Recurrent Pleomorphic Adenoma of the Parotid Gland: Treatment Outcomes and Risks of Ulterior Recurrence

Mahendra Maharjan, Pranay RSakya, Zhang Fuyin

Abstract

Background: Surgical management of recurrent pleomorphic adenoma (RPA) of the parotid gland has a considerable risk of facial nerve injury and a high re-recurrence rate. To obtain more insight into this issue we evaluated our experiences. 
Materials and methods: A retrospective analysis of all patients treated surgically for recurrent pleomorphic adenoma (RPA) of the parotid gland was performed. Clinical examination included the site and nature of the RPA, facial nerve status and so on. The extent of clinically suspected recurrences was determined by CT and sometimes with MRI. The surgical treatment included local excision, partial or total superficial parotidectomy with preservation of the facial nerve, and total parotidectomy with sacrifice of the facial nerve. Patients were followed regularly at 3, 6 and 12 months interval for the first year followed by once annually during a period ranging from 1 to 9. 
Result: 20 out of 48 patients were included. Mean age at the time of the first surgery was 44.5 years, 65% were female and 35% were male. Mean time between IPS and I-RPA was 15.7 years. Mean interval between recurrences was 10.6 years for first recurrence, 9.5 years for the second, 3.2 years for the third and 2 years for the fourth.Tumor recurrence lateral to the facial nerve (superficial lobe) was 85% and medial to the nerve (deep lobe) was 15%. Multinodular recurrence was 80%, with the largest nodule ranging from 0.7 to 6 cm (mean 2.3cm). IPS with local excision (P=0.04), surgery other than parotidectomy at I-RPA (P=0.006), detection of microscopic multinodular disease at I-RPA (P=0.003) and age of 30 years or less at the time of IPS (P=0.001) were associated with an increased risk of new recurrence. 
Conclusion: In treatment of RPA, PSP has a better local control rate than LE and has results similar to those of SP or TP. Thus, we recommend that PSP with careful dissection of facial nerve should be considered for the treatment of RPAs.

Keywords

Background: Surgical management of recurrent pleomorphic adenoma (RPA) of the parotid gland has a considerable risk of facial nerve injury and a high re-recurrence rate. To obtain more insight into this issue we evaluated our experiences. Materials and methods: A retrospective analysis of all patients treated surgically for recurrent pleomorphic adenoma (RPA) of the parotid gland was performed. Clinical examination included the site and nature of the RPA, facial nerve status and so on. The extent of clinically suspected recurrences was determined by CT and sometimes with MRI. The surgical treatment included local excision, partial or total superficial parotidectomy with preservation of the facial nerve, and total parotidectomy with sacrifice of the facial nerve. Patients were followed regularly at 3, 6 and 12 months interval for the first year followed by once annually during a period ranging from 1 to 9. Result: 20 out of 48 patients were included. Mean age at the time of the first surgery was 44.5 years, 65

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