressed T2-weighted images showed mild hyperintensity, T1-weighted images showed hypointensity, and postcontrast images showed low contrast enhancement). Fine needle aspiration biopsy revealed indeterminant cytology with suspicions malignancy. Due to these findings, a left conservative total parotidectomy plus single adjacent lymph node excision had been performed.
Clinical and laboratory review for SARS – COVD-19 was negative. However all precautions for SARS – COVID-19 were taken during operation.
After histopathologic analysis, Adenoid cystic carcinoma with reactive lymph node.
Uneventful postoperative course with completely intact left facial nerve. The patient referred to oncology deportment.

Review of literature

Conservative and functional surgery in the treatment of salivary gland tumours

Guangyan Yu & Xin Peng
International Journal of Oral Science volume 11, Article number: 22 (2019)

Abstract

The principle of modern oncological surgery is to conserve the functional organs or tissues as much as possible based on eradication of the tumour. For salivary gland tumours, conservative and functional salivary surgery, including partial sialoadenectomy as well as anatomical and functional preservation of the facial nerve, great auricular nerve, superficial musculo-aponeurotic system (SMAS), and Stensen’s duct, has become increasingly popular. In the present review, we discuss the following aspects of conservative and functional surgery in the treatment of salivary gland tumours: (i) partial superficial parotidectomy (PP) to treat benign parotid gland tumours, (ii) modification of surgical incisions to improve cosmetic results, (iii) modification of the surgical approach to decrease complications, (iv) extracardial dissection to treat benign superficial parotid tumours, (v) partial sialoadenectomy to treat benign submandibular gland tumours, and (vi) 125I brachytherapy to preserve facial nerves. The majority of the operated parotid or submandibular glands are preserved, and surgical complications are also decreased. Conservative and functional surgery plays a significant role in maintaining normal salivary gland function and in improving patients’ quality of life during the treatment of salivary gland tumours and thus should be further promoted.