Recurrent Pleomorphic Adenoma: Results of Surgical Treatment

Abstract

Background

Recurrent parotid pleomorphic adenoma surgery increases the risk of facial nerve injury, and there is also a risk of ulterior recurrence.

Methods

Postoperative results from 62 consecutive patients operated for recurrent pleomorphic adenoma were analyzed. It was the first recurrence for 49 patients (79%), the second or more for 13 patients (21%).

Results

Total parotidectomy was performed in 69.4% of cases. Skin resection was performed in 47 patients (75.8%). Resection of a facial nerve branch was performed in seven patients (11.3%). Pathologic examination findings revealed carcinoma ex pleomorphic adenoma in 10/62 cases (16.1%) and microscopic multinodular disease in 39 patients (62.9%). Nine patients had preoperative facial palsy, 95% had postoperative facial paralysis ≥grade II (House–Brackmann scale), and 11.3% still had ≥grade III facial palsy after 1 year. Six patients developed another recurrence after our intervention (9.68%). Moreover, carcinoma was discovered after a new intervention in 40% of these patients. Initial partial parotid surgery [hazard ratio (HR) = 8.477, P = 0.008], microscopic multinodular recurrent disease (HR = 11.717, P = 0.005), and ≥1 recurrence number (HR = 10.608, P = 0.01) were associated with increased risk of ulterior recurrence.

Conclusion

Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%). Nevertheless, a definitive facial paralysis ≥grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.

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Acknowledgment

The authors stated that they do not have any commercial interest in the subject of this study and the source of any financial or material support.

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Correspondence to Marc Makeieff MD, PhD.

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Makeieff, M., Pelliccia, P., Letois, F. et al. Recurrent Pleomorphic Adenoma: Results of Surgical Treatment. Ann Surg Oncol 17, 3308–3313 (2010). https://doi.org/10.1245/s10434-010-1173-2

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Keywords

  • Facial Nerve
  • Pleomorphic Adenoma
  • Facial Nerve Function
  • Facial Paralysis
  • Salivary Gland Tissue