A 35-year-old woman is found to have a parotid swelling. FNAC reveals a tumour with a biphasic pattern of epithelial cells in a myxochondroid stroma. This is the most common parotid tumour. Surgical excision reveals the tumour has a thin pseudocapsule with satellite nodules. Which operation should have been performed to minimise recurrence?
- A Superficial parotidectomy with facial nerve preservation ✓
- B Simple enucleation of the tumour
- C Radical parotidectomy with facial nerve sacrifice
- D Total conservative parotidectomy with total removal of all parotid tissue
Correct answer: A. Superficial parotidectomy with facial nerve preservation
Explanation
Pleomorphic adenoma (mixed parotid tumour) is the most common parotid gland neoplasm. Its pseudocapsule has finger-like projections (satellite nodules) that extend into surrounding parotid tissue. Simple enucleation leaves these satellite nodules behind, causing high recurrence rates (20-45%). Superficial parotidectomy with preservation of the facial nerve (if the tumour is in the superficial lobe) is the operation of choice, reducing recurrence to under 5%. Radical parotidectomy is reserved for malignant tumours involving the nerve.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.