The successful treatment of salivary gland malignancies originating in the parotid gland begins with rigorous and thorough surgical management coupled with the directed and appropriate potential adjuvant use of radiation therapy and chemotherapy. The anatomic complexity of the region in relation to the facial nerve and adjoining neurovascular and musculoskeletal structures requires sound surgical planning and decision making based on preoperative and intraoperative findings. The clinical presentation of parotid malignancy is summarized, as well as the further evaluations that are performed, including imaging and tissue biopsy. A systematic approach to ensure resection with clear margins, management of the facial nerve, applicable extensions of the primary resection and management of the neck are presented. The key determinants of disease control, including the stage (early or advanced), histologic grade (low or high) and margin status (clear or positive), are highlighted as critical aspects of surgical management.
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