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

Index: Clinical Practice Guidelines for Parotid

Resource Appropriate Parotid Guideline Scenarios