Management
Diagnostic and Therapeutic Surgical Procedures
➤ Surgeons should offer open surgical excision for histologically confirmed
salivary gland malignancies. (Strong recommendation; EB-H)
➤ Surgeons may request intraoperative pathologic examination to support
immediate alterations in intraoperative management (extent of resection,
neck dissection). Decisions that would result in major harm such as facial
nerve resection should not be based on indeterminate preoperative or
intraoperative diagnoses alone. (Weak recommendation; EB-L)
➤ Surgeons may perform partial superficial parotidectomy for
appropriately located superficial T1 or T2 low grade salivary gland
cancers. (Weak recommendation; EB-L)
➤ Because of the risk of intraparotid nodal metastases in high-grade
or advanced stage parotid cancer, surgeons should perform at least
a superficial parotidectomy with consideration of a total or subtotal
parotidectomy for any high-grade or advanced (T3–T4) parotid cancer.
(Strong recommendation; EB-I)
➤ Surgeons should perform facial nerve preservation in patients with intact
preoperative facial nerve function when a dissection plane can be created
between the tumor and the nerve. (Strong recommendation; EB-I)
➤ Surgeons should perform resection of involved facial nerve branches in
patients with impaired facial nerve movement preoperatively or when
branches are found to be encased or grossly involved by a confirmed
malignancy. (Moderate recommendation; EB-I)
➤ Surgeons should offer an elective neck treatment over observation
in a clinically negative neck in T3 and T4 tumors and high-grade
malignancies. (Moderate recommendation; EB-I)
➤ For operative elective neck management of salivary cancers, ipsilateral
selective neck dissection should be performed with levels dependent
on the primary site. For parotid malignancies, levels may include 2–4.
(Moderate recommendation; EB-L)
➤ For a cN+ neck, surgeons may perform an ipsilateral neck dissection of
involved and at-risk levels and may extend to adjacent levels, up to levels
1–5. (Moderate recommendation; EB-L)
➤ In the setting of resectable, recurrent locoregional disease and
no distant metastatic disease, regardless of prior treatment type,
patients should be offered revision resection and appropriate surgical
reconstruction and rehabilitation. (Strong recommendation; EB-I)
