Massive Pleomorphic Adenoma of the Parotid Gland: Surgical Considerations

Abstract

A 70-year-old woman presented with a 2-to 3decade history of an untreated facial/neck mass. She stated that the neck mass had grown steadily over the years, but she denied facial pain, paresis, or paralysis. Examination of the neck revealed a 25-cm right parotid mass with multiple lobes that was engorged and warm to the touch (figure 1). Facial anatomy and symmetry were distorted because of the lesion's mass effect. Palpation of the neck revealed no lymphadenopathy. Magnetic resonance imaging demonstrated a wellcircumscribed and encapsulated mass extending from the level of the right temporal region inferiorly to the right supraclavicular region, and protruding in a pedunculated fashion. A leftward shift was seen of the hypopharynx, larynx, proximal trachea, and thyroid gland. Intraoperatively, a massive 7 to 10 lb., multilobular lesion was seen originating from the superficial lobe of the parotid gland; the lesion was excised (figure 2). Care was taken to preserve the branches of the facial nerve, and blood supply to the lesion was effectively ligated. Pathologic examination of the mass specimen was consistent with a pleomorphic adenoma without differentiation or progression to carcinoma ex-pleomorphic adenoma. The patient experienced no intraoperative or postoperative complications, with no residual facial nerve deficit. Pleomorphic adenoma is the most common benign tumor of the salivary glands, most typically arising from the parotid gland.':' Because of the obvious facial deformity that occurs when parotid tumors are left untreated, it is uncommon for patients to allow such massive growth. Lack of information and fear of surgery are thought to playa role.'> In cases of massive From the Osborne Head and Neck Institute, Los Angeles.