THERE ARE several key points in the preoperative examination of a patient with a parotid tumor: (1) Is the tumor benign, or a low-grade vs high-grade malignancy? (2) Does the tumor involve the facial nerve, ie, will the patient need a nerve graft? (3) Does the tumor involve the deep lobe, and how is it related to the carotid artery? (4) Will a neck dissection be necessary?
The most efficient and least expensive evaluation consists of a history and physical examination. In 90% of patients, a careful history and physical examination will direct the physician to the next course of action—usually a superficial parotidectomy and a frozen section of the tumor followed by a deep-lobe parotidectomy if deemed necessary. No other test or imaging is needed. The frozen-section diagnosis is accurate about 93% of the time,1 when the tumor is categorized into 1 of 3 broad groups: (1) benign, (2) low-grade cancer, and (3) high-grade cancer. In the case of a benign or low-grade malignancy with adequate margins, a superficial parotidectomy is adequate treatment. On the other hand, when dealing with positive margins, adenoid cystic carcinoma, or one of the high-grade malignancies (high-grade adenocarcinoma, malignant mixed tumor, high-grade mucoepidermoid or acinic cell adenocarcinoma, squamous cell carcinoma, or undifferentiated carcinoma), a deep-lobe parotidectomy should be performed.
Fee WE, Tran LE. Evaluation of a Patient With a Parotid Tumor. Arch Otolaryngol Head Neck Surg. 2003;129(9):937-938. doi:10.1001/archotol.129.9.937