Operative Procedure of Choice

The treatment of choice for salivary gland neoplasms is surgical excision. In the United States, it is generally agreed that superficial parotidectomy consisting of the identification and preservation of the facial nerve and removal of the portion of the gland superficial to the nerve is both diagnostic and curative for most parotid gland neoplasms.

French surgeons15 recommend a procedure called total conservative parotidectomy with facial nerve preservation for the most common parotid neoplasm, benign pleomorphic adenoma. On the basis of their experience with 256 patients, their analysis showed pleomorphic adenoma to involve the deep lobe of the gland in17% of patients and both the superficial and deep lobe in 32%. They conclude that a superficial parotidectomy would have been inadequate in almost one-half of this large series of patients. The procedure carried a rather high complication rate in terms of temporary facial paresis (65%) and permanent facial paresis (4%). These surgeons noted postoperative Frey syndrome in two-thirds of their patients. Using this procedure, they observed only one recurrent pleomorphic adenoma in the entire series.

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