Current diagnosis and therapy of parotid tumours

After reviewing a group of more than 400 patients with parotid tumours, we feel that clinical examination, screening ultrasound scanning and pre-operative CT-scan are our most important diagnostic tools. Our treatment concept is based on direct posterior dissection of the main trunk of the facial nerve, total conservative parotidectomy with ablation of all glandular tissue especially in pleomorphic adenomas so that recurrency can be avoided, intra- and postoperative histological examination and filling in the post-operative soft tissue depression in all cases where intra-operative histological examination excludes malignancy. Primary post-parotidectomy defect substitution techniques using the platysma (Roscic) and the sternocleidomastoid muscle (Rausch) as well as a SMAS- and temporoparietal fascia- or galea-flap are illustrated. We currently use the combination of the Rauch- and Roscic- techniques in a way that a sternocleidomastoideus muscle rotation-flap together with a platysma-SMAS-fat-flap entirely cover the defect. We believe that the substitution-plasty, primarily performed for aesthetic reasons, acts as a mechanical barrier for the misdirected regeneration of the nervs to the skin and the sweat glands, and thus tends to avoid Frey's Syndrome. Using our technique concept, we feel that any disadvantage is counter-balanced by the absence of recurrences, no permanent facial paralysis, relatively good aesthetic results and lower incidence of Frey's Syndrome.