Abstract
Objective
The current study presents our experience with accessory parotid gland masses and reviews the literature on accessory parotid tumor incidence and surgical management. Based on our results, we advocate a standard parotidectomy approach with routine facial nerve dissection at the time of excision.
Study Design
We performed a retrospective chart review and comprehensive literature review on incidence of accessory parotid gland neoplasms.
Methods
A retrospective chart review of all patients with mid-cheek masses treated by the senior author was conducted from January 2003 to January 2009. The tumor size at presentation, FNA biopsy, pathologic diagnosis, and surgical treatment were recorded for 13 patients.
Results
In the case series, 54% of lesions were benign (n = 7) and 46% were malignant (n = 6) including benign pathologies of 4 pleomorphic adenomas, 2 lymphadenitis, 1 monomorphic adenoma and malignant pathologies of 2 mucoepidermoid carcinoma, 2 B-cell lymphomas, 1 adenocarcinoma, and 1 myofibrosarcoma. Surgical intervention was performed on all patients with standard parotidectomy incision for accessory parotid mass excision after identification and tracing of facial nerve and its branches.
Conclusion
The present study provides support for a standard parotid incision with identification of the facial nerve at the time of surgical incision as this resulted in successful excision of accessory parotid tumors with favorable cosmetic results and without facial paralysis or tumor recurrence. Literature review of 152 cases of accessory parotid gland lesions, revealed a pooled incidence of 70% benign and 30% malignant.
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Introduction
Mid-cheek masses can be difficult to manage clinically. In order to ensure proper management, a high clinical suspicion and awareness of accessory parotid gland tumors is necessary. Lesions arising from the accessory parotid gland occur with an incidence of 1–8% of all parotid tumors. However, it is important to note that 26–52% of all accessory parotid gland tumors are malignant compared to the 18.5% malignancy rate for tumors of the main parotid gland .
The accessory parotid gland (APG) is a relatively common anatomical variant with cadaveric incidence of 21–56% . Accessory parotid gland tissue is a small gland ranging from 0.5–1 cm diameter in size and is located, on average, 6 mm anterior and separate from the main parotid gland. The APG is found between or deep to the zygomatic and buccal branches of the facial nerve and closely related to Stensen’s duct. Although typically clinically undetectable, the APG may become noticeable as a mid-cheek lump in diseased states secondary to underlying pathology.
Surgical excision remains the treatment of choice for mid-cheek masses, although the type of surgery remains a source of debate. Surgical approaches advocated in literature include direct skin incision overlying tumor and removal , intraoral excision with or without facial nerve monitoring, face-lift approach , standard parotidectomy incision with anterior approach , “parotidotomy” approach , and minimally invasive endoscopic assisted resection with preauricular incision . While advocates of the direct incision and intraoral approach argue that the facial nerve is well arborized in the mid-cheek area, others routinely observe a large branch of the facial nerve lying over the mass and therefore advocate tracing the main branches of the facial nerve proximal to the mass ( Fig. 1 ). In this series we performed standard parotidectomy incision for mass excision. As Johnson and Spiro suggest, this approach allows for maximal surgical exposure of the lesion and enables identification of the distal facial nerve branches for preservation of nerve function .
