Powikłania leczenia chirurgicznego gruczolaka wielopostaciowego ślinianki przyusznej

Abstract

Surgery for benign parotid tumours is associated with potential sequelae which may significantly deteriorate patient's quality of life. Sometimes the pursuit of reducing the risk of these complications induces surgeon to limit the extent of the parotid gland removed with a tumour. This may lead to a decrease in tumour local control which is especially true for pleomorphic adenoma. The purpose of this study was to evaluate the incidence of complications after certain types of parotid surgery for primary pleomorphic adenomas and to analyse risk factors related to their occurrence. The medical records of 386 consecutive patients (250 women and 136 men) operated on for primary pleomorphic adenoma between the years 1988 and 2008 at the Otolaryngology Department, Medical University of Warsaw, were reviewed. Postoperative facial nerve impairment was the most common complication of parotid surgery for primary pleomorphic adenomas (found in 84 [21.8%] of patients). The other adverse effects of this type of surgery included: sialocele (12.2%), salivary fistula (6.7%), Frey's syndrome (6.2%), and hematoma (2.8%). Significantly more often iatrogenic facial nerve injury was encountered in women and in the elderly. Impaired function of the facial nerve was found more commonly after total parotidectomy (41.9%; p<0.001), and least commonly after extracapsular tumour resection (4.8%; p=0.036). The lack of sialoceles and salivary fistulas after extracapsular tumour resection and isolated deep parotidectomy was symptomatic. Impairment of the facial nerve function is the most common complication of surgical treatment of primary pleomorphic adenomas. Statistically significant risk factors of postoperative facial nerve dysfunction include: female gender; older patient age, tumour location in the deep lobe, type of surgical procedure (total parotidectomy). Some decrease in the incidence of sialoceles and salivary fistulas may be achieved by preservation of the Stensen's duct or by radical resection of glandular tissue.