Bilateral parotid neoplasms

In this case, the experts come out of the starting blocks disagreeing. One expert (Dr. Myers) does not routinely use FNA, relying instead on clinical signs to suspect a malignancy. the other physicians (Drs. Robbins and Suen) obtain an FNA for each parotid mass and use the information in counseling patients. MRI is an important preoperative tool for one physician (Dr. Suen). When faced with bilateral tumors, one approach is to stage the operations to avoid possible bilateral facial nerve injury (Dr. Myers). Other approaches include operating on the larger tumor first if both are benign, the malignant tumor first if one is benign and one malignant, and on both sides under the same anesthetic if both are malignant (Dr. Robbins). The other consultant agrees with this latter approach, with the exception being that in the case of bilateral benign tumors, he would operate on the smaller side first (Dr. Suen). Regarding the role for further surgery, one expert would reoperate if there were a suspicion for residual gross tumor on the facial nerve (Dr. Robbins). The others (Drs. Myers and Suen) agree that the positive margin likely reflects microscopic disease and further surgery is not warranted. Radiotherapy is recommended by all the experts. There is no proven role for chemotherapy. There is disagreement regarding whether the facial nerve should have been removed on the left side. Two experts (Drs. Myers and Suen) agree on peeling tumor off the nerve and following with radiotherapy. However, one physician (Dr. Robbins) believes that the facial nerve should have been removed.(ABSTRACT TRUNCATED AT 250 WORDS)