Case of the Month February 2004

A 74-year-old white female presented to the Otolaryngology Clinic status post excision of a left parotid mass at an outside institution. The patient had initially presented with a 9-month history of a progressively enlarging mass near her left cheek. The patient was referred to the Head and Neck Oncology service for further evaluation of the parotid mass secondary to positive surgical margins and possible involvement of the facial nerve. Past medical history was significant for emphysema and hip replacement surgery. Patient states she smoked cigarettes for forty years but quit seven years ago. Physical examination was remarkable only for intermittent fasciculation of the left facial nerve musculature. Cranial nerves II-VII were intact bilaterally, and palpation of the left parotid demonstrated no obvious mass.

Two weeks later, the patient underwent a left subtotal parotidectomy with identification and preservation of the left facial nerve. The patient tolerated the surgery well and no additional tumor was identified in the parotidectomy specimen.