The Role of Extracapsular Dissection for Benign Parotid Tumors

Surgical treatment of benign parotid tumors has been debated for decades. Extracapsular dissection (ECD) differs markedly from classic surgical approaches to the parotid neoplasm because facial nerve dissection is not performed. ECD, its advantages, disadvantages, indications, and contra-indications for benign tumors with an emphasis on benign mixed tumor will be comprehensively explored in this chapter. Factors noted to favor this approach include mobility of the tumor within the gland, a thin covering of capsule and glandular tissue, and a tumor large enough to allow digital manipulation during dissection. Imaging, fine needle aspiration cytology, and neuro-monitoring play a heightened role in ECD. Recurrence and permanent facial nerve dysfunction with ECD are not higher in high volume centers performed by experienced surgeons. Transient facial nerve dysfunction, Frey’s syndrome, sensory deficits, and sialocele are lower with ECD. Devastating adverse outcomes of permanent facial nerve dysfunction and recurrence should be considered by the occasional and inexperienced parotid surgeon.