Recurrent pleomorphic adenoma

  • 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