[Update on salivary gland surgery].

BACKGROUND AND

OBJECTIVE

Recent years have seen publication of studies on salivary gland surgery with a major impact on daily practice. This applies to both the surgical treatment of benign and malignant tumors and to the treatment of obstructive and inflammatory diseases of the salivary glands. In the case of tumors, extracapsular dissection has led to a shift toward de-escalation of facial exposure and resection with low morbidity over the past 20 years. For inflammatory and obstructive diseases, minimally invasive treatment methods have become established over the past 35 years, especially over the past 10. This paper provides an update on salivary gland surgery. Part 1 deals with tumor surgery and part 2 with the surgical therapy of obstructive and inflammatory diseases.

MATERIALS AND

METHODS

This article represents a compilation of current developments based on the latest literature, with a focus on the past decade and the authors' our own experience.

RESULTS

Extracapsular dissection is superior to superficial parotidectomy in terms of Frey syndrome, operating time, esthetic appearance, and transient and permanent facial function-provided the indications are appropriate. In malignant tumors without infiltration of the facial nerve, the latter should be preserved in the context of complete parotidectomy. Radical parotidectomy is only indicated in cases of facial nerve infiltration. Elective ipsilateral neck dissection is indicated for T3/4 tumors, high-grade carcinomas, and adenoid cystic carcinomas. Therapeutic and interventional sialendoscopy and sialendoscopy-assisted surgical procedures dominate the treatment of obstructive and inflammatory salivary gland diseases and can also be important in cases of salivary duct injury.

CONCLUSION

The indication for surgery and the choice of surgical technique depend on the location and biological behavior of the tumor. Based on the developments outlined above, resection of the major salivary glands is indicated in less than 5% of cases of obstructive or inflammatory diseases.