[Recurrent pleomorphic adenoma of the parotid gland]

Recurrent pleomorphic adenoma of the parotid gland is a challenging surgical experience. Resection of such recurrences is associated with an increased risk of facial nerve injury and a higher incidence of recurrent disease. Resection of the primary tumor with a cuff of normal tissue around it during the primary surgical resection lowers the incidence of such metastases, but even with them, metastases still occur. Surgery of such metastases requires high surgical expertise as well as intra-operative decision-making. Intraoperative monitoring of the facial nerve may be of help during these surgical interventions, but the surgeon need not rely on the monitor only, but identify the nerve based on its well known anatomy and use the monitor as another surgical tool for safe removal of the tumor. Resection of the facial nerve or some of its branches is usually not necessary, but if the nerve is the only site making the resection an incomplete one - then the nerve should sometimes be resected, after sufficient effort has been made to preserve it. In these cases, the nerve should be reconstructed with a cable graft (mainly greater auricular or sural) when possible. Radiotherapy is reserved for patients that had multiple recurrences or had massive tumor spillage during their surgical procedure of the recurrent tumor.