Parotid gland and parapharyngeal space imaging--the surgical significance

Wise head and neck surgeons, for whom parotid gland surgery constitutes a substantial portion of their case load, make full use of the radiologist and cytologist in arriving at a rational pre-operative diagnosis. They utilize the skill of these allied consultants to qualify (by histology) and quantify (by staging) diffuse and mass lesions of the parotid gland (and subjacent parapharyngeal space) in order to evolve an effective surgical, radiation or other treatment plan. They understand the basic principles of diagnostic imaging and apply them to the clinical problem at hand. They minimize diagnostic and intra-operative "surprises", reduce intra-operative and post-operative complications and generally have a more "informed" patient and patient's family. The purpose of this manuscript is to discuss a contemporary role for diagnostic imaging in neoplastic (and other) diseases of the parotid gland and subjacent parapharyngeal space. Not all lesions of the parotid gland require imaging, although a pre-operative clinical photograph, including evidence of facial nerve function, is always welcome. Other lesions may need diagnostic imaging, from simple to complex and sophisticated, depending upon the problem. Properly used, effective and selective diagnostic imaging can improve the surgeon's confidence by providing a more realistic provisional diagnosis and a better pre-operative staging process and treatment plan, thereby avoiding the surgically unexpected and facilitating prognosis.