Risk factors for recurrence of pleomorphic adenoma.

Pleomorphic adenoma is the most frequent benign tumor of the salivary glands. It is characterized by a tendency to recur, which is determined by the biological characteristics of the tumor as well as the mode of its treatment. Recurrence of the tumor is associated with a high risk of postoperative facial palsy, risk of subsequent recurrence after revision surgery, and an increased risk of malignant transformation. Knowledge of the recurrence risk factors could allow selection of treatments that minimize the risk. Among the factors in this study the most important are: incomplete excision, intraoperative capsule rupture, myxoid subtype, presence of the satellite nodules and tumor extensions (pseudopodia), lack of the glandular tissue margin and the experience of the surgeon. The possible factors are: the female sex, young age, location and size of the tumor, and the duration of the tumor growth. The technique of tumor enucleation of pleomorphic adenoma carries a high risk of recurrence and should be replaced by parotidectomy. In cases of recurrence the treatment is individually tailored and may: further follow up, limited resection of the tumor, lateral parotidectomy or extended radical parotidectomy with concurrent reconstruction of the facial nerve. The role of radiotherapy is discussed.

Adenoma pleoformio em palato: relato de caso clínico / Pleomorphic adenoma in palate: a case report

O adenoma pleomorfo é uma neoplasia benigna que pode acometer glândulas salivares menores e maiores, apresentando peculiaridades como ocorrência de recidivas e potencial de malignização. Neste artigo é apresentado um caso clínico onde houve o acometimento de glândulas salivares menores no palato, cujo tratamento realizado foi o cirúrgico. O acompanhamento do caso por dois anos não evidenciou sinais de recidiva. De diagnóstico nem sempre fácil e tratamento cirúrgico, o adenoma pleomórfico merece atenção do cirurgião-dentista, sendo seu diagnóstico precoce e pronto tratamento, fatores determinantes para o sucesso terapêutico.

The pleomorphic adenoma is a benign neoplasia that can attack major and minor salivary glands, presenting peculiarities as recurrences and potential of malignization. ln this paper a clinical case is presented where there was the attack minor salivary glands in the palate whose surgical treatment was made. The attendance of the case for two years didn't evidence recurrence signs. The diagnosis is not always easy and the best treatment is surgical. The pleomorphic adenoma deserves the surgeon dentist's attention, being the precocious diagnosis and subsequent surgical treatment decisive factors for the therapeutic success.

Treatment of parotid gland tumors in Latvian Oncological Center.

A total of 268 patients were treated for parotid gland lesions at department of Head and Neck Surgery of Latvian Oncological Center between 1996 and 2000, and the results were analyzed retrospectively. The objective was to analyze the incidence and factors associated with facial nerve dysfunction after different types of parotidectomies with facial nerve dissection and to compare the changing attitudes towards the pathology and surgical treatment in order to better define prevention and management of pleomorphic adenoma recurrences. Limited superficial parotidectomy was the commonest operation performed in 143 patients. Other procedures were complete superficial parotidectomy in 11%, total radical surgery in 10 patients and enucleation in 20 patients. Neck node dissection was done in 9 patients. In 4 patients (6%) paresis was observed after limited superficial parotidectomy, in 10 patients (16%) after complete superficial parotidectomy, in 18 cases (28%) after near - total (subtotal) parotidectomy and in 32 patients (50%) after total parotidectomy. Recurences after the surgical treatment of benign diseases were observed in 12 patients (5.2%). Overall 5-year survival for all stages and histologic types was 58 %.

Recurrent pleomorphic adenomas of the parotid gland: clinical evaluation and long-term follow-up.

We report 94 patients with recurrent pleomorphic adenomas of the parotid gland who were referred to our clinics after operations elsewhere. In 78 patients (83%) enucleation was the surgical technique used to remove the tumour. Patients with more than one recurrence were significantly younger than patients who had only one. Many recurrent adenomas (44%) were multifocal. In 20 (21%) further recurrences became obvious after we had operated on them. The mean time interval before recurrence ranged from 7.3 to 10.1 years. Twenty patients (14%) had persistent motor disorders of the facial nerve after operation for recurrence (n = 143). Twenty eight of the 84 patients from whom follow-up data could be obtained developed Frey's syndrome (33%). Our data support the importance of an adequate initial operation to avoid recurrences of pleomorphic adenomas in the parotid gland.