title: Pleomorphic adenoma of the parotid gland: is long-term follow-up needed?
abstract: BACKGROUND
  Pleomorphic adenoma is a slow-growing benign salivary tumour most commonly arising in the parotid gland. Macroscopically it has a surrounding capsule from which it can be enucleated-often the treatment used in the past. These tumours do not have a true capsule but can press surrounding normal salivary gland, frequently having finger-like extensions into the normal tissues. Recurrence, or more accurately residual disease, is thought to be due to these small islands of tumour which can be left behind at surgery, in particular enucleation which is associated with high recurrence rate. The current, most common practice is the excision of these tumours through superficial parotidectomy and postoperative follow-up. However, is long-term follow-up necessary and does it reduce the morbidity from tumour recurrence?
  
  
  METHODS
  We reviewed the charts of 182 patients who underwent parotid surgery operated upon by a single surgeon (RKM) between 1973 and 1999. We included only 58 cases of pleomorphic adenomas removed by superficial parotidectomy. We excluded cases that had follow-up of less than 12 months and cases which had previous surgery elsewhere. Adequate tumour excision and the integrity of the capsule were ascertained intra-operatively, and this was confirmed by postoperative histology.
  
  
  RESULTS
  In our study we had 34 females, mean age of 58, and 24 males, mean age of 50. The average follow-up was 6 years with a range of 1-23 years. We had no permanent facial nerve dysfunction, and we recorded only one recurrence (1.7%).
  
  
  CONCLUSIONS
  Provided adequate excision of the tumour with intact capsule and histological confirmation are achieved, long-term follow-up is unnecessary and can be replaced by patient education and self-examination.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Southmead Hospital, Bristol, UK. omarayoub@hotmail.com
authors.forename: Omar M
authors.initials: OM
authors.lastname: Ayoub
authors.forename: Kunwar
authors.initials: K
authors.lastname: Bhatia
authors.forename: Ranjit K
authors.initials: RK
authors.lastname: Mal
mesh_terms: D008949:Adenoma, Pleomorphic / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D018365:Neoplasm, Residual / Q000175:diagnosis*; D010306:Parotid Gland / Q000473:pathology / Q000601:surgery; D010307:Parotid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies