Parotid tumours

The parotid gland is a large salivary gland situated just in front of the ear. Benign as well as malignant (cancer) tumours can occur in the parotid gland. In Australia where the incidence of skin cancer is very high, metastasis (secondary spread) from facial skin cancer, especially squamous cell carcinoma, melanoma and Merkel cell carcinoma to lymph nodes around/ within the parotid gland is common.

Benign tumours include

  • Pleomorphic adenoma (most common)
  • Warthin’s tumour (bilateral in some cases, present most commonly in the 6th and 7th decades)
  • Oncocytoma and other rare tumours

Malignant tumours include

  • Metastasis from skin cancers
  • High and low grade mucoepidermoid carcinoma
  • Salivary duct carcinoma
  • Squamous cell carcinoma
  • Acinic cell carcinoma
  • Adenoid cystic carcinoma

Management

Ultrasound-guided fine needle aspiration (FNA) is used to obtain cytology for diagnosis. CT scan can be used to assess tumour bulk, local invasion and whether there is any radiological sign of disease having spread to lymph nodes in the neck.

Surgery (parotidectomy) is the standard treatment for most parotid pathology. Radiotherapy may be used following surgery as an adjunct. Targeted molecular therapy is hoped to bring breakthroughs.

Parotidectomy

Parotidectomy is surgery to remove the parotid gland, the largest salivary gland. The parotid gland is usually removed because of a tumour (benign or malignant), chronic infection, or a blocked salivary duct.

The facial nerve (the nerve responsible for frowning, eye closure, nose wrinkling, smiling, and lip movement) passes through the middle of the parotid gland, and has to be protected during parotidectomy. The aim is to protect the facial nerve so that the surgery does not result in weakened facial movements. In a small minority of patients this is impossible due to the location or size of the tumour. A facial nerve monitoring device allows monitoring of the nerve during the operation.

If your parotid tumour is benign, Associate Professor Ch’ng can usually perform your surgery through a mini-facelift incision. She can also correct any contour deformity in your cheek or upper neck following removal of your tumour with fat transferred from another part of your body. Your scar will be inconspicuous.

A small drain is usually inserted into the wound to drain body fluid and blood from the wound site. The drain is usually removed before you are discharged from hospital. You will remain in hospital for 2 nights.