En bloc temporo-parotid resection for malignant tumours of the parotid: surgical technique

Objective. Advanced malignant tumours of the parotid gland often extend to the skull base and adjacent soft tissues. Conventional extended parotidectomy has shown limitations in achieving radical margins. Temporo-parotid resection (TPR) was developed to ensure oncological continuity of the specimen in an en bloc fashion and to achieve reliable surgical margins. A detailed description of the surgical technique has not been reported in the literature to date and is the aim of the present work.
Methods. Thirty-four patients with malignant parotid tumours were treated with TPR between 2019 and 2025. The surgical technique is detailed step-by-step herein. The procedure begins with a combined cervico-parotid incision, followed by total parotidectomy with preservation or sacrifice of the facial nerve according to tumour involvement. A selective or modified radical neck dissection is carried out en bloc. Temporal bone resection is then performed according to 3 reproducible osteotomy patterns: type 1 (partial tympano-mastoidectomy running lateral to fallopian canal); type 2 (partial mastoidectomy, radical tympanectomy medial to fallopian canal and lateral to the labyrinth); type 3 (radical tympano-mastoidectomy, medial to fallopian canal and variably extending to the spheno-temporal bone, labyrinth, jugular fossa, carotid canal). The parotid, neck and temporal bone components are removed in continuity, without specimen disruption, thereby ensuring accurate deep margin assessment.
Results. TPR type 1 was performed in 10 cases (29.4%), type 2 in 20 cases (58.8%), and type 3 in 4 cases (11.8%). Outcome analysis was beyond the scope of the present study and will be reported separately.
Conclusions. TPR provides a reproducible en bloc approach to parotid malignancies with skull base extension, optimises oncological radicality, facilitates processing and assessment of surgical specimens, and enables standardisation of bone resections.