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.