Removing Mastoid Tip Procedure for Advanced Parotid Cancer Results in Easy Identification of the Facial Nerve and Adequate Surgical Margin

Abstract

Background: Advanced parotid cancers larger than 4 cm were firmly fixed around the tissue, and the main trunk of the facial nerve could hardly be detected in the narrow working space between the mastoid tip and parotid gland with cancer. Though the facial nerve was preserved, facial nerve stretching during surgery can have the serious effect of postoperative facial palsy. Methods: The study was performed on 23 advanced parotid cancers that were larger than 4 cm and invaded firmly around the parotid. Seventeen cases were fresh cases and 6 were recurrent cases. Number of Stage III, IVA, and IVB were 4, 11, and 8, respectively. Results: Twenty-three patients required either mastoid tip removal (n: 19) or extended temporal bone resection (n: 4) for advanced parotid cancer. In nine cases, the main trunk of the facial nerve was sacrificed, and in five cases, tumors in the lower division of the nerve were resected. Theses facial nerves were reconstructed immediately. Negative margins were achieved in 100% of the patients. Conclusion: Removing the mastoid tip for advanced parotid tumors facilitates identification of the facial nerve and, therefore, better preservation of the normal facial nerve function.