Warthin's tumor shows rising prevalence and strong smoking association.

FNAC and MRI are key for accurate diagnosis and surgical planning.

FNAC demonstrated high sensitivity (91.3 %) for Warthin's tumor.

Patients reported cosmetic dissatisfaction despite conservative surgery.

Active surveillance, when possible, can minimize morbidity in selected cases.

To evaluate the incidence, diagnostic accuracy, surgical outcomes, complications, and patient-reported aesthetic satisfaction among patients with surgically treated Warthin's tumor (WT) over a 14-year period in a single tertiary center.

A retrospective review of 150 patients undergoing parotidectomy (2009–2022) was performed. Fifty-four patients with histopathologically confirmed WT comprised the primary analysis group. Demographics, smoking history, preoperative diagnostics [fine-needle aspiration cytology (FNAC), ultrasonography (US), magnetic resonance imaging (MRI)], surgical technique, and outcomes were recorded. Aesthetic satisfaction was assessed in a prospective subgroup (n = 37) using a 5-point Likert scale. Statistical analyses were applied with significance at p < 0.05.

WT accounted for 41.2 % of benign parotid tumors, nearly equal to pleomorphic adenoma (42.0 %). Mean age was 59.5 ± 8.9 years; 75.9 % were male. Mean smoking exposure was 42 ± 12.5 pack-years, and all patients with metachronous contralateral tumors continued smoking. FNAC sensitivity was 77.8 % overall and 91.3 % for adequate samples (PPV 94.4 %). US suggested WT in 5/43 (11.6 %) of reported examinations; MRI suggested WT in 34/39 (87.2 %) of US/MRI reports available. Superficial parotidectomy was performed in 70.4 % and partial superficial parotidectomy in 29.6 %. The most common complication was great auricular nerve sensory deficit (35.2 %); permanent facial nerve paralysis occurred in 1.9 %. In the aesthetic subgroup, 8.1 % rated contour deformity as “Poor/Very Poor,” and 10.8 % reported similar dissatisfaction with scarring.

Our 14-year analysis confirms that WT now constitutes a substantial proportion of benign parotid tumors, approaching the incidence of pleomorphic adenoma, with a strong association with smoking. FNAC and MRI demonstrated high diagnostic accuracy, supporting their role in reliable preoperative evaluation. While surgical treatment remains safe, postoperative sensory deficits and aesthetic concerns are not uncommon and may meaningfully affect patient satisfaction, even after limited surgery. Individualized management—particularly active surveillance for small, asymptomatic tumors in elderly or comorbid patients—may help balance oncologic safety with quality-of-life considerations.

Warthin's tumor

Parotidectomy

FNAC

Patient satisfaction

Smoking

Active surveillance

© 2025 The Authors. Published by Elsevier Inc.