Treatment of benign salivary gland tumors

The WHO classification includes 11 benign tumors, the most frequent being pleomorphic adenomas with around 50% and Warthin tumors with 25%. The ratio of benign to malignant tumors varies distinctively between the glands: 80% at the parotid gland are benign but only 10% at the sublingual gland. Besides imaging, complete excision of minor salivary glands or of the sublingual gland provides diagnostic information, whereas core needle biopsy is preferred at the submandibular and the parotid glands; incisional biopsies should not be performed. Generally, surgery of benign salivary gland tumors is much easier compared to malignancies of similar size and location or to the various inflammatory and cystic entities, which must always be considered in the differential diagnosis. For example, submandibulectomy can be performed by predominantly blunt dissection with less adherence to relevant neighboring structures, perhaps even via an intraoral approach. At the parotid gland enucleation is regarded as obsolete. Total, lateral (superficial), and partial lateral parotidectomies are established, but extracapsular dissection is nowadays usually considered the first-choice method. The latter is recommended in mobile tumors of the superficial lobe without adhesion to the facial nerve up to a diameter of 4 cm and with surgical experience in preparation of the nerve, which may ultimately become necessary. Expenditures, complications, contour deficits and scar lengths, sialoceles, Frey syndromes, temporary and permanent lesions of the facial nerve, and frequencies of recurrence differ between the respective procedures. Individual selection of the best method is impaired by the lack of prospective randomized studies.