Keywords
pleomorphic adenoma
parotidectomy
facial nerve
computed tomography
How to Cite
Abstract
In press
Background. The significant size of tumors of the maxillofacial region, destruction of bone structures and involvement of adjacent anatomical areas significantly complicate the choice of optimal treatment tactics.
Aim. To demonstrate the experience of surgical treatment of a very large parotid gland tumor.
Materials and Methods. The clinical course, diagnostics and surgical treatment of a patient with a very large parotid gland tumor were analyzed. Computed tomography with 3D reconstruction was used to determine the localization, prevalence of the tumor process and the degree of damage to bone structures. Surgical treatment was performed according to an individually developed plan taking into account the size and prevalence of the tumor and the anatomical features of the lesion. The study was carried out within the research work of Kharkiv National Medical University "Optimization of modern methods of diagnosis and treatment of diseases, traumatic injuries, deformities and developmental anomalies of the maxillofacial region in peacetime and wartime" (state registration No.0125U000945).
Research Ethics. The study complied with the Declaration of Helsinki of the World Medical Association (1964–2024), the Convention on Human Rights and Biomedicine (Oviedo, 1997) and Order of the Ministry of Health of Ukraine No.690 of September 23, 2009; approved by the Ethics Committee of Kharkiv National Medical University (protocol No.24 of December 04, 2024). Informed consent to publication was obtained from the patient.
Results. Surgical treatment of a very large pleomorphic adenoma of the left parotid gland measuring 110×92×86 mm in a 73-year-old patient is presented. The main difficulties are: the large size of the tumor limits surgical access and complicates its mobilization without damaging the capsule, i.e. there is a risk of capsule rupture caused by a thin or incomplete capsule and by microscopic outgrowths (pseudopodia). The intervention lasted 6 hours 20 minutes. Facial nerve function was preserved after surgery. The pleomorphic adenoma of the parotid salivary gland was histopathologically confirmed. The patient was hospitalized for 7 days and discharged without complications.
Conclusions. The presented experience of surgical treatment of a very large tumor of the maxillofacial region, namely pleomorphic adenoma of the salivary gland, is of practical interest, as it allows analysis of the clinical course, diagnostics and surgical treatment, identification of the difficulties of the operation and contributes to the accumulation of experience in managing patients with rare forms of neoplasms.
Keywords: dentistry, pleomorphic adenoma, parotidectomy, facial nerve, computed tomography.
References
Nguyen TTH, Eo MY, Cho YJ, Myoung H, Kim SM. Large myxomatous odontogenic tumor in the jaw: a case series. J Korean Assoc Oral Maxillofac Surg. 2021; 47(2):112-19. DOI: 10.5125/jkaoms.2021.47.2.112. PMID: 33911043.
Rastogi V, Chaurasia S, Maddheshiya N, Dhungel D. Title of the article: diagnostic markers for odontogenic tumors: an insight: a review. Discov Oncol.15(1):558. DOI: 10.1007/s12672-024-01237-0. PMID: 39404913.
Shaw SE, Chan CH. Non-Odontogenic Tumors of the Jaws. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 35015466. https://www.ncbi.nlm.nih.gov/books/NBK576441/
Jain A, Sudharshan M, Vijayakumar C, Kumbhar U, Nelamangala Ramakrishnaiah VP. Colossal Parotid Tumors: A Diagnostic and Surgical Challenge. Cureus. 2021;13(4):e14539. DOI: 10.7759/cureus.14539. PMID: 34017654.
Fashina AA, Aina OF, Adeyemo WL, Ladeinde A. Psychological Distress Before and After Surgical Resection of Benign Orofacial Tumors: A Prospective Study. J Oral Maxillofac Surg. 2020;78(9):1654.1651-1654. DOI: 10.1016/j.joms.2020.04.012. Epub 2020 Apr 18. PMID: 32422191.
Kawata R, Kinoshita I, Omura S, Higashino M, Nishikawa S, Terada T, et al. Risk Factors of Postoperative Facial Palsy for Benign Parotid Tumors: Outcome of 1,018 Patients. Laryngoscope. 2021;131(12):2857-64. DOI: 10.1002/lary.29623. PMID: 34002863.
Wright JM, Vered M. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors. Head Neck Pathol. 2017;11(1):68-77. DOI: 10.1007/s12105-017-0794-1. PMID: 28247226.
Sharma R, Khera S, Yadav T, Badkur M. Pleomorphic adenoma: Indeed, a versatile tumor. J Cancer Res Ther. 2024;20(5):1611-14. DOI: 10.4103/jcrt.jcrt_2259_22. PMID: 39412930.
Jacob S, Ahuja S, Zaheer S, Singh M. Metastasizing pleomorphic adenoma of the parotid gland: A common tumour with a very unusual presentation. Rev Esp Patol. 2024;57(2):123-7. DOI: 10.1016/j.patol.2023.10.002. PMID: 38599732.
Vergez S, Fakhry N, Cartier C, Kennel T, Courtade-Saidi M, Uro-Coste E, et al. Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part I: Primary treatment of pleomorphic adenoma. Eur Ann Otorhinolaryngol Head Neck Dis. 2021;138(4):269-74. DOI: 10.1016/j.anorl.2020.09.002. PMID: 33060032.
Webb AJ, Eveson JW. Pleomorphic adenomas of the major salivary glands: a study of the capsular form in relation to surgical management. Clin Otolaryngol Allied Sci. 2001;26(2):134-42. DOI: 10.1046/j.1365-2273.2001.00440.x. PMID: 11309055.
Bonavolontà P, Dell'Aversana Orabona G, Maglitto F, Abbate V, Committeri U, Salzano G, et al. Postoperative complications after removal of pleomorphic adenoma from the parotid gland: A long-term follow up of 297 patients from 2002 to 2016 and a review of publications. Br J Oral Maxillofac Surg. 2019;57(10):998-1002. DOI: 10.1016/j.bjoms.2019.08.008. PMID: 31500918.
Infante-Cossio P, Gonzalez-Cardero E, Garcia-Perla-Garcia A, Montes-Latorre E, Gutierrez-Perez JL, Prats-Golczer VE. Complications after superficial parotidectomy for pleomorphic adenoma. Med Oral Patol Oral Cir Bucal. 2018;23(4):e485-92. DOI: 10.4317/medoral.22386. PMID: 29924764.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.