Clinicopathologic and surgical study of pleomorphic adenoma of the parotid gland: Analysis of risk factors for recurrence and facial nerve dysfunction

Publication date: Available online 3 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Carlos A. Espinosa, Álvaro Fernández-Valle, Paloma Lequerica-Fernández, Lucas de Villalaín, Juan Carlos de Vicente
ObjectiveTo determine whether clinicopathologic or surgical features are risk factors for recurrence and facial nerve dysfunction in pleomorphic adenoma (PA) of the parotid gland.Patients and methodsThe records of 198 patients surgically treated for a PA of the parotid gland between 1999 and 2013 were retrospectively reviewed to identify patients who developed a tumor recurrence. Fisher's exact test and Mann-Whitney U test were used to analyze patient characteristics between recurrent and non-recurrent PAs. Logistic regression was used to determine the risks of recurrence and facial nerve dysfunction.Results23 (11.6%) patients developed a recurrence. Patients with tumor recurrence were significantly younger than patients that remained recurrence free. Of the 14 patients who underwent enucleation, 11 cases (78.6%) experienced residual disease, as did 10 of 165 (6%) of patients managed by a superficial parotidectomy (p < 0.0005). Furthermore, the risk of residual disease was 9.3 to 21.6 times higher in patients who underwent enucleation than in those who underwent a total or superficial parotidectomy. Regarding tumor histology, recurrence was observed in 3 (15.8%) of the 19 cellular types, in 18 (11.5%) of the 157 classic cases, and in 1 (4.8%) of the 21 myxoid cases (p = 0.5). The risk of recurrence if the resection margins were positive was 49 times higher than when they were not affected (p = 0.001).ConclusionYoung age, enucleation, and positive margins are risk factors for residual pleomorphic adenoma, and surgical technique and histomorphologic features are associated with increased facial nerve dysfunction.



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