Because of poor survival rates for patients with parotid cancer, surgeons in the past often recommended total parotidectomy with facial nerve sacrifice, radical mastoidectomy, and radical neck dissection. Unfortunately, these procedures had high morbidity, did not provide adequate local-regional control, and did not improve survival. Today, more conservative surgical procedures are often combined with postoperative radiation therapy to provide improved local regional control and outcome. Unfortunately, no one oncologic procedure is applicable to all parotid cancers. The surgeon must individualize the approach to each tumor so that the entire lesion can be resected en bloc with negative margins and with the least amount of morbidity.
Most parotid cancers arise in the gland's superficial lobe.
The surgical procedure of choice provides an adequate tumor free margin and is dictated by the amount of tumor extension. The facial nerve is sacrificed only if directly incorporated in the tumor mass or if preservation would require violation of the tumor. The nerve can often be preserved even when adjacent to a malignant tumor. When a previously functioning nerve is sacrificed, it should be reconstructed with a cable graft from the greater auricular or sural nerve. Nerves that lack function before surgery rarely regain function with resection and grafting.