Indications for neck dissection or irradiation in parotid cancers

  • When neck dissection is indicated and a surgeon lacks the expertise, refer to another centre for neck dissection
  • Clinically/radiologically apparent cervical metastases: Modified radical neck dissection (Levels 1-5)
  • Clinically/radiologically N0 neck
    • Elective treatment of the neck (Levels 2/3/4) for parotid cancer is controversial
    • Elective neck dissection and elective radiotherapy are equally effective
    • Known risk factors for occult neck disease are
      • Tumour size >4cm
      • High-grade histology
      • Extraparotid tumour extension
    • Always sample nodes in Level 2a at the time of parotidectomy, or perform Level 2 selective neck dissection, to avoid having to redissect Level 2
      • If positive on frozen section, proceed to modified neck dissection
      • If frozen section not available, then histological examination guides subsequent treatment planning
    • When performing elective neck dissection (Levels 2/3/4) for skin cancer metastases to the parotid, always include the nodes overlying the sternomastoid along the external jugular vein

Index: Clinical Practice Guidelines for Parotid

Resource Appropriate Parotid Guideline Scenarios