Parotid masses can be parotiditis, cysts or tumors. In parotiditis, the cause should be addressed and the inflammation and stones should be removed as soon as possible to prevent more serious complications and sequelae, while cysts and tumors should be surgically removed. Since tumors are common and more dangerous, they are discussed here mainly.
Among parotid tumors, benign tumors account for most of them (about 75%) and malignant tumors account for only a few (about 25%).
Most parotid tumors are “borderline tumors”. They are characterized by chronic growth and no conscious symptoms in the early stage. When the tumor is examined, it is generally well-defined and hard in texture. The surface of the mass is not smooth, mostly nodular, without facial palsy, which can occur if malignant. Low-grade malignant tumors are mucinous epidermis-like carcinoma most frequently, whose envelope is often incomplete and has a high recurrence rate clinically. Adenocarcinoma of the parotid is also not uncommon. Adenoid cystic carcinoma is characterized by rapid growth of the mass and early onset of facial paralysis due to tumor compression, and cancer cells can rapidly invade the facial nerve. Parotid adenoma-like lesions are rare.
The recognition of parotid tumors, which mostly have a malignant tendency and tend to be younger, can generally make a correct diagnosis, but there are still difficulties in the diagnosis of smaller tumors in the gland, and preoperative biopsy is generally not advocated to prevent the spread of tumor cells and implantation. Most people believe that iodine oil imaging of the parotid gland is also worthless for the diagnosis of small tumors in the gland. Currently, the best preoperative diagnostic test is MRI, followed by CT and ultrasound. Surgery for parotid tumors depends on the nature, size and location of the tumor. The removal of the tumor alone should be discarded because of the high recurrence rate. At present, the tumor gland is mostly removed together to prevent recurrence of the tumor.
For parotid malignant tumors that have invaded the facial nerve and clinically appear facial paralysis, the facial nerve should be sacrificed. The affinity between adenoid cystic carcinoma of parotid gland and facial nerve is strong and it is most likely to damage the facial nerve and cause facial palsy in early stage. …… Most of the parotid tumor resection adopts partial and total resection of tumor and gland to preserve the facial nerve. In the case of recurrence of mixed tumors, the facial nerve can be preserved again for removal of the tumor, and the search for the facial nerve depends on the location and size of the mass. In principle, the convenience at the time of surgery prevails.
Parotid tumors, whether benign or malignant, can occur at any age, but are more common between the ages of 30 and 50. Benign tumors are painless and slow-growing, and are often discovered unintentionally. The duration of the disease varies, from a few days to several years. Mixed
The tumor is usually centered on the earlobe and grows painlessly and gradually, spherical or oval, or nodular in shape. The surface is smooth, tough, non-adherent to the surrounding tissue, and mobile. When the tumor is large, it may appear as a typical nodule with an uneven surface and no adhesion to the skin, often soft at the elevated area and hard at the low area. Except for facial deformities, mixed tumors generally do not cause facial nerve dysfunction. If a mixed tumor grows slowly and exists for many years, and then grows faster in the near future, with signs of malignancy such as pain, tumor no longer moving, and facial nerve paralysis, it should be considered as a possible malignancy.
Mixed tumors of the parotid gland are usually seen in middle age. Generally, there are no obvious conscious symptoms, and the growth is slow, and the disease can last for several years or even decades. The tumor mostly appears as a firm and solid mass in the subauricular region with nodular surface, clear border, medium hardness, non-adhesive with surrounding tissues, mobility and no pressure pain. If the tumor has one of the following conditions, it should be considered to have the possibility of malignant transformation.
①Tumor suddenly grows rapidly and rapidly.
②Decreased mobility or even fixed.
(3) Pain or ipsilateral facial paralysis occurs.
The diagnosis of mixed tumor of the parotid gland is based on a thorough medical history, local physical examination, CT scan before surgery, and finally pathological examination to confirm the diagnosis.
Treatment of mixed tumors is based on the principle of complete surgical excision. Preoperative biopsy is generally not indicated. The envelope of the tumor is often incomplete, and sometimes the tumor cells may invade the envelope or extra-envelope tissues, which will recur if the resection is not complete. Therefore, the tumor should not be removed by enucleation, but by removing the tumor together with the surrounding parotid tissue. During surgery, attention should be paid to maintain the facial nerve. If there is malignant change, it should be treated according to the principles of malignant tumor treatment.
Parotid masses should be taken seriously, otherwise they may cause symptoms due to nerve compression due to gradual enlargement, or infection in the adjacent tissue spaces due to inflammation, or even loss of parotid function. The longer duration of the disease will affect the treatment effect and make it more difficult to cure and prone to recurrence. Therefore, parotid masses should be treated promptly to prevent complications and sequelae when they are found.
Inappropriate treatment modalities.
(1) External application of Chinese medicine. The external application of Chinese medicine to the parotid mass will cause tissue congestion and fiber proliferation, causing adhesions in the parotid tissue, which will not only prevent the tumor and cyst from receding, but also make surgical dissection of the facial nerve difficult, so external application of Chinese medicine should be absolutely contraindicated.
(2) Biopsy of parotid area. No matter how benign or malignant the parotid tumor is, biopsy such as puncture has the risk of implantation of tumor cells, so any kind of biopsy should be absolutely forbidden.
(3) Surgical treatment by removing only the tumor body. Parotid tumors, no matter benign or malignant, are invasive, i.e. tumors can invade adjacent tissues. The surgical method of removing only the tumor body without removing the superficial or deep lobe of parotid gland is extremely imperfect and is the main reason for recurrence after surgery. Therefore, once a lump grows in the parotid area, you should promptly consult a large regular hospital and avoid external application of Chinese medicine and puncture biopsy.
Suggestions.
Surgery is the only effective means to treat parotid tumor, and whether the first operation is correct and thorough is the key to cure. The first time the surgery is correct and thorough is the key to cure. Two principles must be followed in the surgery of benign parotid tumors: one is to ensure that the facial nerve is not damaged, especially the temporal facial stem; the second is to avoid breaking the tumor envelope, otherwise it will lead to the recurrence of tumor cell implantation.
Most of the benign tumors in parotid gland (75%) can be completely cured by surgical excision. However, the common complications after surgery are gustatory sweating syndrome, earlobe numbness and soft tissue depression in the earlobe area, etc. There is no ideal solution for their management. In our department, we use a modified surgical procedure to preserve the parotid chewing muscle fascia, the greater auricular nerve, and the sternocleidomastoid flap to achieve a radical effect and significantly reduce the occurrence of postoperative complications while preserving the function of the parotid gland. Patients treated with this procedure have received satisfactory results and relevant academic papers have been published.