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<p>Salivary gland tumors account for less than 3% of all head and neck neoplasms. </p><p>Benign tumors are more common than malignant ones. The primary treatment for benigh tumours is surgical excision and for malignant tumours is resection followed by adjuvant treatment depending on stage. A 38-year-old female presented to the outpatient department with recurrent left parotid swelling. Previously excision of the swelling was done twice, initially in 2018 and later in 2023. Facial nerve functions were intact and the deep lobe was not palpable on examination. Ultrasonography revealed recurrent left parotid neoplasm possibly pleomorphic adenoma involving the superficial lobe. CT and MRI were suggestive of recurrent parotid tumour with intraparotid lymph nodes. FNAC was inconclusive. Patient underwent total parotidectomy with facial nerve preservation with frozen section of level II lymph node under general anaesthesia. Due to anatomical distortion, facial nerve was traced in a retrograde manner. Patient developed slight neuropraxia in the postoperative period which resolved on follow up. Histopathology report was suggestive of epithelial myoepithelial carcinoma stage pT4aN0 with lymphovascular invasion. Postoperatively, patient received concurrent chemoradiotherapy. Preoperative FNAs are not reliable to differentiate between benign versus malignant parotid swellings and hence, a clinical decision should be made on examination and radiological findings. MRI is a better modality to check involvement of facial nerve as compared to a CT scan and should be judiciously used when required. Such cases should be planned with a frozen section of level II LN and complete neck dissection if positive. The surgeon must be well versed with basic principles of parotid surgery and retrograde as well as anterograde facial nerve dissection. Recurrent parotid swellings require in depth evaluation. Facial nerve preservation should be attempted in total parotidectomy cases where preoperative nerve functions are intact and anatomy is favourable. Malignant parotid tumours should be discussed in the tumour board and referred for radiation where indicated.</p>

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Total Parotidectomy with Facial Nerve Preservation in a rare case of Primary Epithelial Myoepithelial Carcinoma of Parotid Gland

  • 期刊论文

  • 发表日期：

    2026年4月4日

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  • Shivang Shukla,
  • Shreyanshi Gupta

摘要

Salivary gland tumors account for less than 3% of all head and neck neoplasms.

Benign tumors are more common than malignant ones. The primary treatment for benigh tumours is surgical excision and for malignant tumours is resection followed by adjuvant treatment depending on stage. A 38-year-old female presented to the outpatient department with recurrent left parotid swelling. Previously excision of the swelling was done twice, initially in 2018 and later in 2023. Facial nerve functions were intact and the deep lobe was not palpable on examination. Ultrasonography revealed recurrent left parotid neoplasm possibly pleomorphic adenoma involving the superficial lobe. CT and MRI were suggestive of recurrent parotid tumour with intraparotid lymph nodes. FNAC was inconclusive. Patient underwent total parotidectomy with facial nerve preservation with frozen section of level II lymph node under general anaesthesia. Due to anatomical distortion, facial nerve was traced in a retrograde manner. Patient developed slight neuropraxia in the postoperative period which resolved on follow up. Histopathology report was suggestive of epithelial myoepithelial carcinoma stage pT4aN0 with lymphovascular invasion. Postoperatively, patient received concurrent chemoradiotherapy. Preoperative FNAs are not reliable to differentiate between benign versus malignant parotid swellings and hence, a clinical decision should be made on examination and radiological findings. MRI is a better modality to check involvement of facial nerve as compared to a CT scan and should be judiciously used when required. Such cases should be planned with a frozen section of level II LN and complete neck dissection if positive. The surgeon must be well versed with basic principles of parotid surgery and retrograde as well as anterograde facial nerve dissection. Recurrent parotid swellings require in depth evaluation. Facial nerve preservation should be attempted in total parotidectomy cases where preoperative nerve functions are intact and anatomy is favourable. Malignant parotid tumours should be discussed in the tumour board and referred for radiation where indicated.