Clinicopathological characteristics and surgical outcomes of pleomorphic adenoma of salivary glands among Sudanese patients.

BACKGROUND: Pleomorphic adenoma is the most common salivary gland tumor affecting both major and minor glands. It has different clinical presentations and histological patterns. Outcome of pleomorphic adenoma varies widely with the risk of recurrence, malignant transformation and facial nerve involvement being the most important aspects among other postoperative complications. OBJECTIVES: To study the clinicopathological features of pleomorphic adenoma, its distribution in head and neck region and evaluation of outcomes of surgical treatment in terms of tumor recurrence and other postoperative complications. METHODOLOGY: Retrospective analytical hospital–based study of all records of patients diagnosed with pleomorphic adenoma of salivary glands who attended Khartoum Teaching Dental Hospital (KTDH) during period from 2007 to 2021. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 27. Chi square test to assess associations. Linear regression, binary logistic regression & cox regression multivariate analysis to estimate the significance and relations. RESULTS: Two hundred fifteen patients fulfilled the inclusion criteria. Pleomorphic adenoma was found to be more common in females, in the fourth decade of life affecting the right side more commonly. Minor glands were affected more commonly with the palate being the most common site followed by the parotid. Definitive histopathological assessment revealed 201 (93.5%) pleomorphic adenoma with classic subtype being the most common, while 14 (6.5%) were carcinoma arising within pleomorphic adenoma. Post operative complications occurred in 72(33%) with facial nerve injury and oroantral fistula being the most commonly encountered. Recurrence was observed in 15 (7%) and malignant transformation in 3 cases (1.4%). CONCLUSION: Although pleomorphic adenoma is a benign salivary gland neoplasm, it can grow into extensive size if left untreated causing disfigurement and may undergo malignant transformation thus need to be diagnosed early and complete excision of the tumor is the definitive treatment to prevent tumor recurrence. Meticulous dissection of facial nerve during parotid operation and use of SMAS layer flap is also recommended so as to prevent facial nerve damage and occurrence of Frey syndrome. Long-term follow up of pleomorphic adenoma is required to assess the risk of recurrence and malignant transformation as they usually occur over a long duration.