Clinical significance of the tumour capsule in the treatment of parotid pleomorphic adenomas

Abstract

The propensity of pleomorphic adenomas to recur is generally attributed to the biological nature of the tumour, and surgery close to the capsule is perceived as undesirable. At the Christie Hospital, Manchester, between 1947 and 1992, 475 tumours arising within the superficial portion of the parotid gland were treated by two surgical techniques: extracapsular dissection (380 patients) and superficial parotidectomy (95). Recurrence rates were 2 per cent in each group (median follow-up 12.5 years). Contact of the tumour with the facial nerve was recorded in 51 per cent of patients. There was no difference between the treatment groups in the incidence of permanent facial nerve injury (2 versus 1 per cent respectively). This study demonstrates that dissection in close proximity to the tumour is possible without inducing recurrence and that in practice the microinvasion of the capsule by tumour buds has limited clinical significance.

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

“…Recurrence was observed in 2% of each group with median follow up of 12.5 years [14]. They emphasised once again that extracapsular dissection did not equate to enucleation.…”

“…It is imperative to emphasise that the capsular dissection technique is different to the enucleation of parotid lesions which involves a ''shelling out'' of the lesion. Local extracapsular dissection performed with a slow and precise bloodless technique with the aid of facial nerve neuromonitoring allows these aforementioned lesions to be removed with a cuff of normal parotid tissue without capsular breach [14]. It is also important for us to emphasise the different approach taken for pleomorphic adenomas and Warthin's tumours.…”

Imaging Characteristics of Recurrent Pleomorphic Adenoma of the Parotid Gland

“…[6][7][8] The major risk factors for recurrence of benign mixed tumors include enucleation and rupture of the tumor at the time of surgical resection. 9 Other associations for increased risk of recurrence include hypocellular tumors, 10 younger age at initial presentation, 11 female patients, 12 and tumors that have already recurred. 13,14 Management recommendations for recurrent tumors include observation, local or extensive surgery, radiation therapy, or a combination of these.…”

“…3,9 Microscopic disease beyond capsular margins and multifocal disease are also implicated in recurrence of benign mixed tumors. 14 We found a fair number of lesions in the subcutaneous tissue and in locations distant from the surgical bed, probably related to tumor spillage during surgery.…”

Parotidectomy in a 54 Years Old Patient: Case Report

“…This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve [2]. We present herein a case of parotid tumor treated by parotidectomy.…”