Recurrent Benign Salivary Gland Neoplasms

Area of Science:

• Otolaryngology
• Surgical Oncology
• Radiology

Background:

• Benign salivary gland neoplasms, particularly pleomorphic adenomas, can recur after initial treatment.
• Recurrence is often linked to surgical technique and specific tumor histology, such as incomplete excision and pseudocapsule involvement.
• Multinodularity and multicentricity are common features of recurrent pleomorphic adenomas (RPAs).

Purpose of the Study:

• To review the causes, diagnostic imaging, and management strategies for recurrent benign salivary gland neoplasms, focusing on pleomorphic adenomas.
• To highlight the role of advanced imaging and surgical techniques in managing these challenging cases.
• To discuss the efficacy of adjuvant therapies like radiotherapy in improving local control rates.

Main Methods:

• Review of literature on recurrent pleomorphic adenomas and other benign salivary gland tumors.
• Discussion of diagnostic modalities, emphasizing Magnetic Resonance Imaging (MRI).
• Analysis of surgical approaches, including total parotidectomy and nerve integrity monitoring, and the role of postoperative radiotherapy.

Main Results:

• Incomplete excision and intraoperative spillage are primary causes of RPA recurrence.
• MRI is the preferred imaging modality for assessing RPAs, which are often multinodular.
• Total parotidectomy is generally recommended for RPAs due to multicentricity, and postoperative radiotherapy shows improved local control.
• Warthin tumors can recur metachronously due to incomplete excision of multicentric foci.
• Other benign salivary neoplasms like myoepithelioma and oncocytoma rarely recur after resection.

Conclusions:

• Recurrent pleomorphic adenomas present significant management challenges, often requiring individualized, multimodal treatment approaches.
• Surgery alone may be insufficient for long-term control; postoperative radiotherapy is increasingly recognized for its benefit in local tumor control.
• Patients must be thoroughly informed about the potential for multiple treatments, functional deficits (e.g., facial nerve impairment), and the possibility of radiotherapy for recurrent benign salivary gland tumors.