Overview
Recurrent pleomorphic adenoma (RPA) of the parotid gland represents a challenging clinical scenario characterized by tumor recurrence post-initial surgical excision. Management requires careful consideration of resection completeness, patient risk factors, and potential adjuvant therapies.Diagnosis
Imaging: MRI recommended preoperatively to assess tumor extension and detect subclinical lesions 1.
Surgical Assessment: Consider neuromonitoring during surgery to preserve function 1.Management
Primary Treatment: Complete resection under neuromonitoring is recommended 1.
Adjuvant Therapy: Radiotherapy considered for multi-recurrent cases, incomplete resections, or non-operable scenarios at high risk of recurrence 1.Special Populations
Younger Patients: Higher risk of progression and malignant transformation necessitates careful monitoring and aggressive management 1.Key Recommendations
Perform complete resection with neuromonitoring for recurrent pleomorphic adenomas of the parotid gland to minimize functional sequelae (Evidence: Strong 1).
Utilize MRI preoperatively to evaluate tumor extent and identify subclinical lesions (Evidence: Moderate 1).
Consider radiotherapy in cases of multi-recurrent pleomorphic adenomas, following incomplete resection, or in non-operable scenarios with high recurrence risk (Evidence: Moderate 1).References
1 Malard O, Thariat J, Cartier C, Chevalier D, Courtade-Saidi M, Uro-Coste E et al.. Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part II: Management of recurrent pleomorphic adenoma of the parotid gland. European annals of otorhinolaryngology, head and neck diseases 2021. link