THE SURGICAL MANAGEMENT OF PAROTID PLEOMORPHIC ADENOMAS: A SYSTEMATIC REVIEW

Abstract

<h3>Background</h3> Pleomorphic adenoma is the most common benign neoplasm of the parotid gland. Treatment is through surgical excision, for which there are 2 main techniques: superficial parotidectomy (SP), which involves removal of the tumor and the entire superficial lobe, and extracapsular dissection (ECD), which involves removal of the tumor with a margin of normal parotid parenchyma. Variations in patient outcomes including risk of recurrence have been reported for both techniques. <h3>Objective</h3> The aim of this systematic review was to determine which surgical technique is more successful in the management of parotid pleomorphic adenomas. <h3>Methods</h3> A preliminary literature search identified variations in nomenclature that were used to inform the search strategy. Medline, Embase, and PubMed databases and reference lists of selected papers were searched with no language restrictions. Only studies with primary data reporting ECD and/or SP for the treatment of pleomorphic adenoma in the superficial lobe of the parotid gland were included for qualitative synthesis. <h3>Results</h3> Seventy-two studies were identified, of which 12 cohort studies were eligible for analysis. The Newcastle-Ottawa Scale was used to assess risk of bias. SP was associated with increased complications, including transient and permanent facial nerve palsy, Frey's syndrome, fistula, and sialoceles. However, higher frequencies of recurrence were reported with ECD. There was considerable heterogeneity between studies, including the duration of follow-up, which may have impacted the incidence reporting of recurrent disease. <h3>Conclusions</h3> There are key differences in reported outcomes of surgical success for ECD and SP. A long-term follow-up study is required to determine definitive conclusions.