A COMPREHENSIVE APPROACH TO THE TREATMENT OF PATIENTS WITH PRIMARY GROWTH OF PLEOMORPHIC ADENOMA OFTHE PAROTID SALIVARY GLAND

Objective: The aim of the study is to develop a patient management algorithm for pleomorphic adenoma (PA) of the parotid salivary gland (PSG) based on a retrospective analysis of medical histories of patients with parotid gland tumors. Materials and Methods: An analysis of archival data was conducted to determine the total number of patients with PA who were operated on from 2002 to 2021 (excluding the period from 2006 to 2008) at Department No. 8 of the Research Institute of Stomatology and Maxillofacial Surgery, St. Petersburg State Medical University named after Acad. I.P. Pavlov, Ministry of Health of the RF, as well as the conclusions from the postoperative dispensary follow-up of these patients.

Results: 537 patients with neoplasms of the parotid salivary gland (PSG) were identified, of whom 253 (47.1%) were diagnosed with PA based on postoperative morphological findings. In 175 (32.6%) patients, no tumor growth was detected. The concordance rate between preoperative fine-needle aspiration biopsy (FNAB) under ultrasound (US) guidance and postoperative histological findings in patients with PA was 90.9%. During long-term follow-up ultrasound monitoring, recurrence of PA of the PSG was detected in 5 (14.7%) of the 34 examined patients. The average time to recurrence of PA of the PSG in patients with primary tumor growth was 8.9 years. Conclusions: Based on the analysis of domestic and foreign sources, as well as the data from our study, a management algorithm for patients with primary growth of PA of the salivary glands was proposed. The key points include: mandatory preoperative FNAB under US guidance, exclusion of enucleation as a surgical treatment for PA, an alternative approach for superficially located PAs, removal of PA with a 0.9 cm margin from the fibrous capsule, and lifelong follow-up with ultrasound examination once a year.