Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
Juan P. Rodrigo
Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
Antti A. Mäkitie
Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, 00029 HUS Helsinki, Finland
Alessandra Rinaldo
University of Udine School of Medicine, 33100 Udine, Italy
Luiz P. Kowalski
Head and Neck Surgery Department, University of Sao Paulo Medical School, São Paulo 01509, Brazil
Alvaro Sanabria
Department of Surgery, School of Medicine, Universidad de Antioquia, IPS Universitaria-Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
Remco de Bree
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Robert P. Takes
Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
Fernando López
Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
Kerry D. Olsen
Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55902, USA
Ashok R. Shaha
Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
Alfio Ferlito
Coordinator of the International Head and Neck Scientific Group, 35125 Padua, Italy
Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.