Dr. SLN Chandra Mohan Head & Neck Surgical Oncologist
Treatment Details

Parotid Gland Tumors

The parotid glands are the largest of the salivary glands, located just in front of and beneath each ear. The management of tumours in this region is clinically unique due to the facial nerve, which traverses through the gland, dividing it into superficial and deep lobes. This nerve is responsible for all muscles of facial expression, including the ability to smile, raise eyebrows, and close the eyes.

Overview

Dr SLN Chandra Mohan had been trained at one of the most renowned Cancer institutes of India, CMC Hospital, Vellore and the Kidwai Memorial Institute of Oncology at Bangalore, where some of the highest number of Parotid tumour cases are operated every year. With extensive experience and added skill in managing Facial nerve, Dr SLN Chandra Mohan is a master expert in operating Parotid tumours with added Facial nerve preservation.

Clinical Presentation & Diagnosis

  • Symptoms: Most patients present with a slow-growing, painless mass. Persistent pain, rapid growth, or facial weakness  are significant "red flags" that often correlate with malignancy or nerve infiltration.
  • Diagnostic Standard: Fine Needle Aspiration Cytology (FNAC/FNAB) is the preferred primary diagnostic tool.
  • Imaging: Contrast-enhanced MRI 

Surgical Management & Facial Nerve Preservation

Surgery is the definitive treatment for parotid tumours. The extent of the procedure is dictated by the tumour's location and grade:

  • Superficial Parotidectomy
  • Total Conservative Parotidectomy
  • Facial Nerve Monitoring (IONM): For advanced, recurrent, or deep-lobe tumours, Intraoperative Facial Nerve Monitoring is a critical tool used to map and protect the nerve branches. This technology provides real-time feedback, significantly reducing the risk of accidental injury during complex dissections.
  • Nerve Grafting: If the cancer has directly invaded the facial nerve, the involved segment is resected, and immediate micro vascular nerve grafting is performed to restore future function. This is done under Magnification with aid of Loupes/Microscope and done meticulously , and with precision , done only in few centers in India, with our centre being one among them  where surgical expertise is required in the nerve grafting technique.

Neck Management & Adjuvant Therapy

  • Neck Dissection: For all cases of Malignant parotid tumours
  • Radiotherapy: Postoperative radiation is indicated for advanced stages, high-grade histology, positive margins, or perineural invasion.

Chemotherapy: As per ASCO guidelines, the role of adjuvant chemotherapy remains investigational and is typically reserved for clinical trials or palliative settings.

Post-Operative Expectations

  • Temporary Weakness: Literature suggests temporary facial nerve dysfunction occurs in 25–40% of cases due to surgical handling reduced further at our centre with  added advantage of Facial nerve monitor .Most patients see a full recovery within 8–12 weeks.
  • Permanent Injury: The risk of permanent nerve damage is low (1–2%) but increases with the complexity of recurrent or invasive cancers.

At our centre the risk of Permanent Facial nerve injury is <2% with further reduction of the palsy with added expertise in nerve grafting technique.