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Remove mass on parotid gland sooner rather than later

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Dear Dr. Roach • I recently was diagnosed with a benign pleomorphic adenoma of the parotid gland. My surgeon says that the mass should be removed, and explained many of the risks. The risks terrify me: Frey’s syndrome, facial paralysis, numbness.

My mass is 11 mm. Is that considered large? Could this mass be slow-growing, with little chance of it becoming cancerous? How long could I wait before agreeing to the surgery? — J.M.

Answer • I think I agree with your surgeon: Most masses like this should be removed. As with any procedure, there are risks and benefits. One risk is Frey’s syndrome (sweating around the face), which is a possible complication of the surgery. Another risk is damage to the facial nerve, which runs through the parotid, and damage to it during surgery can cause facial weakness and numbness.

That’s the bad news. The good news is that 11 mm is a small tumor, and the risks of complications are fairly low. For example, temporary facial nerve damage happens in 10 to 60 percent of surgeries (depending on size and proximity to the facial nerve), but 90 percent recover within one month. Permanent facial nerve damage occurs in 0 to 8 percent of cases in different studies.

Balanced against the risks of surgery are the risks of not doing surgery. Untreated, the tumor is likely to grow, making it harder and more dangerous to remove. However, there is always a small chance of transformation to a malignant tumor. If you are going to do surgery, it’s better to do so sooner.

Dear Dr. Roach • What is insulin resistance? Is there such a thing? Does it cause belly fat? How do we get rid of it?

My husband and I are in our 70s, have belly fat, are overweight and are Type 2 diabetics. I take metformin, while my husband is on insulin. We take medications for cholesterol and blood pressure. No matter what we do, we cannot lose weight. — G. and B.

Answer • Insulin resistance is the primary defect of Type 2 diabetes, but insulin resistance happens before diabetes is diagnosed. The exact mechanism that causes it is not clear. However, it is clear that belly fat is strongly associated with insulin resistance, and that behaviors that reduce belly fat tend to reduce insulin resistance. The preponderance of the evidence is that belly fat is a major cause.

Some diabetes medications help reverse insulin resistance. One of them, metformin, is increasingly used to prevent diabetes in people with insulin resistance.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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