Monday, March 5, 2012

Pleomorphic Adenoma

Preserving nerves and nerve function with parotidectomy for pleomorphic adenoma. Least invasive procedure?

Patrick Ha, MD, F.A.C.S. replies...

Pleomorphic adenoma is the most common type of parotid tumor. While it is benign, it exhibits steady growth and has a small chance of transforming into malignancy if left alone for a long period of time, so we generally recommend excision, unless there are other medical or personal reasons against surgery.

Typically, we are able to preserve the facial nerve during this surgery, as it is rare for this tumor to actually invade the nerve. However, as part of the dissection, we are almost always identifying at least some branch of the facial nerve, and thus the use of an intraoperative nerve monitoring system is commonly used amongst surgeons. Functional preservation is optimized through gentle handling of tissues and can be accomplished in most cases, although there are times when permanent weakness can occur. Most surgeons advocate identification of the facial nerve in order to ensure that it is preserved.

The incision is largely guided by the surgeon and the location of the tumor. If it is low in the parotid tail, one can often use a small neck incision to remove this. Alternatively, one can use a facelift incision that starts in front of the ear, underneath the earlobe, and then postauricularly into the hairline such that the incision is largely hidden. Another option is extending the postauricular incision down towards the neck. The bottom line is that one has to have adequate exposure in order to protect the nerve and safely remove the tumor, as well as use an approach that is comfortable to the surgeon. While endoscopic approaches with perhaps smaller incisions have been considered, these techniques are not yet standard or widely accepted.

Patrick Ha, MD, F.A.C.S.
Head & Neck Surgeon

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