Symposium: management of tumors of the parotid gland

The successful management of swellings in the parotid gland region is dependent upon the establishment of a clinical and/or histologic diagnosis of the condition responsible for the production of the abnormal swelling. All mobile parotid tumors are removed as an excisional biopsy with preservation of the facial nerve. A preoperative biopsy will not influence the subsequent management of these lesions. An aspiration biopsy is employed to evaluate all primary, previously undiagnosed, non-ulcerative parotid tumors suspected of being clinically malignant. An experienced pathologist views with confidence evaluation of solid material that has been carefully separated from the aspirated specimen. It is our opinion that when the biopsy tract is removed with the tumor, there is less risk of surgical wound contamination by tumor than when there is an incisional biopsy or incomplete excision of the tumor for frozen or permanent section diagnosis. One should not expect to derive as much information from an aspiration biopsy as may be derived from a formal incisional biopsy. If the histologic interpretation of the aspirated material is inconclusive, one may proceed to accept the added risk of an open biopsy. If it is known preoperatively that the tumor is malignant, that it is other than a low grade cancer, and that the tumor should be treated surgically, management of the facial nerve and the cervical nodes may be anticipated. This may be accomplished by an aspiration biopsy.