Clinicopathologic and Surgical Study of Pleomorphic Adenoma of the Parotid Gland: Analysis of Risk Factors for Recurrence and Facial Nerve Dysfunction

ntroduction: Salivary tumors represent a heterogeneous group of tumors of diverse location, histological structure and bio logical behavior. The purpose of this study was a retrospective evaluation of surgical treatment of a group of patients with newly dia gnosed benign tumors of the parotid salivary gland operated in the years 2014–2018 at the ENT department of Hospital České Budějovice, a.s. Material and methods: A type of surgery, defi nitive histology, postoperative complications and a number of recurrences were monitored. The data were evaluated by descriptive statistical methods. Results: A total of 190 surgeries with benign histological fi ndings in 182 patients were performed. The most common benign result was Warthin‘s tumor (90 cases, 47.4%), followed by pleomorphic adenoma (66 cases, 34.7%). Uncommon histological types of tumors were dia gnosed in 14 patients (7.4%). Non-tumorous fi ndings were found in 20 cases (10.5%). The most frequently performed procedure in 84 cases (44.2%) was extracapsular extirpation. Transient lesion in the area of innervation of the temporofacial and / or cervicofacial branch of the facial nerve was present in 34 (17.9%) patients. Permanent paresis of some of the branches of the facial nerve was reported in 2 (1.1%) patients. In 12 patients, the postoperative course was complicated by the development of salivary fi stula (6.3%). Pleomorphic adenoma relapsed after extracapsular extirpation in 5 cases (20.0%). After partial parotidectomy, one recurrence of pleomorphic adenoma (3.6%) was recorded. Warthin‘s tumor relapsed after simple extirpation in 4 cases (20.0%). Conclusion: Our evaluation results of the surgical treatment of benign parotid gland tumors lead us to make further eff orts improve the care of our patients. We see reserves mainly in the routine use of ultrasonographic examination with performance FNAC and thus planning a safe and suffi ciently radical operational solution. Keywords: parotid gland – pleomorphic adenoma – Warthin‘s tumor – parotidectomy – recurrence – facial nerve paresis – FNAC

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Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland

Head & Neck ◽

10.1002/hed.26570 ◽

2020 ◽

Author(s):

Steven A. Rooker ◽

Kathryn M. Van Abel ◽

Linda X. Yin ◽

Alex A. Nagelschneider ◽

Daniel L. Price ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Parotid Gland ◽

Pleomorphic Adenoma ◽

Recurrent Pleomorphic Adenoma

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Facial nerve monitoring in giant malignant tumor ex pleomorphic adenoma of parotid gland

JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY ◽

10.5106/jjshns.27.351 ◽

2018 ◽

Vol 27 (3) ◽

pp. 351-356

Author(s):

Munehito Moriyama ◽

Takashi Hirano ◽

Keigo Fujita ◽

Masashi Suzuki

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Malignant Tumor ◽

Nerve Monitoring ◽

Facial Nerve Monitoring

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Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195591 ◽

2019 ◽

Vol 6 (1) ◽

pp. 60

Author(s):

Dheer S. Kalwaniya ◽

Goutam Kothathi Chowdegowda ◽

Monish Raj ◽

Jaspreet S. Bajwa ◽

Satya V. Arya ◽

...

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Surgical Approaches ◽

Depth Of Invasion ◽

Tumor Depth ◽

Facial Paresis ◽

Superficial Parotidectomy ◽

Parotid Surgery ◽

Nerve Paresis

Background: The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.Methods: This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system. Results: Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size <4 cm), 2 suffered facial paresis and out of 11 patients (size >4 cm), 5 suffered same. Out of 59 patients with depth of tumor <2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth >2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).Conclusions: Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.

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Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland

BMJ Case Reports ◽

10.1136/bcr-2020-238759 ◽

2021 ◽

Vol 14 (6) ◽

pp. e238759

Author(s):

Auric Bhattacharya ◽

Madhumati Singh ◽

Anjan Shah ◽

Lynn Lilly Varghese

Keyword(s):

Salivary Gland ◽

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Needle Aspiration ◽

Superficial Parotidectomy ◽

Salivary Gland Tumours ◽

Patient Reported ◽

The Face ◽

Needle Aspiration Cytology

Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair’s incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.

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Risk factors for recurrence of pleomorphic adenoma

Otolaryngologia Polska ◽

10.5604/00306657.1193691 ◽

2016 ◽

Vol 70 (3) ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Krzysztof Kiciński ◽

Bogusław Mikaszewski ◽

Czesław Stankiewicz

Keyword(s):

Risk Factors ◽

Pleomorphic Adenoma ◽

Risk Factors For Recurrence

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Minimally Invasive Surgery for Parotid Pleomorphic Adenoma

Ear Nose & Throat Journal ◽

10.1177/014556130508400517 ◽

2005 ◽

Vol 84 (5) ◽

pp. 308-311 ◽

Cited By ~ 33

Author(s):

Robert L. Witt

Keyword(s):

Facial Nerve ◽

Pleomorphic Adenoma ◽

Operating Time ◽

Frey’S Syndrome ◽

Superficial Parotidectomy ◽

Facial Contour ◽

Great Auricular Nerve ◽

Objective Reduction ◽

Frey's Syndrome ◽

Nerve Dysfunction

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve—defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve—is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved. To test this hypothesis, the author conducted a retrospective study of 30 patients—15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms of morbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.

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Synchronous bilateral mucoepidermoid carcinoma of the parotid gland

The Journal of Laryngology & Otology ◽

10.1258/002221503321626537 ◽

2003 ◽

Vol 117 (5) ◽

pp. 419-421 ◽

Cited By ~ 7

Author(s):

Nobuhiro Hakuba ◽

Masamitsu Hyodo

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Mucoepidermoid Carcinoma ◽

English Literature ◽

Parotid Gland Cancer ◽

Warthin’S Tumour ◽

Nerve Dysfunction ◽

Gland Tumour

It is rare for a parotid gland tumour to arise bilaterally, the most common example being Warthin’s tumour. Furthermore, it is rare for a parotid gland cancer to occur bilaterally. Here, we describe a case of synchronous bilateral mucoepidermoid carcinoma arising in the parotid gland. A case of bilateral facial nerve dysfunction is presented in which aggressive surgery failed to save the life of a 48-year-old man. This is the first such case reported in the available English literature.

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