A 60-year-old male presents with a painless right parotid swelling that is hard and fixed to skin. FNAC shows carcinoma cells. Intraoperative frozen section reveals high-grade mucoepidermoid carcinoma with facial nerve involvement. The appropriate surgical management is:
- A Total parotidectomy with facial nerve sacrifice and ipsilateral neck dissection ✓
- B Superficial parotidectomy preserving the facial nerve
- C Total parotidectomy with nerve preservation and postoperative radiotherapy
- D Incisional biopsy followed by radiation therapy alone
Correct answer: A. Total parotidectomy with facial nerve sacrifice and ipsilateral neck dissection
Explanation
High-grade mucoepidermoid carcinoma with macroscopic involvement and fixation of the facial nerve mandates sacrifice of the involved nerve segments. Attempting preservation of a macroscopically invaded nerve leaves positive margins and worsens locoregional control. Total parotidectomy with radical neck dissection and postoperative radiotherapy is the standard. Nerve cable grafting for reconstruction is planned after oncologically clear margins are confirmed. Radiation alone is inadequate for high-grade disease.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.