Surgical approach for primary parotid malignancies

Primary parotid malignancies are one of the most diverse, complex group of tumors the head and neck surgeon faces in practice. Surgical management of these tumors is based on histological tumor type, tumor involvement of the facial nerve, local extent, and regional spread. Primary parotid malignancies can extend to local skin and subcutaneous tissues, parapharyngeal space, retropharyngeal space, and skull base. Distant metastatic disease often leaves the surgeon with the decision to recommend no surgical treatment or palliative procedure only. Treatment of primary parotid malignancies is individualized with the surgical goal of complete eradication of all local and regional disease. Because of the complexity of parotid malignancies, accurate pathological diagnosis is of paramount importance for optimal surgical therapy. Characteristics of the various parotid malignancies are discussed, and the surgical management is approached according to histological type, facial nerve involvement, and local or regional extent.