Massive pleomorphic adenoma of the parotid gland: Surgical considerations

May 7, 2014
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Head and Neck Clinic

Preservation of the facial nerve and its branches requires special consideration when dealing with a large parotid mass. The traditional approach of anterograde dissection of the facial nerve proves ineffective in patients with large lesions that effectively obstruct the field of view and origin of the nerve trunk

A 70-year-old woman presented with a 2- to 3- decade history of an untreated facial/neck mass. She stated that the neck mass had grown steadily over the years, but she denied facial pain, paresis, or paralysis. Examination of the neck revealed a 25-cm right parotid mass with multiple lobes that was engorged and warm to the touch (figure 1). Facial anatomy and symmetry were distorted because of the lesion's mass effect. Palpation of the neck revealed no lymphadenopathy.

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