Improving Surgical Guidelines for Parotid Tumours: Insights on the European Salivary Gland Society Classification from Clinical Practice

Year 2025, Volume: 35 Issue: 2, 87 - 94, 11.06.2025

Sibel Yıldırım , Muhammed Sefa Uyar , Kürşat Gökcan , Tarık Babür Küçük

https://doi.org/10.26650/Tr-ENT.2025.1653576

Abstract

Objective: This study evaluates the European Salivary Gland Society (ESGS) classification system’s effective ness in guiding surgical decisionmaking for benign parotid tumours. This study aims to identify limitations and propose refinements to optimise classification accuracy and surgical outcomes.

Material and Methods: Operative records of patients who underwent parotidectomy for benign parotoid tumours between 2015 and 2019 were analysed. Tumours were classified using the ESGS system, and the recommended surgical approaches were compared with actual practices. Facial nerve paralysis rates and deviations from the ESGS guidelines were assessed.

Results: Among the 185 patients, 55.6% had pleomorphic adenomas, 37.8% had Warthin’s tumours, and %6.4 had other benign tumours, with a mean followup of 18.72 months. Postoperative facial nerve paralysis occurred in 10.81%, increasing in the advanced ESGS categories with a permanent paralysis rate of 3.24%. All Category I tumours were managed with either a onelevel parotidectomy or extracapsular dissection (ECD), aligning well with the ESGS recommendations. However, 22% of Category II Warthin’s tumours required more extensive resections, suggesting that the recommendation should be revised to “one or twolevel parotidectomy (most often partial superficial) or ECD.” For Category III tumors, compliance with the guideline was complete for Warthin tumors. However, the surgical management deviated from the guidelines in two cases of deep lobe pleomorphic adenomas. The recommendation should be revised to “twolevel parotidec tomy (more commonly superficial); tumours located in the deep lobe can be treated with three or four level parotidectomy.” It is also necessary to acknowledge that the guideline does not address multifocal benign tumours.

Conclusion: The ESGS classification offers a valuable framework for surgical planning in benign parotid tumours; however, refinements are suggested to improve applicability, particularly for multifocal and deep lobe tumours. Further studies with larger cohorts are recommended to refine these guidelines, enhancing their efficacy in surgical decisionmaking.

Keywords

Parotid Neoplasms , partial Superficial Parotidectomy , Pleomorphic Adenoma , Superficial Parotidectomy , Warthin’s Tumour

Ethical Statement

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ankara University (04-297-19)

Supporting Institution

No funding was received for conducting this study.

References

• Quer M, Guntinas-Lichius O, MarchaL F, Vander Poorten V, ChevaLier D, Leon X, et aL. CLassification of parotidectomies: a proposaL of the European SaLivary GLand Society. Eur Arch OtorhinoLaryngoL 2016;273(l0):3307-12. google scholar
• Aasen MH, Hutz MJ, Yuhan BT, Britt CJ. Deep Lobe Parotid Tumors: A Systematic Review and Meta-anaLysis. OtoLaryngoL Head Neck Surg 2022;166(l):60-7. google scholar
• Tweedie DJ, Jacob A. Surgery of the parotid gLand: evoLution of techniques, nomencLature and a revised cLassification system. CLin OtoLaryngoL 2009;34(4):303-8. google scholar
• Quer M, Vander Poorten V, Takes RP, SiLver CE, Boedeker CC, de Bree R, et aL. SurgicaL options in benign parotid tumors: a proposaL for cLassification. Eur Arch OtorhinoLaryngoL 2017;274(ll):3825-36. google scholar
• Foresta E, Torroni A, Di Nardo F, de Waure C, Poscia A, Gasparini G, et aL. PLeomorphic adenoma and benign parotid tumors: extracapsuLar dissection vs superficiaL parotidectomy-review of Literatüre and meta-anaLysis. OraL Surg OraL Med OraL PathoL OraL RadioL 2014;117(6):663-76. google scholar
• KadLetz L, GrasL S, GrasL MC, Perisanidis C, Erovic BM. ExtracapsuLar dissection versus superficiaL parotidectomy in benign parotid gLand tumors: The Vienna MedicaL SchooL experience. Head Neck 2017;39(2):356-60. google scholar
• Mehta V, Nathan CA. ExtracapsuLar dissection versus superficiaL parotidectomy for benign parotid tumors. Laryngoscope 2015;125(5):1039-40. google scholar
• Wong WK, Shetty S. CLassification of parotidectomy: a proposed modification to the European SaLivary GLand Society cLassification system. Eur Arch OtorhinoLaryngoL 2017;274(8):3175-81. google scholar
• Nishimura H, Kawata R, Kinoshita I, Higashino M, Terada T, Haginomori SI, et al. Proposal for a novel classification of benign parotid tumors based on localization. Aurİs Nasus Larynx 2023;50(5):790-8. google scholar
• Reerds STH, Gerdsen M, van den Hoogen FJA, Takes RP, van den Broek GB, Vallen H, et al. Surgical management of deep lobe parotid tumours with and without involvement of the parapharyngeal space. Int J Oral Maxillofac Surg 2022;51(6):762-7. google scholar
• Larian B. Parotidectomy for Benign Parotid Tumors. Otolaryngol Clin North Am 2016;49(2):395-413. google scholar
• Tresserra L, Tresserra F. [Tumors of the parotid gland]. Rev Stomatol Chir Maxillofac 1997;98(3):220-30. google scholar
• Sesenna E, Bianchi B, Ferrari S, Copelli C, Ferri T, Ferri A. Selective deep lobe parotidectomy for pleomorphic adenomas. Int J Oral Maxillofac Surg 2013;42(9):1129-33. google scholar
• Wallerius KP, Xie KZ, Lu LY, Lohse CM, Yin LX, Price DL, et al. Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid TumoRS. JAMA OtolaRyngol Head Neck SuRg 2023;149(11):1003-10. google scholar
• Roh JL, PaRk Cl. Function-preserving parotid surgery for benign tumoRS involving the deep parotid lobe. J SuRg Oncol 2008;98(1):42-5. google scholar
• Psychogios G, BohR C, Constantinidis J, Canis M, VandeR PooRten V, Plzak J, et al. Review oP suRgical techniques and guide PoR decision making in the tReatment of benign paROtid tumoRS. Eur Arch Otorhinolaryngol 2021;278(1):15-29. google scholar
• Mendenhall WM, Mendenhall CM, WeRning JW, Malyapa RS, Mendenhall NP. Salivary gland pleomoRphic adenoma. Am J Clin Oncol 2008;31(1):95-9. google scholar
• ZbaRen P, TRiantafyllou A, Devaney KO, PooRten VV, Hellquist H, Rinaldo A, et al. Preoperative diagnostic of parotid gland neoplasms: fne-needle aspiration cytology or core needle biopsy? Eur Arch Otorhinolaryngol 2018;275(11):2609-13. MaioRano E, Lo Muzio L, Favia G, Piattelli A. WaRthin's tumouR: a study of 78 cases with emphasis on bilateRality, multifocality and association with otheR malignancies. Oral Oncol 2002;38(1):35-40. google scholar
• Mantsopoulos K, Goncalves M, Koch M, lRo H. ExtRacapsulaR dissection foR waRthin tumoRs despite the Risk of ipsilateRal metachRonous occuRRence. Laryngoscope 2018;128(11):2521-4. google scholar
• Guntinas-Lichius O, Gabriel B, Klussmann JP, Risk of facial palsy and severe FRey's syndRome afteR conseRvative paRotidectomy foR benign disease: analysis of 610 operations. Açta Otolaryngol 2006;126(10) :1104-9. google scholar
• Chiesa-Estomba CM, Saga-Gutierrez C, Gonzalez-Garcia JA, Calvo-Henriquez C, Larruscain E, Sistiaga-Suarez JA, et al. Intraoperative monitoring of the facial nerve during parotid gland surgery in Otolaryngology Services - Head and Neck Surgery. Açta Otorrinolaringol Esp (Engl Ed) 2021;72(3):158-63. google scholar
• Schapher M, Koch M, Agaimy A, Goncalves M, Mantsopoulos K, lro H. Parotid pleomorphic adenomas: Factors influencing surgical techniques, morbidity, and long-term outcome relative to the new ESGS classification in a retrospective study. J Craniomaxillofac Surg 2019;47(9):1356-62. google scholar
• Gur H, lsmi O, Vayisoglu Y, Gorur K, Unal M, Guven O, et al. Results of 301 Parotidectomies: A Twenty-Year Experience of One Single Institution. Indian J Otolaryngol Head Neck Surg 2023;75(1):2 0 8-17. google scholar