Improving Surgical Guidelines for Parotid Tumours: Insights on the European Salivary Gland Society Classification from Clinical Practice

<strong>Objective:</strong> This study evaluates the European Salivary Gland Society (ESGS) classification system’s effec tiveness in guiding surgical decisionmaking for benign parotid tumours. This study aims to identify limitations and propose refinements to optimise classification accuracy and surgical outcomes. <strong>Material and Methods:</strong> Operative records of patients who underwent parotidectomy for benign parotoid tumours between 2015 and 2019 were analysed. Tumours were classified using the ESGS system, and the recommended surgical approaches were compared with actual practices. Facial nerve paralysis rates and deviations from the ESGS guidelines were assessed. <strong>Results:</strong> Among the 185 patients, 55.6% had pleomorphic adenomas, 37.8% had Warthin’s tumours, and %6.4 had other benign tumours, with a mean followup of 18.72 months. Postoperative facial nerve paralysis occurred in 10.81%, increasing in the advanced ESGS categories with a permanent paralysis rate of 3.24%. All Category I tumours were managed with either a onelevel parotidectomy or extracapsular dissection (ECD), aligning well with the ESGS recommendations. However, 22% of Category II Warthin’s tumours required more extensive resections, suggesting that the recommendation should be revised to “one or twolevel parotidectomy (most often partial superficial) or ECD.” For Category III tumors, compli ance with the guideline was complete for Warthin tumors. However, the surgical management deviated from the guidelines in two cases of deep lobe pleomorphic adenomas. The recommendation should be revised to “twolevel parotidectomy (more commonly superficial); tumours located in the deep lobe can be treated with three or four level parotidectomy.” It is also necessary to acknowledge that the guideline does not address multifocal benign tumours. <strong>Conclusion:</strong> The ESGS classification offers a valuable framework for surgical planning in benign parotid tumours; however, refinements are suggested to improve applicability, particularly for multifocal and deep lobe tumours. Further studies with larger cohorts are recommended to refine these guidelines, enhancing their efficacy in surgical decisionmaking.