James Y Suen

The Parotid Neoplasm

CHAPTER 64

Byron J. Bailey

Parotid neoplasms are quite diverse in terms of their histology and biologic behavior. As a group, they represent about 2% of all head and neck neoplasms, and parotid gland tumors account for 70 to 80% of all neoplasms of the salivary glands. Parotid neoplasms are usually benign (80% for adults), and the most common benign neoplasm is the pleomorphic adenoma (about 85%) in adults, whereas hemangiomas and lymphangiomas are the most common neoplasms in children. Malignant tumors are divided into low-grade and high-grade neoplasms. The low-grade category comprises (1) low-grade mucoepidermoid,

(2) low-grade adenocarcinoma, (3) acinic cell carcinoma, (4) basal cell adenocarcinoma, and (5) terminal duct adenocar-cinoma. The high-grade group includes intermediate and highgrade mucoepidermoid, (2) adenoid cystic, (3) carcinoma ex pleomorphic adenoma, (4) adenocarcinoma, (5) undifferentiated carcinoma, (6) salivary duct carcinoma, and (7) dediffer-entiated acinic cell carcinoma.

The controversies that arise concerning the diagnosis and management of salivary gland neoplasms reflect the necessity to achieve an accurate pathologic diagnosis in order to initiate the proper therapy. In most circumstances, the surgeon will not have definitive diagnostic information until the surgical specimen has undergone permanent section analysis by the surgical pathologist. In this situation, we are pushed to the limit to outline a treatment course most likely to preserve facial nerve function, prevent tumor recurrence, and deal appropriately with a broad range of tumor aggressiveness.

The controversies dealt within this section are: (1) the role of fine-needle aspiration biopsy, (2) imaging parotid neoplasms,

(3) selecting the proper surgical procedure, and (4) the role of radiotherapy.

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