Is surgical excision of lipomas arising from the parotid gland systematically required?

Lipomas arising from the parotid gland are very rare. We report a 10-year experience in a single institution (La Timone University Hospital of Marseille, France). Among 614 parotidectomies for neoplasms performed from 1998 to 2008, 12 lipomas were identified. A retrospective analysis based on medical records was made. Evaluation, analysis and current management of lipomas of the parotid gland are described. Lipomas accounted for 2% of all parotid neoplasms and 2.6% of benign tumors in our series. The median age of patients was 60 years with a M/F sex ratio of 5-1. The main presentation was a soft asymptomatic, slow-growing, mobile mass although 30% had an indurated mass on palpation. Diagnosis of lipoma, based on the results of imaging, was made preoperatively in all cases. The mean tumor duration prior to excision was 11.5 months. The surgical decision was made regarding increased swelling with functional/esthetic discomfort in 83% of cases. Partial parotidectomy was performed in most cases. Postoperative complications occurred in 16% of cases although no permanent complication was observed. No recurrence was observed in our series. Histologically, 92% of tumors were classic lipomas. Lipomas can be clinically misleading since 30% of patients in our series showed an indurated mass on palpation. Preoperative imaging, especially MRI, is the cornerstone of their management as it allows very accurate lipoma diagnosis. Since in our series, diagnosis of lipoma had been made preoperatively in all cases, the surgical excision could be delayed and finally surgical decision has been made for esthetic and/or functional considerations in more than 80% of cases.