Carcinoma of the parotid gland with extracapsular extension and recurrent carcinoma of the gland, which is frequently much more advanced than is clinically discernible, are most difficult and challenging problems to treat.
Four patients underwent aggressive radical surgery to achieve adequate margins. In addition to radical parotidectomy and neck dissection, surgery included resection of the masseter muscle, medial and lateral pterygoid muscles, temporal muscle, skin, mandible, temporal bone and other involved structures such as parapharyngeal space.
In this series, one tumor was previously untreated and the remaining 3 were recurrent after initial surgery. Histologic type of the tumors was carcinoma in pleomorphic adenoma in 2 patients, adenoid cystic carcinoma in 1, and high-grade mucoepidermoid carcinoma in 1. Two of the recurrent tumors had become more highly malignant than the initial tumors.
Histopathologically skin overlying the parotid gland was involved in 2 patients, masticatory muscles in 3, capsule of the temporomandibular joint in 1 and parapharyngeal space in 1. No bony involvement was revealed in the surgical specimens. These histologic findings were satisfactorily correspondent to those of the preoperative CT scan. Nodal involvement of the tumor was histologically confirmed in 3 patients, and metastatic nodes spread in the deep jugular chain from the base of the skull to the middle jugular portion and the spinal accessory chain. In addition to the direct extension of the primary tumor, these nodal findings demanded the dissection of the parapharyngeal space in conjunction with the resection of ascending ramus of the mandible.
Three of 4 radically parotidectomized patients were alive with no evidence of disease from 6 to 28 months postoperatively. One patients died of local recurrence 29 months after the operation.