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

Step 1: Recall what pleomorphic adenoma is.
Pleomorphic adenoma is the most common benign salivary gland tumour, usually found in the superficial lobe of the parotid gland. It has a thin, often incomplete capsule with small finger-like projections (pseudopodia) pushing into the surrounding gland tissue.

Step 2: Understand why simple removal fails.
Because the capsule is incomplete and pseudopodia extend beyond it, shelling the tumour out along its capsule (enucleation) leaves tumour cells behind. This is why enucleation carries a high rate of local recurrence and is no longer recommended.

Step 3: Understand why superficial parotidectomy works.
Superficial parotidectomy removes the whole superficial lobe of the parotid gland, along with the tumour and a margin of healthy tissue, while carefully identifying and preserving the facial nerve. Removing a wide margin of normal gland around the tumour takes out any pseudopodia along with it, giving a much lower recurrence rate.

Step 4: Rule out the other options.
Deep parotidectomy removes the deep lobe, which lies below the facial nerve plane; it is reserved for tumours that arise in or extend into the deep lobe, not typical superficial pleomorphic adenoma.
Radical parotidectomy removes the whole gland along with the facial nerve, done only for malignant tumours invading the nerve, which is far more aggressive than what a benign adenoma needs.

Step 5: Final answer.
For a typical pleomorphic adenoma of the superficial lobe, the standard treatment is
\[ \boxed{\text{Superficial parotidectomy}} \]