Preoperative approach and technical considerations in parotid surgery

Various approaches and techniques have been developed to address parotid neoplasms over the years. This article reflects on the integration, modification, and refinement of these techniques over a decade of clinical practice. This article provides a narrative description of the evolution of a head and neck oncologic surgeon's approach to parotid neoplasms. It describes technical considerations in the preoperative, operative, and postoperative settings. Thoughtful diagnostic workup and treatment planning based on patient history and parotid tumor characteristics can assist with diagnostics, the decision of surveillance vs. surgery, operative approach, and extent of surgery. Point of care ultrasound (US) is invaluable both in the office and intraoperatively as it can be used to understand tumor characteristics, guide incision placement, and for surveillance practices. Minimally invasive approaches can be performed safely and integrated into practice with a clear understanding of parotid and facial nerve anatomy and further aided with US guidance. Furthermore, key points based on the gland compartment in which the tumor exists help influence the nerve dissection and reconstructive techniques employed. By embracing the multitude of options as they relate to diagnostic workup, surgical approach, and extent of surgery, head and neck surgeons today have the opportunity and ability to tailor unique and individualized treatment plans for parotid neoplasms.