Thoughts about the basic principles of parotid surgery

Thoughts about the basic principles of parotid surgery

Do you perform subtotal parotidectomy in the event of a Warthin’s tumour?


Dr.Huszka, Janos; Dr.Pacz, Zoltan ; Dr. Balazs, Gyorgyike; Dr. Csiky Marta

Szent Istvan Hospital, ENT&Maxillofacial Surgery Dept.



The thought-provoking title of this presentation originates from a self-critical learning process of parotid surgery.

Biopsy or enucleation of the parotid tumor should not be carried out. Correct minimal treatment is parotidectomy (subtotal or total, sometimes partial). This is the basic principle of parotid operations at our ENT Department. The answer to the question proposed by the title will be yes by the end of this lecture on the bases of the following:

Papillary cystadenolymphoma or Warthin’s tumor was most frequent benign lesions (66 cases, 36%, in 185 parotid operations in last 6.5 years) at the author’s department.

A review of the scientific literature on Warthin’s tumor characteristics and treatment types will be performed.

The author analyzed  his 66 cases (62 patients) and the results were:

  • 14 patients had multifocal (2,3 or more focus) Warthin’s tumor.
  • 1 adenocarcinoma, 1 pleomorphic adenoma, 1 bening lyphoepithelial lesion was found not close connection to but in the same gland as the Warthin’s tumor.
  • It means 17 (27%) unusual cases.
  • The preoperative examinations (palpation, ultrasonography, CT, MRI, fine needle aspiration cytology) did not prove the multiple of tumor in 90% of cases.
  • Malignant transformation of the Warthin’s tumor is rare but occurs.
  • After enucleation of the tumor additional neoplasm could develop and the reoperation will be more difficult, endangering the facial nerve.
  • In the experienced hands of the operating surgeon the chance of injury of the facial nerve is minimal.
  • The interest of the patient should be above any other consideration.