A conservative approach to benign parotid tumours

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Neil Shah

Queen's Hospital, UK

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Abstract

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Extracapsular dissection (ECD) for benign parotid tumors is increasingly carried out in many centers but remains controversial. Historically these tumors were removed by enucleation which resulted in very high (up to 45%) recurrence rates. This, along with histological perspectives on pleomorphic adenomas caused a shift towards procedures involving a formal identification of the facial nerve along with removal of the tumor (for example: partial superficial parotidectomy, PSP). ECD involves careful blunt dissection through the parotid by way of a cruciate incision placed directly over the tumor. The neoplasm is then removed with a 2-3 mm rim of normal parenchyma surrounding the tumor. Case selection is crucial and well defined, mobile lumps in the superficial lobe approximately 2 cm in diameter, ideal. Some surgeons carry out MRI scans on all patients due to the potential for synchronous tumors. I will present the retrospective results for four centers, including my own, for 2,229 patients. We have shown a recurrence rate of 0.75% with a median follow up of 9.5 years. There is an 8.65% incidence of facial nerve weakness (1.5% permanent). The incidence of Frey’s syndrome is 3.05%. There is a need for a prospective, potentially randomized, study with plans to form a parotid surgery interest group to take this forward. Progress on this front will be presented.

Biography

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Neil Shah was trained in Medicine at St Bartholomew's Hospital and in Dentistry at University College London. He had a broad training in General Surgery leading to FRCS. This was followed by Maxillofacial training in the south east of England including the world famous Queen Victoria Hospital in East Grinstead where he specialized in Head & Neck Reconstructive Surgery. He learnt minimally invasive techniques at Guy's Hospital and now has one of the largest personal series of parotid surgery in United Kingdom.

Email: neil.shah4@icloud.com