Removal of the Inferior Half of the Superficial Lobe Is Sufficient to Treat Pleomorphic Adenoma in the Tail of the Parotid Gland

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Abstract
For a 3-cm pleomorphic adenoma confined to the tail of the parotid gland, dissection of the inferior branch of the facial trunk nerve and removal of the inferior half of the superficial lobe are sufficient. In the first half of the 20th century, benign parotid neoplasms were enucleated, irradiated, or both. Complications were common, and recurrence rates for benign pleomorphic adenomas were high (20%-45%), probably because of spillage of tumor cells into the wound.1 A major advance occurred when Janes2(1940) and Bailey3(1941) described a supraneural approach to treatment of parotid neoplasms. The facial nerve runs through the parotid gland. It enters posteriorly as a main trunk, and branches within the gland. The cervical and marginal mandibular branches of the lower division are the lowest branches of the facial nerve in the neck. Although the branches share some redundancy, the nerve does not cross over itself. Dissection along one branch will not reveal a branch deeper to it. This branching pattern divides the gland into a deeper or medial portion, now often called the deep lobe, and a much larger, more superficial portion (superficial lobe). There is no true anatomic compartmental separation of the superficial and deep parotid lobes. Rather, the facial nerve constitutes the surgical division. The radiologic demarcation between deep and superficial lobes is an imaginary line from the stylomastoid foramen to the retromandibular vein or the lateral ascending ramus of the mandible.