Recurrent parotid tumors unfortunately regrow after initial treatment, requiring further surgery. Repeat surgery increases both the chances of facial paralysis and facial cosmetic deformities. We specialize in removing recurrent tumors while maintaining facial nerve function and facial symmetry.
Recurrent Pleomorphic (Benign) Parotid Tumors
When faced with a recurrence, treatment options are fairly limited. Knowing when and how to use these options requires judgment, experience, and an understanding of the patient’s long term goals.
Parotid tumors can recur as a single solitary mass or the recurrence may present as a large cluster of separate tumors.
Solitary Recurrent Parotid Tumor
26-year-old female presented to the institute with her third recurrence after a history of undergoing two prior parotid surgeries. She was noted to have a single solitary left recurrent parotid tumor shown in figure 1 (arrow to circle). Due to significant scar tissue increasing the risk of facial nerve paralysis the tumor was removed through an incision placed behind her ear accompanied by facial nerve monitoring. The patient suffered no facial nerve paralysis and recovered uneventfully with no further significant facial scarring.
Multiple Recurrent Parotid Tumors
31-year-old male underwent a right parotidectomy at age 23 for a large benign pleomorphic adenoma of the right parotid gland. Seven years after surgery the patient was diagnosed with a recurrent tumor and an MRI was ordered. The radiologist reported that there were too many tumors to accurately count. The patient traveled from Texas to the Institute to undergo his Revision Parotid Surgery. During his surgery over 100 separate benign parotid tumors were removed. He sustained no facial paralysis.
43-year-old female traveled from Florida to have surgery at the institute after four prior parotid surgeries. The patient was told she was at high risk for permanent facial paralysis. After seeing multiple surgeons who recommended sacrificing her facial nerve during her fifth parotid surgery she flew to the institute to undergo her procedure. She successfully underwent revision parotidectomy with no post-operative facial weakness . Approximately 28 tumors were removed from her face.
Surgical challenges of recurrent parotid tumors
A. After surgery, the body forms scar tissue as a by-product of surgery. This scar tissue makes subsequent surgeries harder to perform due to the firmness of the tissue. B. When a parotid tumor is removed for the first time, it is usually a solitary mass. When there is a recurrence, there are often multiple separate tumors. This requires more dissection and increases the risk of facial nerve paralysis. C. Surgeons rely on their sight and sense of touch. After surgery scar tissue is formed in the parotid gland, which makes the remaining gland tissue firm to the touch. This firm area can often be mistaken for tumor during surgery. Visually, parotid gland tumors are generally white, however so are scar tissue and the facial nerve. Trying to distinguish between these structures can be harder to do at a revision procedure.
What is the standard treatment philosophy for the treatment of recurrent benign parotid tumors?
We do not believe there is a “standard” treatment which is appropriate for recurrent benign parotid tumors. This is where the “art” of medicine is practiced. The surgeon must consider all of the following variables and customize a treatment plan that is appropriate for each different patient.
- Patient desires and long term goals?
- Age of patient?
- Size of parotid tumor recurrence?
- Number of prior surgical procedures?
- Any type of prior treatment?
- Is the recurrence solitary or multifocal?
- Is the facial nerve functioning or is it weak?
- Is the patient willing to sacrifice their facial nerve?
- Where is the location of the recurrence?
- How much time passed before the recurrence was noted?
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