title: Pleomorphic adenoma of the submandibular gland: an evolving change in practice following review of a personal case series.
abstract: We reviewed patients with submandibular gland pleomorphic adenoma treated at a tertiary referral centre in the United Kingdom (1988-2004). Thirty-seven patients were identified, 32 newly diagnosed cases and 5 cases of recurrent disease previously treated elsewhere. The exact pre-operative diagnosis was "unknown" in 76% of the new cases. All cases were surgically excised (41% with extracapsular gland excision and 59% by selective level Ib, IIa and III neck dissection). Temporary marginal mandibular nerve neuropraxia was documented in 25% of cases. All 32 new cases remain clinically tumour free at the time of writing. In patients with recurrent disease, complete microscopic tumour clearance was achieved in three of the five cases, however all remain clinically tumour free. Pleomorphic adenomas of the submandibular gland are uncommon, with good prognosis following complete tumour excision. Recurrent tumours, however, are frequently multi-focal and difficult to excise completely. The adequacy of primary surgery is crucial and supports an approach for a more radical excision primarily by a selective level lb, IIa and III neck dissection; ensuring complete disease clearance for pleomorphic adenoma, avoiding the risks of tumour spillage associated with a limited excision and tumour handling; and removing the primary echelon of lymph nodes at risk of metastasis if the pathology turns out to be malignant.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Queen's Medical Centre Campus, University Hospitals Nottingham, Derby Road, Nottingham, NG7 2UH, UK. munirnazia@doctors.org.uk
authors.forename: Nazia
authors.initials: N
authors.lastname: Munir
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bradley
mesh_terms: D008949:Adenoma, Pleomorphic / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D013365:Submandibular Gland Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom