Pleomorphic Adenoma of Parotid Gland in The Elderly: Do We Always Need to Operate?

Introduction: Pleomorphic adenoma is the most common salivary gland tumor, which usually involves the parotid gland. It can seldom undergo malignant transformation. Therefore, the best treatment to avoid malignant transformation is to excise the tumor, which is a straightforward decision in young and fit patients. However, surgery under general anaesthesia can lead to a rapid postoperative cognitive impairment in the elderly patients. Also, some patients may be at a higher risk for a general anaesthetic due to their general health and associated medical conditions. Aim: To discuss the advantages and disadvantages of surgical versus non-surgical management of parotid pleomorphic adenomas in the elderly and medically compromised. Methods & Material: A review of English literature. Conclusion: A decision to excise a parotid pleomorphic adenoma, with no malignant pointers, in the elderly and in patients who are high risk for general anaesthesia should be taken cautiously and a non-surgical approach should be considered.

[1]  T. Sakabe,et al.  Prediction of postoperative delirium after abdominal surgery in the elderly , 2009, Journal of Anesthesia.

[2]  M. Kanematsu,et al.  Carcinoma Ex Pleomorphic Adenoma of the Parotid Gland: Radiologic-Pathologic Correlation with MR Imaging Including Diffusion-Weighted Imaging , 2008, American Journal of Neuroradiology.

[3]  K. Heilman,et al.  Predictors of Cognitive Dysfunction after Major Noncardiac Surgery , 2008, Anesthesiology.

[4]  N. Siddiqi,et al.  Interventions for preventing delirium in hospitalised patients. , 2007, The Cochrane database of systematic reviews.

[5]  A. Dumbrell,et al.  Preoperative Risk Assessment for Delirium After Noncardiac Surgery: A Systematic Review , 2006, Journal of the American Geriatrics Society.

[6]  K. Balakrishnan,et al.  Fine needle aspiration cytology in the management of a parotid mass: a two centre retrospective study. , 2005, The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland.

[7]  K. Olsen,et al.  Carcinoma ex pleomorphic adenoma: A clinicopathologic review , 2001, Head & neck.

[8]  Y. Imai,et al.  The Revised Hasegawa's Dementia Scale (HDS-R)-Evaluation of Its Usefulness as a Screening Test for Dementia , 1994 .

[9]  G. Seifert,et al.  Histopathology of malignant salivary gland tumours. , 1992, European journal of cancer. Part B, Oral oncology.

[10]  R. Rzepko,et al.  [Carcinoma ex pleomorphic adenoma of major salivary glands--a clinicopathologic review]. , 2007, Otolaryngologia polska = The Polish otolaryngology.

[11]  G. Fillola,et al.  [Value of of fine-needle aspiration cytology and MRI in parotid gland masses]. , 2002, Revue de laryngologie - otologie - rhinologie.