Extended radical parotidectomy with mastoidectomy and facial nerve resection for advanced parotid malignancy: a case report

Abstract

Advanced parotid malignancies with perineural spread pose significant surgical challenges and often require aggressive multidisciplinary management. We report a case of a 52-year-old male who presented with a progressively enlarging right parotid swelling for 1.5 years associated with right lower motor neuron facial nerve palsy for one year. Patient was evaluated clinically and radiologically. Fine needle aspiration cytology initially suggested mucoepidermoid carcinoma. The patient underwent radical parotidectomy with extended radiacal neck dissection, intact canal wall mastoidectomy, facial nerve resection through a combined surgical approach involving ENT and surgical oncology teams. Intraoperatively, tumour infiltration into the sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve and posterior belly of digastric was noted, necessitating an extended radical resection. Final histopathology revealed salivary duct carcinoma with lymphovascular and perineural invasion and nodal metastasis. Postoperative radiotherapy was planned as adjuvant therapy. This case highlights the importance of aggressive surgical management with skull base exposure in advanced parotid malignancies with perineural spread to achieve optimal oncological clearance.