Parotid Gland Surgery for Benign Tumours: Have We Come Full Circle?

Abstract

Parotid gland surgery has been described for over two centuries. The surgical philosophies in management of parotid gland tumors started off in the 18th century from a conservative approach of simple enucleation so as to minimize post-operative facial nerve palsy rate. This occurred, as there was a lack of understanding of surgical anatomy of the parotid gland and facial nerve. However unacceptably high recurrence rates ensued and this encouraged the further study of parotid gland anatomy till the 1950s when, deriving from a better understanding of the surgical anatomy, superficial parotidectomy with facial nerve identification and preservation became the new standard of care. This method then evolved to a partial superficial parotidectomy as this slightly more conservative approach allowed adequate parotid tumour resection with low recurrence rates and yet minimising post-operative complication such as Frey's syndrome. Over the last two decades, a more conservative approach known as an extracapsular dissection of parotid tumour emerged in certain high-volume centers as an alternative to a partial superficial parotidectomy. These centers published better post-operative results with lower postoperative facial nerve palsy rates, less Frey's syndrome and faster patient recovery. Dissection of parotid tumours via this technique involves following a plane close to the tumour and is similar to enucleation in terms of its conservative approach with very significant differences post-operatively. This article presents a summary on the surgical philosophies pertaining to parotid gland surgery since its inception two centuries ago.