Clinicopathological Characteristics and Outcomes in Parotidectomy for Parotid Tumors

Background: Parotid gland tumors pose diagnostic and surgical challenges due to their histological heterogeneity and proximity to the facial nerve. This study aimed to evaluate clinicopathological features and postoperative outcomes in a large cohort undergoing parotidectomy. Methods: This retrospective study included 314 patients who underwent parotidectomy between 2008 and 2024 at a tertiary center. Demographic data, tumor histology, and postoperative complications—particularly facial nerve paralysis—were analyzed. Histopathological features such as capsular, perineural, and lymphovascular invasion were also assessed. Results: Of all cases, 79% were benign, 14.6% malignant, and 6.4% non-neoplastic. Pleomorphic adenoma and Warthin tumor were the most common benign entities, while mucoepidermoid carcinoma was the most frequent malignancy. Malignant tumors were associated with higher rates of positive surgical margins (44.2%), capsular invasion (25%), and tumor necrosis (22%). Facial paralysis occurred in 4.4% of patients, more frequently among those with malignant tumors and extensive lymph node dissection. Capsular invasion and necrosis were rare in benign lesions but still observed, especially in pleomorphic adenoma. No significant differences in pathology were found based on place of birth. Conclusion: Most parotid tumors are benign, but certain histopathological features—such as necrosis, capsular and perineural invasion—are strong indicators of malignancy and should guide surgical planning and postoperative surveillance. These findings highlight the need for individualized, risk-adapted management strategies in parotid surgery to balance oncological safety with preservation of function.