What Every Otolaryngologist Needs to Know About Parotid Tumor Management

PROGRAM DESCRIPTION: Parotid gland neoplasms are the most common salivary gland tumors and while most are benign, the parotid gland is also the most frequent site of parotid gland malignancy and many parotid swellings have overlapping clinical features. Understanding the workup and management of parotid masses is a fundamental core knowledge for all otolaryngologists. This panel will provide important guidance to the clinical evaluation of patients with parotid tumors including the role of imaging and biopsy in predicting the risk of malignancy. Surgery is the primary modality of treatment for most parotid neoplasms but tailoring the surgery to the pathology and extent of disease is important to avoid unnecessary morbidity. The panelists will discuss their approaches to incision design, nerve preservation and reconstruction for presumed benign neoplasms of the parotid gland. Panelists will describe nuances in surgery to avoid complications such as Frey's syndrome and wound complications. The controversy about extracapsular dissection will be discussed. In addition, the panel will address the approach to suspected or proven malignancy as well as the discovery of malignancy or other unexpected findings at the time of surgery or final pathology. The WHO classification of the vast array of salivary gland pathologies will be discussed. The Milan Classification for cytopathology and the role of ultrasound and MRI will be detailed. Nuances of surgery including extent of parotidectomy for benign and malignant tumors will be covered with the understanding that surgeons with markedly different levels of experience will encounter a multitude of scenarios. Tumor involvement of the deep lobe of the parotid gland and/or parapharyngeal space will be discussed. While the focus of the panel will be for comprehensive otolaryngologists and thus benign neoplasms will be emphasized, the potential pitfalls in diagnosis of other masses and clues in the workup that what appears benign or nonneoplastic can ultimately be malignancy so that appropriate patient counseling can be provided to patients.

OUTCOME OBJECTIVE 1: Recognize clinical and radiographic findings that are suggestive of malignancy when evaluating parotid tumors incorporating ultrasound, MRI and Fine needle aspiration to be more confident that what is being managed is a benign neoplasm.

OUTCOME OBJECTIVE 2: Understand nuances of parotid surgery for benign disease such as incision, sensory and motor nerve preservation.

OUTCOME OBJECTIVE 3: Discuss both standard and contemporary partial parotidectomy including deep lobe parotidectomy and extracapsular dissection.

BACKGROUND STATEMENT: Many otolaryngologists are not fully aware of the items we have listed in our objectives. A gap in knowledge for the general otolaryngologist who sees parotid tumors is substantial for both removal of tumors and reconstruction. The slightly revised course emphasizes comprehensive ENT.