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Warthin's tumor of parotid gland — Clinical Guidelines

Overview

Warthin's tumor is a benign mixed tumor predominantly found in the parotid gland, characterized by the presence of both epithelial and lymphoid stromal components 9.

Diagnosis

Clinical presentation often includes a slow-growing, painless mass in the parotid gland 1 2.

Imaging studies (e.g., ultrasound, MRI) help in delineating the tumor extent and relationship to surrounding structures 2.

Definitive diagnosis requires histopathological examination, typically showing characteristic biphasic patterns with oncocytes and lymphocytes 9.

Management

Surgical excision: Complete removal of the tumor is the primary treatment, often performed via superficial or partial parotidectomy to preserve gland function and facial nerve integrity 1 3 5 6.

Anesthesia approach: Sedation combined with locoregional anesthesia (cervical plexus and auriculotemporal nerve block) can be a feasible and safe alternative to general anesthesia in selected cases 1.

Facial nerve preservation: Techniques such as antegrade dissection are commonly used to minimize facial nerve injury, with combined techniques also favored in complex cases 5 6.

Monitoring: Perioperative facial nerve monitoring is recommended to reduce the risk of postoperative facial palsy 5 6.

Special Populations

Elderly patients: No specific guidelines provided, but careful patient selection and monitoring are crucial 2.

Comorbidities: No direct evidence provided; however, anesthetic considerations and surgical approach should be tailored to individual patient conditions 1.

Key Recommendations

Surgical excision is the standard treatment for Warthin's tumor, with partial parotidectomy preferred to preserve salivary function and facial nerve integrity (Evidence: Moderate 3 6).

Consider sedation with locoregional anesthesia for selected patients undergoing parotidectomy to enhance safety and feasibility (Evidence: Moderate 1).

Utilize antegrade facial nerve dissection techniques to minimize the risk of postoperative facial nerve dysfunction (Evidence: Moderate 5 6).

Implement perioperative facial nerve monitoring during surgery to reduce the incidence of transient and permanent facial palsy (Evidence: Moderate 5 6).

References

1 Tesseroli MA, Zasso FB, Hepp H, Priante AV, de Mattos Filho AL, Sanabria A. Parotidectomy under sedation and locoregional anesthesia with monitoring of brain activity. Head & neck 2017. link 2 Chloupek A, Zarzycki K, Dąbrowski J, Domański W. Parotid gland tumors. Results of retrospective analysis of 149 patients treated at the Clinical Department of Cranio-Maxillofacial Surgery, Clinic of Otolaryngology and Oncologic Laryngology of Military Institute of Medicine in Warsaw in years 2006-2016. Otolaryngologia polska = The Polish otolaryngology 2017. link 3 Zhang SS, Ma DQ, Guo CB, Huang MX, Peng X, Yu GY. Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy. International journal of oral and maxillofacial surgery 2013. link 4 Morariu I, Dias A, Curran A. Giant parotid pleomorphic adenoma in parapharyngeal space causing severe obstructive sleep apnoea. Irish medical journal 2012. link 5 Adeyemo WL, Taiwo OA, Somefun OA, Olasoji HO, Ndukwe KC, Fashina AA et al.. A survey of facial nerve dissection techniques in benign parotid surgery among maxillofacial and ear, nose, and throat surgeons in Nigeria. Nigerian journal of clinical practice 2011. link 6 O'Regan B, Bharadwaj G, Elders A. Techniques for dissection of the facial nerve in benign parotid surgery: a cross specialty survey of oral and maxillofacial and ear nose and throat surgeons in the UK. The British journal of oral & maxillofacial surgery 2008. link 7 Eng CY, Evans AS, Quraishi MS, Harkness PA. A comparison of the incidence of facial palsy following parotidectomy performed by ENT and non-ENT surgeons. The Journal of laryngology and otology 2007. link 8 Hui Y, Wong DS, Wong LY, Ho WK, Wei WI. A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy. American journal of surgery 2003. link00068-0) 9 Segatto O, Giacomini P, Santoro L, Perrino A, Natali PG. Lymphoid stroma of Warthin's tumor: phenotypic analogies with gut-associated lymphoid tissue. Clinical immunology and immunopathology 1985. link90005-4)

Warthin's tumor of parotid gland