1.Introduction
Pleomorphic adenoma (PA) represents one of the most common benign slow growing parotid tumours. Resection is warranted for definitive histological confirmation and on the basis of a small risk of malignant transformation (<2%).1 Surgical resection has evolved from superficial parotidectomy to less invasive procedures such as the extra capsular (ECD) or capsular dissection (CD) without the upfront recognition of the main trunk of the facial nerve. PA Recurrence does not seem to be related to the extent of the surgical approach2. If recurrence occurs, it poses significant management dilemmas. The risk of malignant transformation increases (up to 7%)1, surgical treatment is associated with high risk of facial nerve damage (up to 30%) and some patients will be incurable despite any treatment3. Recurrent pleomorphic adenomas (RPA) may occur 20 years after surgery1 thus justifying long term clinical surveillance. It is logical that revision surgery poses a smaller risk to the facial nerve if the latter has not been exposed and the recurrence is small, so early detection is desirable. To date, there is only one study exploring the incidence of subclinical RPA after ECD but none after CD. Early detection of a small growing RPA could possibly lead to early and safe re-intervention and therefore may influence decision making and patient counselling.
The aim of the present study is to explore the incidence of subclinical RPA after CD of pleomorphic adenomas by cross sectional imaging and shed more light to the natural history of RPA.