Rhytidectomy Approach in Treating “Giant” Pleomorphic Adenoma

Introduction: Pleomorphic adenoma, the most common salivary gland neoplasm, is located most often in the parotid gland. The parotid gland tumor is usually located in the superficial lobe, where it manifests as a mass over the angle of the mandible below and in front of the ear. The tumor is typically a painless slow-growing and freely moveable mass. The primary choice of treatment is surgical excision to obtain complete resection while avoiding facial disability.

Objectives: To present two cases of considerably large size parotid pleomorphic adenomas, successfully treated via rhytidectomy approach.

Methods: Two males, at their 6th decade of life, were referred to our department due to large but painless mass, located over the angle of their right mandible. Patients have been aware of the mass for a few years but refused treatment since felt no significant discomfort. Pleomorphic adenomas were diagnosed by a fine needle aspiration biopsy. Assisted by nerve monitoring systems, superficial parotidectomies were performed via rhytidectomy approach.

Results: Fully encapsulated masses were surgically removed and facial nerve function was preserved.

Conclusion: Pleomorphic adenomas have the capacity to reach giant size and eventually compromise nearby structures. Evidences of such cases are occasionally reported in the third world due to limited health care access and ignorance. In countries with modern medicine these tumors are usually diagnosed and treated much earlier, mainly because their slow-growing nature and visible appearance. Although no consensus has been reached concerning the size beyond which an adenoma can be considered to be a giant tumor, in areas where modern medicine is available, the here presented cases are proposed to be considered as relatively giant. Possible causes may be low psycho-socio-economic status and fear of surgery. Notwithstanding the size, post-surgical outcomes are still favorable.