title: [Management of recurrent pleomorphic adenoma of the parotid gland: analysis of the material of Otolaryngology Department, Medical University of Warsaw between 1998 and 2008].
abstract: OBJECTIVE
  Treatment of patients with recurrent pleomorphic adenoma of the parotid gland is a challenge for a surgeon due to frequent problems with complete resection of all tumour foci while preserving continuity and function of the facial nerve. The aim of this study was to evaluate the clinical presentation and treatment results of patients with recurrent pleomorphic adenoma of the parotid gland.
  
  
  METHODS
  The medical records of 35 patients (25 women and 10 men) operated on (44 operations) for recurrent pleomorphic adenoma between the years 1988 and 2008 at the Otolaryngology Department, Medical University of Warsaw, were reviewed. These patients accounted for 8.9% of all patients treated for pleomorphic adenoma of the parotid gland (N=395). A retrospective analysis was performed to examine clinical features, surgical technique and facial nerve management.
  
  
  RESULTS
  All patients had palpable, nontender mass or masses in a parotid bed after 1 to 5 previous operations. Multifocal recurrences were present in 79.5% of cases. Median interval between initial treatment and commencement of recurrences was 6.1 (0.25-29) years. Patients with more than one recurrence were younger than patients who had only one. Malignant transformation of recurrent pleomorphic adenoma was observed in two patients (5.7%). Postoperative facial nerve paresis occurred in 15 cases. In two additional cases eradication of recurrent tumour required the facial nerve resection and reconstruction.
  
  
  CONCLUSIONS
  Recurrent pleomorphic adenoma occurs more often in younger patients and women. The risk of the facial nerve injury increases with each successive operation. Surgical treatment should be individualized, taking into consideration the extent of the previous surgery and the type of recurrence.
authors.affiliation: Katedra i Klinika Otolaryngologii Warszawski Uniwersytet Medyczny. pawel.szwedowicz@wum.edu.pl
authors.forename: Paweł
authors.initials: P
authors.lastname: Szwedowicz
authors.forename: Ewa
authors.initials: E
authors.lastname: Osuch-Wójcikiewicz
authors.forename: Antoni
authors.initials: A
authors.lastname: Bruzgielewicz
authors.forename: Piotr
authors.initials: P
authors.lastname: Checiński
authors.forename: Jagna
authors.initials: J
authors.lastname: Nyckowska
authors.forename: Marta
authors.initials: M
authors.lastname: Grotthuss
mesh_terms: D000046:Academic Medical Centers; D008949:Adenoma, Pleomorphic / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery*; D011044:Poland; D012189:Retrospective Studies; D016896:Treatment Outcome