[Recurrences of pleomorphic adenomas of the parotid: changing attitudes]

The real issue of parotid surgery for pleomorphic adenoma is its risk of recurrence. The aim of this study was to compare the changing attitudes towards the pathology and surgical treatment in order to better define prevention and management of pleomorphic adenoma recurrences.

Histological study was performed after reviewing of slides originating from 100 patients with pleomorphic adenomas of the parotid gland, treated in our institution during the period May 1992 - November 2002. Study of the diagnostic value of fine needle cytology aspiration and MRI for pleomorphic adenoma diagnosis was performed for 181 patients operated on for parotid tumors.

Hypocellular pleomorphic adenomas often have a thin capsule and constitute the most frequently encountered subtypes of recurrence. Pseudopodia are considered as an additional risk of recurrence. In our series, cytological study gave excellent diagnostic value with a sensitivity of 92% and a PPV of 96%. MRI study had a sensitivity of 83% and a PPV of 89%.

According to these findings, enucleation surgery on a pleomorphic adenoma should not be performed any more. Parotidectomy techniques (total or superficial) constitute the surgical treatment of choice. The management of recurrences is based on surgery, with total parotidectomy and facial nerve preservation. The rôle of radiotherapy is still indeterminate.