Laterality of pleomorphic adenoma of parotid gland

ABSTRACT

Although pleomorphic adenoma is the commonest benign tumor of both major and minor salivary glands, yet it bears certain peculiar characters like invariable growth rate, short spells of spurts of growth, long quiescent periods, invasion of surrounding tissues by its capsular projections, recurrence, notorious for implantation and classic origin from the tail of parotid gland. Since the nerve of facial expression [facial nerve] falls within the domain of otolaryngologists but its course along with its variable branches through the parotid gland has always remained an area of common interest between general and ENT surgeons. With the more and more involvement of E.N.T. surgeons in head and neck oncology, the cancer of salivary glands looks to be being taken over by them in recent decades. FNAC inspite of its accuracy is loosing its superiority over modern ultrasonography. This is an observational study. This study was carried out in Combined Military Hospital Lahore from Feb 2005 to Feb 2008. A total of 28 patients with unilateral mass of parotid gland, all with FNAC [Fine needle aspiration cytology] positive for pleomorphic adenoma were included in the study without any discrimination of age, sex or size of tumor. Each patient underwent CT scan and surgical modality of treatment was selected for every patient with post-operative histopathology study to confirm or otherwise of FNAC diagnosis. Female male ratio was 34, mean age in males was 44, in females was 37. Histopathology-disproved FNAC in 7.14%. Ratio between involvement of superficial lobe and both lobes was 131. Post-operative transient facial nerve paresis was seen in 12 out of 28 patients and there was surprising laterality of right parotid involvement, ratio between right and left parotid being 113. Smallest tumor at presentation was 3x3 centimeter and largest was 14x10 centimeter in size. Markedly more incidence of pleomorphic adenoma on right side of face is observed. It has not been reported previously. Zero percent facial nerve severance in 28 parotidectomies reflects vigilance and surgical skill of today's otorhinolaryngologists