Revision Parotidectomy in Recurrent Salivary Pleomorphic Adenoma
Authors:
K. Obtulovičová 1; M. Sičák 1; M. Obtulovič 2; A. Kališ 3,4
Authors‘ workplace:
Klinika otorinolaryngológie a chirurgie hlavy a krku, Ústredná vojenská nemocnica a fakultná nemocnica SNP v Ružomberku
prednosta, MUDr. M. Sičák, Ph. D.
1; Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety v Bratislave
2; Fakulta zdravotníctva, Katolícka Univerzita Ružomberok
3; Ústav patologickej anatómie, Ústredná vojenská nemocnica a fakultná nemocnica SNP v Ružomberku
4
Published in:
Otorinolaryngol Foniatr, 66, 2017, No. 2, pp. 60-65.
Category:
Original Article
Overview
Objectives:
Recurrent salivary pleomorphic adenoma is oncogenic continuance of primary tumor. Despite intraoperative capsule rupture, tumor cell spillage and histopathologic type, presumably the internal cell biology plays a role in the recurrence. Revision parotidectomy has high rate of facial nerve morbidity and does not exclude becoming recurrence. The aim of study was to evaluate the results of revisional surgery and to emphasize an importance of primary surgery.
Materials and Methods:
Eighteen patients who underwent 26 reoperations for recurrent parotid pleomorphic adenoma since 1989 to June 2016 were evaluated. The age of particular patients at the time of primary surgery ranged from 13 to 75 (mean 35) years. The female-to-male ratio made 7:2. In retrospective study we evaluated time interval between primary surgery and recurrence and surgical results including consecutive recurrence and facial nerve palsy.
Results:
In a group of 18 patients, the second recurrence was present in 7 cases, third in 4 cases and fourth in 1 case. The time interval between the primary and consecutive first, second, third and fourth recurrence was 1-24 (mean 8.0±7.1), 5-15 (8.3±3.1), 10-25 (11.5±2.1) and 27 years, respectively. Temporary facial nerve palsy was present in 11 cases (61%). Permanent facial nerve palsy (VI.degree of Brackmann-House classification) was present in one case (5.5%). The risk of second and consecutive recurrence was 39%.
Conclusion:
Recurrent pleomorphic adenoma is challenging problem. High risk of facial nerve injury in scar tissue is reduced in experienced hands using facial nerve monitoring. The risk of recurrence still exists even after long period after revisional surgery.
KEYWORDS:
recurrent pleomorphic adenoma, revision parotidectomy, facial nerve palsy, neuromonitoring
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