Parotidectomy and Neck Dissection for Temporal Bone Malignancy

Abstract

Temporal bone malignancies are challenging as the pathologies are heterogeneous and risk stratification is difficult. Depending on the histology, they have the ability for aggressive local invasion and regional metastases. Similarly, primary parotid, parapharyngeal, or cutaneous malignancies may result in temporal bone invasion via local or regional extension. Appropriate work-up including a full history, physical examination, imaging, and pathology review is critical to the primary location and tumor extent. This allows a better understanding for the potential sites of metastasis in the parotid and neck. Several factors must be taken into account when deciding on the role of parotidectomy and neck dissection, specifically, histology, stage, location, and extent of the primary tumor invasion and the need for reconstructive surgery. Parotidectomy is indicated for direct tumor invasion or if the parotid is within the draining nodal basin. Indication for neck dissection is clinically evident nodal disease. Elective neck dissection is based on the risk of metastasis. In the setting of temporal bone malignancy, the risk for nodal metastasis across all pathologies is 13–34%. We advocate elective neck dissection for advanced-stage tumors when at least a 20% risk of metastatic spread exists. Nodal levels dissected are based on the location of the primary. Overall parotidectomy and neck dissection are safe surgeries but convey risks that must be discussed with the patient.