A new approach to parotid tumor treatment

Parotid tumors are one of the high incidences in oral and maxillofacial surgery and are prone to recurrence and local deformity after surgery. In recent years, we have made great progress in individualized radical surgical treatment of parotid tumors and postoperative deformity repair and complication prevention. The traditional surgical treatment is: if the tumor is located in the superficial lobe of the parotid gland, facial nerve dissection together with total excision of the tumor and superficial lobe of the parotid gland is performed; if the tumor is located in the deep lobe and isthmus of the parotid gland, total excision of the tumor and parotid gland is performed. Although the traditional surgery is in accordance with the principles of oncologic surgery, the postoperative deformity is serious and the function of the parotid gland is completely lost. In view of the above situation, our department found through continuous pathological sectioning of the tumor and the parotid tissue around the tumor that the infiltration of the surrounding glands by mixed parotid tumors and adenolymphomas usually does not exceed 0.5 cm. For patients with tumors smaller than 3.5 cm in diameter, we use partial excision of the tumor plus the surrounding gland or excision of the tumor plus the lower pole of the gland; for patients with tumors larger than 3.5 cm in diameter, we perform conventional total excision of the tumor and the superficial lobe of the parotid gland; for patients with tumors located in the deep lobe, we preserve the superficial lobe of the parotid gland and the duct to perform deep lobe excision of the tumor. The correctness of this surgical treatment has also been confirmed by many other scholars at home and abroad. In the field of postoperative deformity repair and complication prevention, we have achieved remarkable results. For malignant parotid tumors and large mixed parotid tumors, total parotidectomy with the tumor is necessary, which results in severe facial depression and deformity after surgery, and many patients develop gustatory sweating syndrome. In recent years, our department has adopted the method of sternocleidomastoid flap rotation filling and other repair methods, which has been proved by clinical practice that this method can achieve good results in eliminating postoperative facial depression deformity and gustatory sweating syndrome. The conventional parotid surgical incision is an “S” type incision in the parotid area and submandibular area, which exposes the surgical field well, but the postoperative incision scar is obvious. The angular incision (i.e., from above the ear screen, down along the free edge of the ear screen to the earlobe, then from the anterior crease of the earlobe around the earlobe to the posterior sulcus of the earlobe, and then turning posteriorly to the posterior area of the ear into the hairline) has been improved in recent years, which not only exposes the surgical field better, but also leaves no obvious incision scar in the postoperative area.