title: The results of temporal bone surgery for advanced or recurrent tumors of the parotid gland.
abstract: OBJECTIVE
  To describe the results of temporal bone surgery in managing advanced or recurrent tumors of the parotid gland.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Patients with advanced or recurrent tumors involving the parotid gland who underwent either mastoidectomy or temporal bone resection were reviewed for treatment outcomes.
  
  
  RESULTS
  Forty-nine patients were identified who required either mastoidectomy (n = 33) or temporal bone resection (n = 16) for malignancies involving the parotid gland. Facial nerve sacrifice was required in 35 patients (71.4%). Perineural invasion was found in 51.1% of patients; and negative margins were achieved in 78.2% patients. Six of 10 patients presenting with normal facial function (House-Brackmann I) and recurrent tumors maintained normal facial function following salvage surgery. Trismus, tumors larger than 4 cm, and the need for mandibulectomy were significantly correlated with higher recurrence rates (P = .025, P = .004, and P = .002, respectively). Patients with preoperative House-Brackmann I or II had a lower risk for recurrence (P = .035) and more favorable survival at 3 years (P = .024). Patients who required parapharyngeal space dissection and those with metastatic neck disease had the poorest survival rates. The overall survival at 3 years was 72.4%.
  
  
  CONCLUSIONS
  Mastoidectomy and temporal bone resection permit preservation of the facial nerve when oncologically safe; they may help to achieve negative margins, and they allow facial nerve grafting when nerve sacrifice is required. Despite the poor prognostic indicators of facial paralysis, recurrent tumors, and perineural invasion, a significant number of patients can be salvaged successfully when a temporal bone procedure is combined with parotidectomy.
authors.affiliation: Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. pwgidley@mdanderson.org
authors.forename: Paul W
authors.initials: PW
authors.lastname: Gidley
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Thompson
authors.forename: Dianna B
authors.initials: DB
authors.lastname: Roberts
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005154:Facial Nerve / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D013701:Temporal Bone / Q000601:surgery*; D055815:Young Adult