What Are The Ways To Prevent A Parotid Tumor & Does It Recur?

Enucleation performed on the parotid tumor (pleomorphic adenoma) is associated with high recurrence rates of 8% to 45%.(1)

A 0.4% rate of recurrence is seen with total parotidectomy of the parotid gland.(1)

Can Parotid Tumors Be Prevented?

Parotid tumors can either present as benign or malignant conditions that are slowly progressive. Parotid tumors have diverse histology due to epithelial and non-epithelial tissue involvement making it challenging to narrow down the growth and extension. Their varied histological appearances and behavior is a study of concern, with a few tumors being sporadic in origin and type. The distinction between tumor types is difficult, mainly based on aspirated material via FNAC. Pleomorphic adenoma is known to be the most commonly occurring benign tumor is highly capable of undergoing malignant transformation, so it becomes a reason for concern.(3)

There are two main theories of the formation of the salivary tumor with the tumor arising from a specific differentiated cell of origin within the salivary gland being the predominant one. The excretory stem cells give rise to mucoepidermoid cells that lead to pleomorphic adenomas, adenoid cystic carcinomas, adenocarcinomas, oncocytomas, and acinic cell carcinomas.(3) The majority of the parotid tumors are benign, with the malignant tumors commonly presenting after the 6th decade of life while the benign ones present in the 4th to 5th decade of life. Most of the salivary gland tumors originate in the parotid gland, whereas about 10% occur in the submandibular gland and 4% in the minor salivary glands. The mortality rate from salivary glands depends on the staging, with the average five-year survival rate being around 70%.(3)

The cause of the parotid tumor remains unclear, so its prevention becomes tricky. A few studies are suggesting that possible risks factor could be the use of tobacco, excess alcohol, and unhealthy eating habits. However, we don’t know for sure if avoiding these factors will prevent parotid tumors from occurring. There has also been the incidence of increased risk of parotid tumors in a few people exposed to radiation beams, but still, a conclusive result is not yet obtained.(2)

Do Parotid Tumors Recur?

There are chances of parotid tumors to reoccur if the benign condition goes on to transform into a malignant disease. This change is mostly seen in the case of pleomorphic adenoma, where the recurrence rates have been high. This recurrence takes place in the form of multinodular recurrence rather than a uninodular one. The chances are high for recurrence if the first surgery performed was limited, as in the case of extracapsular dissection or partial parotidectomy. However, a total parotidectomy is mostly the preferred choice of treatment as there are few or no chances of recurrence with this method. While this surgery decreases the rate of recurrence, but the risk of facial nerve palsy is increased.

Another non-surgical procedure to prevent this recurrence is to offer radiotherapy to control local tumor, but this may still induce a malignant transformation in later years.(4)

Usually, the approach for a benign parotid gland tumor is a total parotidectomy, while additional radiotherapy or chemotherapy for a malignant tumor. This adjuvant therapy helps in preventing metastases and limiting the growth of cancer. The high-grade tumor has more chances of metastases into the surrounding organs and lymph nodes, so the addition lymph node resection and tissues is a must to prevent a recurrence.

In the case of infiltration of the facial nerve, a radical parotidectomy is indicated where parts of the facial nerve that are infiltrated will be resected.(4)

Post-operative care, in terms of keeping note of the recovery and following the clinician’s advice, goes a long way. The patient should also carefully monitor and look for any warning signs that are indicative of recurrence, such as relapse of symptoms. A regular follow-up should be done even after the surgery to ensure complete recovery and tumor-free glands.(2)

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