Carlos A Espinosa1, Álvaro Fernández-Valle2, Paloma Lequerica-Fernández3, Lucas de Villalaín4, Juan Carlos de Vicente5. 1. Clinical Fellow, Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. 2. Consultant, Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. 3. Consultant, Department of Biochemistry, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. 4. Assistant Professor, Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. 5. Professor and Chair, Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias, School of Medicine, and Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Asturias, Spain. Electronic address: jvicente@uniovi.es.
Abstract
PURPOSE: To determine whether clinicopathologic or surgical features are risk factors for recurrence and facial nerve dysfunction in pleomorphic adenoma (PA) of the parotid gland. PATIENTS AND METHODS: The records of 198 patients surgically treated for a PA of the parotid gland from 1999 through 2013 were retrospectively reviewed to identify patients who developed a tumor recurrence. The Fisher exact test and Mann-Whitney U test were used to analyze patient characteristics between recurrent and non-recurrent PAs. Logistic regression was used to determine the risks of recurrence and facial nerve dysfunction. RESULTS: Twenty-three patients (11.6%) developed a recurrence. Patients with tumor recurrence were notably younger than patients without recurrence. Of the 14 patients who underwent enucleation, 11 (78.6%) developed residual disease, as did 10 of 165 patients (6%) managed by a superficial parotidectomy (P < .0005). Furthermore, the risk of residual disease was 9.3 to 21.6 times higher in patients who underwent enucleation than in those who underwent a total or superficial parotidectomy. For tumor histology, recurrence was observed in 3 (15.8%) of the 19 cellular types, 18 (11.5%) of 157 classic cases, and 1 (4.8%) of 21 myxoid cases (P = .5). The risk of recurrence with positive resection margins was 49 times higher than with negative margins (P = .001). CONCLUSION: Young age, enucleation, and positive margins are risk factors for residual pleomorphic adenoma, and surgical technique and histomorphologic features are associated with increased facial nerve dysfunction.
PURPOSE: To determine whether clinicopathologic or surgical features are risk factors for recurrence and facial nerve dysfunction in pleomorphic adenoma (PA) of the parotid gland. PATIENTS AND METHODS: The records of 198 patients surgically treated for a PA of the parotid gland from 1999 through 2013 were retrospectively reviewed to identify patients who developed a tumor recurrence. The Fisher exact test and Mann-Whitney U test were used to analyze patient characteristics between recurrent and non-recurrent PAs. Logistic regression was used to determine the risks of recurrence and facial nerve dysfunction. RESULTS: Twenty-three patients (11.6%) developed a recurrence. Patients with tumor recurrence were notably younger than patients without recurrence. Of the 14 patients who underwent enucleation, 11 (78.6%) developed residual disease, as did 10 of 165 patients (6%) managed by a superficial parotidectomy (P < .0005). Furthermore, the risk of residual disease was 9.3 to 21.6 times higher in patients who underwent enucleation than in those who underwent a total or superficial parotidectomy. For tumor histology, recurrence was observed in 3 (15.8%) of the 19 cellular types, 18 (11.5%) of 157 classic cases, and 1 (4.8%) of 21 myxoid cases (P = .5). The risk of recurrence with positive resection margins was 49 times higher than with negative margins (P = .001). CONCLUSION: Young age, enucleation, and positive margins are risk factors for residual pleomorphic adenoma, and surgical technique and histomorphologic features are associated with increased facial nerve dysfunction.