(620) Extracapsular Dissection as Treatment for Malignant Tumors of the Parotid Gland

Introduction: Extracapsular Dissection (ECD) is an approach for treating parotid lesions that is less invasive than traditional parotidectomy; however, it is not typically indicated for malignant tumors. Literature has shown ECD may avoid facial nerve complications without increasing risk of tumor recurrence, though most literature has focused on benign tumors. This study aims to compare oncologic and functional outcomes associated with ECD vs. traditional parotidectomy for malignant pathologies to investigate whether ECD may be an appropriate treatment option.

Methods: Records were reviewed for patients who underwent parotid surgery at an urban tertiary care center from 2011 to 2025 for cN0 parotid malignancies. Oncologic outcomes, postoperative facial nerve function, and variables related to the immediate postoperative period were compared between ECD and traditional parotidectomy. Facial nerve weakness was considered unanticipated if the nerve was not intentionally resected during the operation.

Results: Sixty-nine patients were included, 18 of whom underwent ECD. Margins were more likely to be positive (38.9% vs. 29.4%, p=0.458), and both transient and permanent unanticipated facial nerve weakness were less likely (5.6% vs. 25.5%, p=0.071; 0% vs 3.9%, p=0.394) following ECD. Patients who underwent ECD were significantly less likely to be admitted for postoperative hospitalization (16.7% vs. 74.5%, p< 0.001) or have a drain placed (16.7% vs. 78.4%, p< 0.001). There was no evidence of disease recurrence in either group, and 5-year disease free survival, when applicable, was 100%.

Conclusions: ECD demonstrated potentially improved facial nerve outcomes without compromising oncologic outcomes compared to traditional parotidectomy, suggesting that it may be an appropriate approach for treating select parotid malignancies, though caution should be exercised as ECD had a higher rate of positive margins. Further investigation into the role of ECD in treating select malignancies is warranted.