The surgical management of advanced malignancies of the parotid gland

Advanced malignancies of the parotid gland frequently invade the parapharyngeal space and the infratemporal fossa. The majority of these lesions have not been cured by surgery and/or radiotherapy, and palliation or cure can only be achieved by en bloc resection of this region. Stylohamular dissection is a systematic method for en bloc resection of the infratemporal fossa and lateral skull base. From January 1980 until December 1987, 18 patients with advanced parotid malignancies underwent stylohamular dissection. Pathologic examination revealed the following diagnosis: adenocarcinoma (7), squamous cell carcinoma (5), high-grade mucoepidermoid carcinoma (2), metastatic adenocarcinoma (1), fibrosarcoma (1), malignant hemangiopericytoma (1), and melanoma (1). Nine patients in this series are alive after a mean follow-up period of 3.5 years (range 1 to 9 years). Three patients are dead of uncontrolled local disease and three of distant metastasis. Three patients died of unrelated causes. All patients except the three who had uncontrolled disease experienced marked palliation from their pain, trismus, and unmanageable ulcerative lesions after surgery. The operative morbidity was relatively low.