Clin Exp Otorhinolaryngol.  2014 Jun;7(2):126-132.

Clinical History, Prognostic Factors, and Management of Facial Nerve in Malignant Tumors of the Parotid Gland

• Bussu F
• Rigante M
• Giglia V
• Bastanza G
• De Corso E
• Almadori G
• Paludetti

Abstract

OBJECTIVES
We analyzed the outcomes following clinical management of parotid masses that were determined to be malignant tumors after parotidectomy.
METHODS
We evaluated data from 70 patients with parotid malignancies between November 1994 and December 2005.
RESULTS
Among salivary histotypes (n=49), the most significant prognostic parameter was cT4 stage at diagnosis (P=0.0055, log-rank) both for clinical involvement of the facial nerve and for invasion of other structures. The main cause of cancer-related death was a distant metastasis.
CONCLUSION
The present series confirms that the main prognostic parameter in salivary parotid malignancies was cT4 classification at diagnosis, often due to clinical involvement of the facial nerve. The oncological outcome of salivary malignancies was influenced by distant metastasis more than most other head and neck sites. We recommend dissecting and preserving the functioning VIIth cranial nerve during surgery for parotid malignancies.

Keyword

Parotid malignancies; Parotidectomy; Facial nerve; VII cranial nerve dissection; Clinical prognostic factors

MeSH Terms

Classification
Cranial Nerves
Diagnosis
Facial Nerve*
Head
Humans
Neck
Neoplasm Metastasis
Parotid Gland*

Figure

• 

  Fig. 1 Overall survival in our series was 85% at 2 years and 72% at 5 years (A); disease-specific survival was 93% at 2 years and 89% at 5 years (B).

• 

  Fig. 2 The most significant clinical parameter in our series was the cT4 at diagnosis, and in particular. (A) Paresis of the facial nerve (T4a; P=0.006, log-rank) was associated with a 66% 5-year disease-specific survival (DSS) (green line) vs. 91% 5-year DSS for patients with normal nerve function at diagnosis. (B) Involvement of other extra-parotid structures such as skin, ear canal, mandible (T4a) or skull base (T4b; P<0.0001, log-rank) was associated with a 44% 5-year DSS (azure line), vs. a 94% 5-year DSS for patients without involvement of the above cited structures at diagnosis. Notably, facial nerve function was always impaired when involvement of such structures was evident.

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