Parotid Quadrantectomy Is a Safe Management for Localized Pleomorphic Adenoma

Abstract

AimPleomorphic adenoma is the most common benign tumor of the parotid gland and is classically treated with superficial or total parotidectomy. Less radical surgeries have been proposed to minimize the risk of facial nerve injury. The oncological safety of these procedures remains controversial. We conducted this study to evaluate the safety of superficial hemi-lobectomy (quadrantectomy).Patients and methodsRetrospective analysis was conducted on the paraffin sections of archived superficial parotidectomy specimens from 11 male and 6 female patients (median age 33 years). The microscopic extent of extra-capsular extension was determined on pathological revision. In addition, prospective evaluation of 12 quadrantectomy procedures (M/F = 7/5, median age = 36 years) compared to 24 radical surgeries (M = F, median age = 40 years) regarding temporary and persistent facial nerve dysfunction on routine clinical assessment and recurrence rate.ResultsOn retrospective pathological revision, pleomorphic adenomata had a median microscopic spread of 3 mm beyond capsule in paraffin sections (SD = 3.6). On prospective analysis with a median follow-up of 33 months (range = 18–54 months), quadrantectomy had similar relative risk of temporary facial nerve dysfunction evaluated at the immediate postoperative period as well as persistent nerve dysfunction assessed at 3 months (P = 0.701 and P = 0.902, respectively). Of the whole study population, one case of recurrence after total parotidectomy was observed at mid-term follow-up (P = 1.000).ConclusionParotid quadrantectomy is a safe management for smaller pleomorphic adenomata localized close to one of the two divisions of the facial nerve.

Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors

“…However, the extent of PSP is not well defined. Many publications use different definitions that make an evaluation of this technique difficult [57]. Our suggestion is to use the definition proposed by the European Salivary Gland Society (ESGS) which divides the parotid gland in five levels.…”

Surgical Treatment of a Giant Pleomorphic Adenoma of the Submandibular Gland: A Case Report

“…Surgical removal of the nodule and the affected gland is thought to be the standard treatment ( 17 ). However, complete excision of the whole affected gland is mainly performed in the submandibular PA, but rarely on the parotid PA. For parotid PA, many surgeons prefer partial gland resection to preserve the facial nerve ( 18 ). Our patient had a history of an excision of a neck mass 40 years prior to presentation at another hospital.…”