Case reports in otolaryngology
Giant Pleomorphic Adenoma of the Parotid Gland: Surgical Management of a Long-Standing Tumor With Facial Deformity and Preservation of Facial Nerve Function
By Ferragina F, Sottile AR, Tarallo G and 2 others.
Abstract
Background
Pleomorphic adenoma (PA), the most prevalent benign neoplasm of the parotid gland, typically manifests as a slow-growing, painless mass. In cases where treatment is substantially delayed, the tumor may undergo progressive enlargement, potentially resulting in significant facial deformity. This, in turn, can complicate surgical management.
Case presentation
A 60-year-old female patient exhibited a long-standing right parotid mass that had been gradually increasing in size since 2007, with a notable escalation in dimensions during the year prior to the preliminary assessment. Magnetic resonance imaging in 2021 revealed a well-defined, multilobulated right parotid lesion measuring over 9 cm, and fine-needle aspiration cytology was consistent with PA. Despite the recommendation of surgical excision, the patient initially declined treatment and was subsequently lost to follow-up. In 2025, the patient returned with a parotid mass measuring over 15 cm, accompanied by pronounced facial asymmetry and significant skin stretching. The patient underwent a superficial parotidectomy with complete excision of the lesion, meticulous monitoring of the facial nerve, and preservation of its function. Concurrently, surgical interventions were performed to modify the patient's skin. A subsequent histopathological examination confirmed the presence of PA, devoid of any substantial nuclear atypia or augmented mitotic activity. On Postoperative Day 3, a hematoma developed at the surgical site, necessitating surgical evacuation and hemostatic revision. The ensuing recovery was uneventful, and follow-up at 14 months postoperatively confirmed no recurrence and complete facial nerve function.