Management of Benign Parotid Lesions: An Overview of Complications and Extent of Surgical Resection

Abstract

Background The surgical management of benign lesions of the parotid gland is focused on the complete removal of the lesion, minimizing the chances of recurrence and to preserve facial nerve function. There is a relative paucity of literature regarding the post-operative complications of the surgical procedures for benign parotid lesions. The aim of this study is to evaluate the post- operative complications of a limited surgical procedure, namely partial superficial parotidectomy. Material and Method This retrospective cohort study included all parotid surgeries performed for benign parotid pathology from January 2008 to December 2018. The patient’s demographic data, presenting symptoms, type of surgery performed, complications, presence of post operative facial nerve paralysis and grade, histopathology type and follow up period were collected from hospital records of Al Shifa system. The mean follow-up time was 12.5 months. Results The study yielded a total of 125 partial superficial parotidectomies performed on 123 patients with a mean age of 44.5 years (range 8-87 years). Pleomorphic adenoma (n= 68, 54.4%) and Warthins tumor (n=32, 25.6%), were the most common neoplastic lesions. Non-neoplastic lesions were 18 (14.4%). Temporary facial nerve weakness occurred in 11 patients (8.8%). All cases of facial nerve weakness improved within three months post-operatively. The rate of salivary fistula and sialocele were 5.5% and 1.5% respectively. One patient who had histologically proven pleomorphic adenoma had recurrence of tumor (0.8%). Conclusion Partial superficial parotidectomy was associated with low incidence of facial nerve dysfunction which was mostly transient, and no permanent facial nerve dysfunction was reported. Other complications like sialocele, salivary fistula and Frey’s syndrome were reported at lower rates than the reported rates in the literature for the conventional superficial parotidectomy. The findings support partial superficial parotidectomy approach for the treatment of benign parotid pathology, which entails less extensive resection of parotid parenchyma and less extensive dissection of facial nerve branches thereby minimizing the risk of post-operative complications.