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6.3.12: 12. Reccurent Pleomorphic Adenoma

  • Page ID
    18320
    • 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