Recurrent Pleomorphic Adenoma of the Parotid Gland: Proposal for an LMCG Classification System and an Optimized Therapeutic Algorithm.

OBJECTIVES

To introduce a novel clinical classification system and corresponding therapeutic strategies for parotid recurrent pleomorphic adenoma (RPA).

METHODS

A retrospective analysis was conducted on parotid RPA cases treated by a single surgical team at Shanghai Ninth People's Hospital between January 2020 and December 2024. Based on tumor features-such as single or multiple nodules, infringement of adjacent structures, or skip metastases-as well as intraoperative facial nerve status, a classification system and corresponding treatment strategy were proposed.

RESULTS

A total of 66 patients were included in the study. The majority (95.5%) presented with multinodular tumors, and 66.7% developed facial paralysis due to intraoperative facial nerve injury. The classification system termed "Localized-Moderate-Complicated-General" (LMCG) was first developed. The Localized type represents the least severe condition, while the subsequent categories reflect progressively more complex presentations. Each classification corresponds to a tailored therapeutic strategy, ranging from partial parotidectomy with or without facial nerve preservation to extensive parotidectomy combined with immediate nerve reconstruction and adjuvant radiotherapy.

CONCLUSION

The LMCG classification offers a concise framework for preoperative assessment and personalized treatment planning in patients with parotid RPA, with the potential to standardize and improve its clinical outcomes.