Giant Pleomorphic Adenoma of the Parotid Gland: Surgical Management of a Long-Standing Tumor With Facial Deformity and Preservation of Facial Nerve Function.

BACKGROUND: Pleomorphic adenoma (PA), the most prevalent benign neoplasm of the parotid gland, typically manifests as a slow-growing, painless mass. In cases where treatment is substantially delayed, the tumor may undergo progressive enlargement, potentially resulting in significant facial deformity. This, in turn, can complicate surgical management.

CASE PRESENTATION: A 60-year-old female patient exhibited a long-standing right parotid mass that had been gradually increasing in size since 2007, with a notable escalation in dimensions during the year prior to the preliminary assessment. Magnetic resonance imaging in 2021 revealed a well-defined, multilobulated right parotid lesion measuring over 9 cm, and fine-needle aspiration cytology was consistent with PA. Despite the recommendation of surgical excision, the patient initially declined treatment and was subsequently lost to follow-up. In 2025, the patient returned with a parotid mass measuring over 15 cm, accompanied by pronounced facial asymmetry and significant skin stretching. The patient underwent a superficial parotidectomy with complete excision of the lesion, meticulous monitoring of the facial nerve, and preservation of its function. Concurrently, surgical interventions were performed to modify the patient's skin. A subsequent histopathological examination confirmed the presence of PA, devoid of any substantial nuclear atypia or augmented mitotic activity. On Postoperative Day 3, a hematoma developed at the surgical site, necessitating surgical evacuation and hemostatic revision. The ensuing recovery was uneventful, and follow-up at 14 months postoperatively confirmed no recurrence and complete facial nerve function.

CONCLUSIONS: This case exemplifies the ramifications of protracted untreated growth of a PA, culminating in substantial tumor enlargement and pronounced facial deformity. Notwithstanding the advanced size of the lesion, complete excision was achieved while preserving the function of the facial nerve. In the management of giant parotid tumors, meticulous surgical planning and close postoperative monitoring are paramount.