Pleomorphic Adenoma Surgery — ORE Part 1 MCQ

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ModerateOral SurgeryPleomorphic Adenoma SurgeryORE Part 1

A 55-year-old patient has a painless, slowly enlarging lump in the right parotid region. Ultrasound demonstrates a well-circumscribed lesion confined to the superficial lobe of the parotid gland. Fine-needle aspiration cytology is consistent with pleomorphic adenoma. Facial nerve function is normal. What is the most appropriate definitive treatment?

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Correct answer: A — Superficial parotidectomy with preservation of the facial nerve

**A. Superficial parotidectomy with preservation of the facial nerve** is the best answer. The cytology and imaging support a benign pleomorphic adenoma in the superficial lobe, and normal facial function provides no indication for nerve sacrifice. Definitive treatment is complete surgical excision with a cuff of parotid tissue while identifying and preserving the facial nerve. A UK survey of oral and maxillofacial surgeons identified superficial parotidectomy as the standard treatment for primary pleomorphic adenoma. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/23623783/?utm_source=openai)) **B** is unsafe because simple enucleation can leave microscopic pseudopodial extensions and predispose to recurrence. **C** is not primary treatment for a resectable benign pleomorphic adenoma. **D** is diagnostic surveillance, not definitive management. **E** is unnecessarily radical: total gland removal and planned facial-nerve sacrifice would be considered only where disease extent or malignant involvement justified it. Although selected units may use limited parotidectomy or extracapsular dissection in carefully chosen cases, the specified option and conventional ORE answer for this superficial-lobe lesion is superficial parotidectomy with nerve preservation. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/17666140/?utm_source=openai))

Reference: Witt RL, et al. Survey of opinions on the management of pleomorphic adenoma among United Kingdom oral and maxillofacial surgeons. 2010. https://pubmed.ncbi.nlm.nih.gov/20465538/