A 70-year-old has a rapidly enlarging parotid mass, new lower facial weakness and a suspicious core biopsy. CT shows deep-lobe extension but no distant metastases. Which statement best guides counselling?
Facial weakness and rapid growth are red flags for malignant parotid disease. Management depends on histology, resectability, nerve involvement and adjuvant-treatment planning; a promise to preserve a clinically invaded nerve would be inappropriate.
A. Treat as Warthin tumour because of the patient’s age: Clinical red flags and biopsy findings require oncological assessment.
B. Proceed with superficial parotidectomy without staging: Deep-lobe disease and possible malignancy require a planned oncological operation.
C. Offer facial-nerve sacrifice before discussing alternatives: The decision requires histological, functional and patient-centred discussion.
D. Manage with sialogogues and review in six months: This would dangerously delay a likely malignancy.
E. The likelihood of malignancy and need for multidisciplinary staging outweigh any presumption that facial-nerve preservation is automatic: Facial weakness and rapid growth are red flags for malignant parotid disease. Management depends on histology, resectability, nerve involvement and adjuvant-treatment planning; a promise to preserve a clinically invaded nerve would be inappropriate.
If a well-defined superficial mass had benign cytology and normal facial function, a conservative parotid surgical discussion would be more appropriate.
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