6.3.12: 12. Reccurent Pleomorphic Adenoma
- Page ID
- 18320
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- Rare if original surgery is properly performed with preservation of tumour capsule
- Prevention
- Avoid open surgical biopsy
- Complete tumour resection
- Avoid tumour rupture and spillage
- If ruptures, copiously irrigate wound
- Clinical features
- Multiple (usually) nodules in previous surgical field
- Painless
- Facial nerve function unaffected
- Investigations
- Details of extent of previous tumour and surgery
- Imaging (MRI / Ultrasound / CT scan) always indicated
- Extent and distribution of nodules
- Residual parotid tissue
- Relationship to facial nerve (retromandibular vein)
- FNAC to exclude malignancy if rapid growth, pain, facial weakness, lymphadenopathy
- Treatment
- Surgery is primary treatment, not radiation therapy
- Refer to experienced surgeon
- Commonly requires total parotidectomy +/- soft tissue resection +/- Level 2 neck dissection
- Facial nerve at significantly greater risk of injury due to scarring in surgical bed and potential for tumour adherence to the nerve
- Informed consent about risk to facial nerve
- Use nerve monitor (if available)
- May require nerve graft
- May require resection of involved skin and reconstruction with e.g. cervicofacial flap
- Consider postoperative radiation therapy in unfavorable cases