Evaluation of a parotid mass: Key points

Most parotid neoplasms are benign
Clinical evaluation, cytology and imaging do not conclusively exclude malignancy….hence the need for complete resection of the tumour and histological examination, or if surgery is not to be done, a core needle biopsy
Objectives of preoperative evaluation
- To avoid unnecessary surgery for e.g. infective or non-neoplastic masses, lymphoma, unresectable tumour
- To do appropriate surgery
- To avoid embarking on surgery that is beyond the scope of a surgeon e.g. deep lobe tumour, tumour extending to parapharyngeal space, tumour requiring neck dissection, or tumour requiring facial nerve reconstruction
History and examination are important means to identify infective causes (e.g. HIV, TB) , benign and malignant primary tumours and metastases to the parotid
FNAC is helpful in selected cases
Imaging is rarely beneficial for clinically benign, mobile parotid tumours as it uncommonly alters surgical management, but may be helpful in other selected cases
Histological classification of primary salivary neoplasms is difficult and complex. Cytological and histological diagnoses should always be treated with caution and viewed in a clinical context, especially if reported from outside centers of excellence