Case 5 Gigantic Pleomorphic Adenoma of Parotid

During the winter of 2016 on a Monday morning, four rustic people were sitting outside our FacioMaxillary Surgery OPD. All of them had covered their faces with scarves which is a common tradition in north India and it was difficult to make out who is the patient amongst them. As soon I had entered the OPD , one of the accompanying persons urged me to see the patient as early as possible because the he was bleeding profusely. “Ah some botched up wisdom molar extraction by a quack” came to my mind but I didn’t knew what surprise awaited me.

It was too early even by hospital standard and our hygiene maintenance guy was just about finishing cleaning up the OPD so I told them to give me 5 more minutes. The moment dirty muffler was unraveled, I was taken aback by this huge growth on right side of face which was almost the size of a human face. There was bleeding from the posterior surface of the tumor just below & behind the right ear. The surface of the tumor had ulcerated and it was continously trickling blood. For now, bleeding was stopped by dressing the surface with a gauze soaked in Tranxemic acid.

The differential diagnosis considered were Pleomorphic Adenoma and Carcinoma ex Pleomorphic Adenoma. Contrst Ct and FNAC were ordered to get a provisional diagnosis. There was no Facial Nerve Palsy noted on clinical examination. Even FNAC and CT scan were pointing to benign pleomorphic tumor of the Parotid. Patient was investigated to prepare for surgery under General Anaesthesia. Superficial Parotidectomy (Nerve Sparing) was planned and Patient was consented for Radical Parotidectomy in case frozen sections dictated any malignant change. Patient was operated under General Anesthesia through Oral intubation and Intraoperative Pathology from multiple sites showed no malignant changes.

Complete tumor excision was done after carefully preserving the VII cranial nerve and the resultant defect was closed with Rotation Flap from Cervical region. Flap took up well and all wounds healed well. The patient was discharged on 6th postoperative day and returned only once after 10 days to get the sutures removed.

Dr Aakarsh Jhamb Parotid Tumor
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