Abstract
We reviewed the surgical treatment of 7 patients with advanced parotid carcinomas treated with radical parotidectomy. Histological types of the group consisted of 2 adenoid cystic carcinomas, 1 adenocarcinoma, carcinosarcoma, salivary duct carcinoma, undifferenciated carcinoma and mucoepidermoid carcinoma. Four were new patients and three had recurrent cases. Preoperative facial nerve paralylsis was observed in all patients, and severe trismus was noted in two.
All patients underwent some type of radical parotidectomy, four of whom had an en block excision, two had a total removal of the tumor in two pieces, and one had microscopic cancer involyment on the resection margins (because of perineural invasion to the facial nerve in the fallopian canal). The facial nerve was sacrificed in all patients, one of which was reconstructed immediately with the cervical plexus and three were reconstructed postoperatively with cross facial anastomoses. Over a variable period of time (2-28 months), three patients had died, two were associated with distant metastases and one had local recurrence.
As a result, we emphasize the importance of an en block excision of a tumor and control of possible distant metastases in the treatment of advanced parotid carcinomas. For the purpose of an en block excision, skull base surgery must be performed when the tumor involves the styloid process or the deep structure of the infratemporal fossa, or when perineural invasions to the facial nerve in the fallopian canal are strongly suspected.
