Two Faces of Parotid Tumors: Different Approaches & Successful outcomes

Background: Parotid gland tumors comprise a diverse group of pathologies within head and neck surgery, with clinical presentation and operative strategies varying greatly depending on tumor location. Regardless of technique, preservation of the facial nerve remains the central objective in achieving optimal functional and oncologic outcomes.

Case Presentation: We present two contrasting cases of parotid tumors managed at Bahrain Specialist Hospital. The first case involved a 39-year-old male with a painless preauricular swelling. Imaging confirmed a superficial lobe parotid mass, and the patient underwent a superficial parotidectomy through a preauricular incision. Intraoperative facial nerve monitoring enabled meticulous dissection and successful preservation of all nerve branches. The tumor was excised en bloc, and the patient recovered uneventfully with normal facial function and no evidence of recurrence.

The second case involved a 55-year-old female who presented with an intraoral bulge and dysphagia. MRI revealed a deep lobe parotid tumor extending into the parapharyngeal space. A minimally invasive endoscopic transoral excision was performed, supported by intraoperative carotid Doppler guidance to minimize the risk of vascular injury. Complete tumor removal was achieved without compromising the facial nerve. The patient demonstrated normal swallowing function, intact facial movement, and no postoperative complications.

Conclusion: These two cases highlight the distinct presentations and surgical considerations of superficial versus deep lobe parotid tumors. While superficial tumors are effectively managed with traditional superficial parotidectomy, deep lobe lesions extending into the parapharyngeal space may benefit from advanced endoscopic transoral approaches. Across all techniques, the fundamental priority remains complete tumor clearance while safeguarding facial nerve integrity.

Credit: Cases managed and reported by Dr. Rashu Mittal, Specialist ENT, Bahrain Specialist Hospital.