Introduction: The study aim was to determine the distribution of parotid gland neoplasms among veterans and re-assess the role of parotidectomy in patients with Warthin Tumors (WT).

Methods: Patients who underwent fine needle aspiration for a parotid gland mass and/or parotidectomy at a single institution from 2000 to 2018 were included. Charts were reviewed for gender, age, tobacco use, surgery date, and pathology results. Two patients with WT are presented. Case 1: Typical presentation of a 55 year-old patient with a parotid WT who underwent superficial parotidectomy. Case 2: A 67 year-old patient who elected to observe his WT for many years, resulting in parapharyngeal tumor extension. He underwent a parotidectomy with parapharyngeal resection via transcervical approach.

Results: One hundred and forty-four patients with parotid gland neoplasms were identified. Of those, 84.7% (122/144) were benign and 15.2% (22/144) were malignant. Of benign neoplasms, WT accounted for the majority at 50.5% (62/122), followed by pleomorphic adenoma at 40.2% (49/122). The incidence of WT increased from 38.3% in 2000-2009 to 58.7% in 2010-2018. Smoking history was significantly associated with WT compared to pleomorphic adenoma (OR: 2.90 [95% confidence interval 1.30-6.08] p=0.046). However, the rate of former and current tobacco use remained steady at 67-68% from the year 2000 to 2018.

Conclusion: The incidence of WT is rising among veterans at our institution despite stable rates of tobacco use. Given the risk of tumor extension, facial nerve compression, and increased operative complexity, surgical management remains the treatment of choice for WT.