| Objective: Clinically,pleomorphic adenoma is the most common benign tumor of parotid gland.Due to its specific histological characteristics of epithelial components,pleomorphic adenoma is considered as precancerous.It can easily progress and the surviving tumor in long-term,it has the possibility of malignant change.So surgery is the primary treatment of pleomorphic adenoma.From abandon traditional Enucleation to superficial parotidectomy,partial superficial parotidectomy or extracapsular dissection successively put forward,The best surgical technique and the extent of surgery remain controversial.This contains data of the primary parotid pleomorphic adenoma from The First Affiliated Hospital of Dalian Medical University and The Second Affiliated Hospital of Dalian Medical University,Oral and Maxillofacial Surgery Department.The purpose of this retrospective analysis is to determine if extracapsular dissection(ECD),partial superficial parotidectomy(PSP)and superficial parotidectomy(SP)show difference in terms of tumor recurrence and postoperative complications for parotid pleomorphic adenoma.And to evaluate clinical practicability between extracapsular dissection(ECD)and partial superficial parotidectomy(PSP).Material and methods: 222 patients of pleomorphic adenoma in the parotid gland were surgically treated in The First Affiliated Hospital of Dalian Medical University and The Second Affiliated Hospital of Dalian Medical University,oral and maxillofacial surgery Department.from January 2010 to February 2015.All of patients accepted surgical treatment including superficial parotidectomy,partial superficial parotidectomy or extracapsular dissection.Collect the epidemiological information,tumor site and size,operation method,scope of operation safety margin,intraoperative facial nerve exposure conditions,overflow of tumor,tumor capsular histopathological characteristics,the occurrence of complications such as postoperative facial nerve injury or the like.A thorough follow-up of the patients were done,statistical postoperative tumor recurrence rate and postoperative complications were evaluated.The statistical analysis are as follows.Recults: Study included 222 patients,male and female ratio 1:1.4,the average age was 45.0±16.1 years of age,tumor average size 2.7 ± 1.2 cm.follow-up was done for 147 patients.follow-up rate was 66.2%,the average 37 months was the follow-up time.Follow-up cases,superficial parotidectomy was applied to 24 cases(16.3%),extracapsular dissection(ECD)was applied to the 67 cases(45.6%),remain 56 patients(38.1%)were treated surgically with the partial superficial parotidectomy(PSP)technique.the recurrence rate is 2.7%,There was no significant difference in the incidence of tumor recurrence between three surgical groups(P=0.820).The incidence of transient facial palsy is 14.9%.There was a significant difference in the incidence of transient facial nerve paralysis between three surgical groups(P=0.001).The incidence of transient facial nerve paralysis in superficial parotidetomy was significantly higher than partial superficial parotidetomy(P=0.033)and extracapsular dissection(P=0.001).Three groups were not seen permanent facial paralysis.Frey’s syndrome after superficial parotidectomy and the incidence of salivary fistula was obviously higher than that of partial superficial parotidectomy extracapsular dissection(P = 0.048,P = 0.048)and extracapsular dissection(P< 0.001,P< 0.001).Histopathological examination results,postoperative recurrence rate coated incomplete group was obviously higher than that of capsular complete group(P= 0.033).Intraoperative tumor overflow with the overflow group there was no difference in the recurrence rate(P= 0.179).Facial nerve to capsular did not significantly increase the risk of recurrent pleomorphic adenoma of(P =0.194).Conclusion: For superficial parotid pleomorphic adenoma of the parotid gland,superficial parotidectomy,partial superficial parotidectomy and extracapsular dissection recurrence rates fairly;By using partial superficial parotid and extracapsular dissection,it is helpful to reduce postoperative temporary facial paralysis,Frey syndrome and the incidence of salivary fistula.Pleomorphic adenoma capsular incomplete are important factors affecting the prognosis,and intraoperative tumor spillage and facial nerve close to the capsule was not significantly affecting the risk of recurrence. |
