Yaremenko A.I., Rybakova M.G., Harutyunyan G.G., Kutukova S.I., Nutfullina G.M., Petrov N.L. Clinical and morphological parallels in the surgical treatment of patients with pleomorphic parotid gland adenoma. Head and neck. Russian Journal. 2021;9(4):51–58 (In Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
Objectives. Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, diagnosed in 60–80% of cases. In recent years, many surgeons have been encouraged to change traditional principles, as interest in the approaches causing minimal trauma to healthy tissues is growing. However, many conflicting issues arise related to the mechanisms of relapse, such as the PA tumor capsule integrity, presence of satellite nodules, surgical approach, and the method of choice for preoperative diagnosis and postoperative follow-up.
Design. A retrospective analysis was carried out to identify the total number of patients with parotid gland (PG) tumors referred to Department No. 8 of the Research Institute of Dentistry and Maxillofacial Surgery, Pavlov State Medical University, during the period from 2002 to 2017, as well as to carry out a comparative analysis of the pre- and post-operative instrumental examination data, and the results of ultrasound examination during postoperative follow-up of patients with primary and relapsed PA.
Material and methods. The retrospective analysis was carried out to identify the total number of patients with PA. A detailed assessment of postoperative morphological data of 391 patients admitted to the Department within the period from 2002 to 2017 found out that pleomorphic adenoma occured in 200 (51%) patients, while no tumor growth was revealed in 120 (30.1%) patients. During the postoperative follow-up of 39 patients out of 200, 7 (17.9%) patients were diagnosed with relapsed PA. Two subgroups were distinguished among the patients with (5 patients) and without (6 patients) relapse to perform the morphometry of the PA capsule. Statistical analysis of both subgroups showed that thickness of PA capsule is significantly lower (p<0.001) in relapsed PA. Conclusions. Analyzing domestic and foreign sources together with our study data, it can be suggested that ultrasound-guided preoperative fine needle biopsy should become mandatory before PG tumor surgery to verify the diagnosis, which influences the surgical approach. It is also recommended to exclude extracapsular enucleation of PA. The nominal volume for surgical treatment of PA should include the removal of PA with a margin of up to 0.5 cm from the fibrous capsule, taking into account the likelihood of the satellites node presence and the need to minimize the relapse risk.
Key words: pleomorphic adenoma, parotid salivary gland, recurrence, fibrous capsule, enucleation, myxoid, morphometry
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.