Limited Parotidectomy: The Role of Extracapsular Dissection in Parotid Gland Neoplasms

OBJECTIVE: Surgical techniques for parotid gland neoplasm removal have been shaped over the years by the importance of the gland's relationship with the facial nerve, histologic behavior of parotid tumors, and recurrence rates from specific techniques. Parotidectomy with facial nerve dissection has become the procedure of choice in removal of parotid gland neoplasms because of the resulting low recurrence rate. However, these more comprehensive dissections can cause significant postoperative complications, some cosmetically devastating. We propose that a more limited dissection yields a similar low recurrence rate but with less risk of complications. STUDY DESIGN: Retrospective case series. METHODS: A retrospective review of the clinical outcomes and pathology of 27 patients who underwent extracapsular dissection for parotid gland neoplasms. RESULTS: All tumors were located in the superficial lobe of the parotid gland and size of the masses ranged from 4.0 to 1.0 cm (mean 2.4 cm) in diameter. Pathology of the parotid tumors consisted of 11 pleomorphic adenomas, six Warthin's tumors, six benign epithelial cysts, one sarcoid lesion, two lymphoid hyperplasia, and one Kaposi's sarcoma. There were no cases of capsular rupture. There was no temporary or permanent facial paralysis and no incidence of Frey's syndrome. One patient developed a sialocele, which was aspirated and resolved after 3 months. There were no recurrences with follow-up times between 5 months and 6 years (mean 41 mo). CONCLUSION: We advocate extracapsular dissection for benign parotid neoplasms because of the acceptable recurrence rates with limited complications as compared to superficial parotidectomy.