Bilateral synchronous acinic cell carcinoma of the parotid glands: challenges in delivery of adjuvant radiotherapy

Background: Bilateral synchronous malignant tumours in the head and neck region are very rare. Radiotherapy treatment for these malignancies is technically difficult as toxicity to the organs at risk needs to be minimised. Case Report: A 52 year old gentleman presented with bilateral swellings in the parotid regions. FNAC suggested bilateral acinic cell carcinoma and MRI imaging suggested multiple superficial and deep lobe lesions. The patient underwent bilateral total parotidectomies and bilateral level I-III selective neck dissections. Adjuvant radiotherapy was administered to both parotid beds. Conclusions: Although bilaterality of malignant tumours in the head and neck region is rare it is important to examine and image the contra-lateral side. This case also highlights the difficulties in surgical and radiotherapy interventions specifically in sparing the organs at risk. Furthermore, it emphasises the need for a multidisciplinary approach in treating these patients.