Pleomorphic adenoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]

Overview

Surgery is the mainstay of treatment for pleomorphic adenoma. There are two procedures superficial parotidectomy and total parotidectomy, the latter of which is the most commonly performed one due to its low incidence on recurrence of the tumor. The complications after surgery include facial nerve palsy, frey's syndrome, trismus, haematoma or haemorrhage and wound infection. Recurrence do occur in pleomorphic adenoma sometimes.

Surgery is the mainstay of treatment for pleomorphic adenoma.There are two procedures:

Superficial parotidectomy(Patey's operation)^[1].
Total parotidectomy, is the more frequently performed procedure due to the incidence of recurrence being lower.
Care should be taken in order to preserve the facial nerve. ^[1]
The tumors of the submandibular glands are treated with excision while preserving the adjacent nerves including the mandibular branch of the trigeminal nerve, the hypoglossal nerve, and the lingual nerve.
When the tumor arises from the minor salivary glands, usually a 5 mm margin is to be obtained.
Recurrence is also sometimes noticed after surgery.
The main causes for recurrence are:^[2]
- Incomplete excision
- Intraoperative capsule rupture
- Myxoid subtype
- Presence of the satellite nodules and tumor extensions
Adjuvant radiotherapy has been shown to be helpful in managing a recurrent pleomorphic adenoma in addition to surgery.^[3]

There aren't any well established contraindications for the surgery of pleomorphic adenoma.

↑ ^1.0 ^1.1 Kadletz, Lorenz; Grasl, Stefan; Grasl, Matthäus C.; Perisanidis, Christos; Erovic, Boban M. (2017). "Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience". Head & Neck. 39 (2): 356–360. doi:10.1002/hed.24598. ISSN 1043-3074.
↑ Kiciński K, Mikaszewski B, Stankiewicz C (February 2016). "Risk factors for recurrence of pleomorphic adenoma". Otolaryngol Pol. 70 (3): 1–7. doi:10.5604/00306657.1193691. PMID 27386926.
↑ Mc Loughlin, Laura; Gillanders, Sarah Louise; Smith, Susan; Young, Orla (2018). "The role of adjuvant radiotherapy in management of recurrent pleomorphic adenoma of the parotid gland: a systematic review". European Archives of Oto-Rhino-Laryngology. doi:10.1007/s00405-018-5205-z. ISSN 0937-4477.