Conclusion

1. Most parotid masses represent benign neoplasms, most commonly pleomorphic adenoma, originating from the superficial lobe of the gland. In this clinical scenario, surgical excision is usually all that is required to provide both definitive diagnosis and adequate treatment.

2. FNAB is helpful in treatment planning for patients presenting with parotid masses. The accuracy of this technique depends on sample adequacy, tumor cellularity, and the experience of the cytopathologist.

3. The routine use of imaging in small well-defined masses of the superficial lobe of the parotid gland is probably not warranted. However, tumors presenting with clinical findings suggestive of malignancy, tumors arising from the deep lobe of the parotid gland, or tumors extending to the parapharyn-geal space are better evaluated with high-resolution imaging.

4. During parotid gland surgery for excision of malignant tumors the facial nerve is usually dissected and preserved, unless there is evidence of gross invasion or microscopic infiltration of the nerve by tumor, or there was evidence of preoperative facial weakness or paralysis.

5. The incidence of occult nodal metastasis in patients with large and/or high-grade malignant tumors is relatively high; therefore, an elective neck dissection should be considered in these patients.

6. Postoperative radiation therapy is generally recommended for patients with poor prognostic indicators including highgrade tumors, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins.

7. Fast-neutron radiotherapy is a promising treatment option for patients with inoperable primary or recurrent malignant salivary gland tumors.

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Hanna and Suen—CHAPTER 66

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