Modifications of parotid surgery in poorly resourced settings

Unreliable follow-up: With patients unlikely to attend regular follow-up to detect early recurrence or metastases, a case can be made for more extensive surgery e.g. total (facial nerve sparing) parotidectomy for all malignant tumours as well as elective treatment of the neck by surgery (preferably) or radiation therapy

Unavailability of postoperative radiation therapy (PORT)

  • Most patients with salivary malignancy receive PORT (Indications for PORT)
  • Not having PORT to treat residual microscopic cancer or nodal metastases in the parotid deep lobe has the following surgical implications:
    • Consider completion total parotidectomy for high risk cancers diagnosed after partial parotidectomy
    • Consider resecting and grafting facial nerve branches adherent to a malignant tumour
    • Consider elective neck dissection for T3 and T4 malignancies
    • Consider who not to offer parotid surgery when outcomes without PORT will be poor
  • Note that current evidence does not support use of chemotherapy for salivary cancers with either curative or palliative intent. (Vander Poorten V, Meulemans J, Delaere P et al. Molecular Markers and Chemotherapy for Advanced Salivary Cancer. Curr Otorhinolaryngol Rep (2014) 2: 85.

Palliative surgery

Index: Clinical Practice Guidelines for Parotid

Resource Appropriate Parotid Guideline Scenarios