Abstract

April 2006

Section 2 Head and Neck

The differential diagnosis of a parotid mass includes nonneoplastic lesions that behave like neoplasms. If the diagnosis is not obvious after a complete history and physical examination, further studies are warranted. The indications for computed tomography or magnetic resonance imaging include clinical uncertainty, deep-lobe presentation, extraglandular extension, cervical node involvement, facial palsy, and a fixed mass. At times, the use of fine-needle aspiration biopsy also helps resolve clinical uncertainty. Once surgery is decided on, the extent of parotidectomy depends more on the tumor's extent than its histology. At the least, superficial parotidectomy with preservation of the facial nerve is necessary. The decision whether to sacrifice the facial nerve is made on the basis of the pathologic diagnosis of malignancy, in conjunction with preoperative assessment of nerve function and intraoperative evaluation of the nerve in relation to the tumor. Management of the neck includes a comprehensive neck dissection for palpable disease; a selective neck dissection should be considered in patients with advanced-stage primary tumors, those with tumors of high-grade histology, and those with certain histologic types of tumor. Finally, postoperative radiotherapy must be considered for all patients except those with T1 or T2 malignant tumors with low-grade histology and clear margins. This chapter contains 46 references.

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