Treatment of a Parotid Tumour

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After diagnosis, staging of the tumour is performed to determine its extent and whether it has spread to lymph nodes or other areas. Staging is crucial to determining appropriate treatment.   

Treatment may vary depending on the type of tumour and its nature (benign or malignant). However, the most common approach is surgery to remove the tumour and, in some cases, additional radiation therapy to kill residual cancer cells. Drug treatment is usually considered in more advanced situations or if the tumour is inoperable. 

Treatment is personalised to the needs of each patient, and is based on the recommendations of the medical team after a complete evaluation. 

Surgical treatment

Surgical removal of a parotid tumour (benign or malignant) is the main treatment in many cases, as well as providing a definitive diagnosis. The type of surgery performed depends on the type of tumour; that is, its size, location and nature (benign or malignant).

Extended lumpectomy. This is performed with the assistance of a neurostimulator that locates and alerts when working near the facial nerve. If the tumour is highly peripheral, it is removed without dissection of the entire facial nerve. 

Removal of part of the parotid gland (superficial parotidectomy). This is done when the tumour is in the superficial part (superficial lobe) of the gland, and the part above the facial nerve is removed. The goal is to preserve the function of the facial nerve and gland. 

Removal of the entire parotid gland (total parotidectomy). When the tumour is malignant, large or positioned such that partial removal is inappropriate, the affected parotid gland is removed. The aim is to preserve the facial nerve to minimise changes in facial function, but this may vary depending on the extent of the tumour

Radical removal (radical parotidectomy). This procedure is performed in advanced malignant tumours that have spread to nearby structures, such as nerves or lymph nodes. It involves the removal of the parotid gland (with the facial nerve inside), regional lymph nodes and other affected structures. 

Reconstruction techniques. In some cases, especially after a total or radical parotidectomy, reconstructive surgery (immediate or delayed) may be performed to restore facial function and appearance. This may involve tissue transfer, such as a nerve or muscle tissue graft (reconstructive microsurgery), to restore facial nerve function; or static techniques to gain facial symmetry, aesthetically improve the face and reduce functional impact. 

After surgery, radiation therapy or facial rehabilitation therapy may be required to achieve a complete recovery and minimise aesthetic and functional sequelae. 

Postoperative Indications

Intravenous chemotherapy bag

Drainage. After surgery, the patient has a drain that remains in place for the first 24-48 hours and is removed before being discharged home. 

Scissors and scalpel

Stitches. Normally, they are removed after 10-12 days, during a follow-up visit at the hospital. 

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Incision care. The incision must be kept clean and dry. It should be cleaned with soap and water and the area dried well. Aqueous chlorhexidine can be applied as a disinfectant.

Inflamación de la boca

Inflammation. Depending on the patient, a variable degree of inflammation may be experienced in the operated area, which is controlled with compression. The discomfort is usually controlled with conventional anti-inflammatory medication and painkillers. 

Bland or astringent diet with rice, fish and bananas

Diet. During hospital stay, a normal diet is progressively introduced. Once at home, patients should eat foods that do not cause discomfort, with a diet that allows them to chew easily; increasing the texture of the foods as they become better tolerated. 

Man running; regular physical exercise

Exercise. Relative rest (sitting with some mobility) is recommended for the first week after the operation, with a progressive return to usual activity after the first postoperative monitoring. 

Showering person with allergy in contact with substance

Hygiene. The patient can shower from the first day after surgery.

Clock with pills that indicates to adjust medication to shorter time intervals

Medication. Sometimes, the patient needs to follow prophylactic antibiotic treatment a few days after surgery, with anti-inflammatory medication (for 2-3 days after the operation, after meals) and painkillers, to relieve any discomfort. 

Non-pharmacological treatment

Non-pharmacological treatment of parotid tumours depends on the nature of the tumour, its staging and individual patient features. The approach to treatment is determined after complete evaluation by a medical team specialising in oncology or head and neck surgery. 

Radiotherapy symbol

Radiotherapy. Radiotherapy uses high-energy radiation to destroy or damage cancer cells. It is used as primary treatment in cases where surgery is not an option or as an adjunctive therapy after surgery, to destroy the remaining cancer cells or prevent their recurrence.

Face paralysis with hands

Rehabilitation. After surgery, facial rehabilitation and speech therapy may be necessary to help patients regain facial function and appearance as well as to treat potential complications, such as facial nerve weakness. When nerve reconstruction procedures are performed, combination with subsequent rehabilitation is essential.

Doctor talking to a patient

Medical monitoring. Regular medical follow-up is essential to monitor tumour progression after treatment and to detect any early recurrence.

Drug treatment

Pharmacotherapy of malignant parotid tumours is not the first line of treatment and is usually used in combination with other therapeutic approaches, such as surgery and radiotherapy; depending on the type of tumour and its staging. 

Drug treatment includes the following approaches: 

Intravenous chemotherapy bag

Chemotherapy. Chemotherapy is a treatment that uses drugs to stop or slow down the growth of cancer cells. In the case of malignant parotid tumours, such as squamous cell carcinoma or mucoepidermoid carcinoma, chemotherapy may be an additional option to surgery and radiation therapy. However, this is not the main treatment, as glandular tumours are generally not very sensitive to chemotherapy.

Drug with a target and an arrow

Targeted therapy. Some parotid tumours express certain proteins or markers that can be the target of specific drugs known as targeted therapies. These drugs are designed to block specific signalling pathways that promote tumour growth. Targeted therapy can be used along with other treatments.

linfocito T

Immunotherapy. Immunotherapy uses drugs that stimulate the patient's immune system to kill cancer more effectively. Despite that, it is not a first-line therapy for parotid tumours, with options under investigation to treat certain types of head and neck cancer.

Substantiated information by:

Francisco Javier Cuesta
Sandra Vázquez

Published: 9 May 2024
Updated: 9 May 2024

The donations that can be done through this webpage are exclusively for the benefit of Hospital Clínic of Barcelona through Fundació Clínic per a la Recerca Biomèdica and not for BBVA Foundation, entity that collaborates with the project of PortalClínic.

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