Extracapsular dissection of parotid tumors and postoperative Malignant histology

Introduction
Extracapsular dissection (ECD) of parotid gland tumors is a surgical method associated with fewer complications compared to lateral or total parotidectomy. If a preoperative evaluation indicates a benign parotid tumor, and the location allows an ECD, this approach is recommended. However, challenges arise when histopathology contradicts the suspected benign diagnosis postoperatively.

Materials and Methods
We retrospectively reviewed patients who underwent ECD at our university hospital between 2014 and 2022, revealing malignant histopathological findings. Decisions from tumor board regarding postoperative treatment and patient clinical courses were documented.

Results
Of a total of 1242 parotidectomies, in 645 patients an ECD was performed and 39 were diagnosed with malignant histology after ECD. Malignant lymphoma was seen in 12 cases (31%), followed by metastases (n=10). Of the 17 patients (44%) who had a primary parotid tumor, 41% (n=7) showed a low grade tumor with free margins and were decided for follow up. No recurrence was detected until now. The other 10 patients had either unclear margins or high grade tumors and received a total parotidectomy with or without neck dissection.

Discussion
Nowadays 21 distinct malignant epithelial tumor types in salivary glands are recognized. Given the tumors' heterogeneity, personalized treatment plans are crucial. In situations requiring operation after ECD, the risk for a facial nerve palsy remains the same as for the first surgery. Moreover our results demonstrate excellent outcomes when employing only ECD as a single treatment modality for carefully selected patients with low-stage, low-grade lesions, free margins and high compliance.

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