Pleomorphic adenoma natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]
Overview
Pleomorphic adenoma is usually asymptomatic though some people present with a palpable nodular mass which is slow growing and painless. The complications that arise from surgery include rupture of the capsule of the tumor, incomplete resection of the tumor, haematoma or haemorrhage, facial nerve palsy, trismus, wound infection, frey's syndrome, parotid fistula and hypoesthesia of the greater auricular nerve. The prognosis of pleomorphic adenoma is generally excellent after complete resection of the tumor. Although a small proportion i.e 2-7% of cases can go to malignant transformation.
Natural History, Complications, and Prognosis
Natural History
- Pleomorphic adenoma usually presents as an asymptomatic disease.[1]
- If symptomatic it presents as a slow growing, painless and a palpable single nodular mass.
- If left untreated a small proportion of patients with peomorphic adenoma may progress to malignant transformation.
Complications
Intra-operative complications include[2]:
- Rupture of the capsule of the parotid tumor.
- Incomplete resection of the tumor.
- Facial nerve transection especially after superficial parotidectomy.
Post-operative complications include[2]:
- Haemorrhage or haematoma
- Infection at the site
- Trismus
- Parotid fistula
- Frey's syndrome[3]
- Hypoesthesia of the greater auricular nerve.[4]
Apart from the above mentioned other complications include facial disfigurement and multiple recurrences.
Prognosis
- Prognosis is generally excellent for most of the patients after surgical resection.
- Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary sometimes.
- Recurrence can be a problem if the tumor arises from the parotid gland.[5][6]
- 2-7% of cases can go into malignant transformation if left untreated.[7]
References
- ↑ Zhan, Kevin Y.; Khaja, Sobia F.; Flack, Allen B.; Day, Terry A. (2016). "Benign Parotid Tumors". Otolaryngologic Clinics of North America. 49 (2): 327–342. doi:10.1016/j.otc.2015.10.005. ISSN 0030-6665.
- ↑ 2.0 2.1 Infante-Cossio, P; Gonzalez-Cardero, E; Garcia-Perla-Garcia, A.; Montes-Latorre, E; Gutierrez-Perez, JL; Prats-Golczer, E (2018). "Complications after superficial parotidectomy for pleomorphic adenoma". Medicina Oral Patología Oral y Cirugia Bucal: 0–0. doi:10.4317/medoral.22386. ISSN 1698-6946.
- ↑ Bjerkhoel A, Trobbe O (September 1997). "Frey's syndrome: treatment with botulinum toxin". J Laryngol Otol. 111 (9): 839–44. PMID 9373550.
- ↑ Hui, Yau; Wong, David S.Y; Wong, Ling-Yuen; Ho, Wai-Kuen; Wei, William I (2003). "A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy". The American Journal of Surgery. 185 (6): 574–579. doi:10.1016/S0002-9610(03)00068-0. ISSN 0002-9610.
- ↑ Laskawi R, Schott T, Schröder M (February 1998). "Recurrent pleomorphic adenomas of the parotid gland: clinical evaluation and long-term follow-up". Br J Oral Maxillofac Surg. 36 (1): 48–51. PMID 9578257.
- ↑ Wittekindt, Claus; Streubel, Kristina; Arnold, Georg; Stennert, Eberhard; Guntinas-Lichius, Orlando (2007). "Recurrent pleomorphic adenoma of the parotid gland: Analysis of 108 consecutive patients". Head & Neck. 29 (9): 822–828. doi:10.1002/hed.20613. ISSN 1043-3074.
- ↑ Said, Sherif; Campana, John (2005). "Myoepithelial carcinoma ex pleomorphic adenoma of salivary glands: A problematic diagnosis". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 99 (2): 196–201. doi:10.1016/j.tripleo.2003.11.014. ISSN 1079-2104.