Question

What is the treatment of choice for pleomorphic adenoma?

• A. Superficial parotidectomy
• B. Enucleation
• C. Deep parotidectomy
• D. Radical parotidectomy

Hint:

Think about why simply shelling out the tumour along its capsule is not enough.

Answer 1

The Correct Option is A

Pleomorphic adenoma is a benign tumour of the parotid gland with an incomplete capsule, which shapes the choice of surgery.

1. Superficial parotidectomy: removes the whole superficial lobe with a safe margin of normal tissue around the tumour, taking out any capsule breaches along with it. This gives the lowest recurrence rate and is the standard operation.
2. Enucleation: just shells the tumour out along its capsule. Since the capsule has gaps with tumour pushing through, bits are left behind and the tumour often comes back. This is why enucleation is avoided now.
3. Deep parotidectomy: removes the lobe under the facial nerve, needed only when the tumour is in the deep lobe, which is not the usual site for this tumour.
4. Radical parotidectomy: removes the entire gland and the facial nerve, an operation reserved for cancers invading the nerve, far more than a benign growth needs.

Since the goal is to clear the tumour with a safety margin while keeping the facial nerve and avoiding unnecessary tissue loss, superficial parotidectomy is the right balance and the accepted treatment of choice.

Let's summarize:

• Enucleation leaves tumour behind because the capsule is incomplete.
• Superficial parotidectomy takes a safety margin and cuts recurrence sharply.

The correct answer is superficial parotidectomy.