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6.3.4: 4. Clinical Evaluation- History and Examination

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    • Objectives
      • Avoid unnecessary surgery for e.g. infective or non-neoplastic masses, lymphoma, unresectable tumour
      • Do appropriate surgery
      • Avoid embarking on surgery that is beyond the scope of a surgeon e.g. deep lobe tumour, tumour extending to the parapharyngeal space, tumour requiring neck dissection, or tumour requiring facial nerve reconstruction
    • Malignant parotid tumours may have clinically benign features
    • Consider lymphoma
      • Past lymphoma
      • HIV +ve
      • Cervical / generalised lymphadenopathy
    • Suspicious for malignancy
      • Pain
      • Rapid growth
      • Neurological deficits
      • Facial nerve: Facial twitching or weakness
      • Trigeminal nerve
      • Greater auricular nerve
      • Skin invasion
      • Muscle invasion….trismus
      • Cervical nodes
      • Prior skin/conjunctival cancer/melanoma
      • Previous salivary cancer
      • Previous radiation to salivary gland region