Revision parotidectomy - analysis of indications for the procedure and treatment results based on 10 years of follow-up in a single center

Introduction: Surgical removal of recurrent parotid gland tumours is the first-line treatment but presents an increased risk of facial nerve injury and a considerable re-recurrence failure rate. Aim: Identification of individuals exposed to a higher risk of re-procedure, raising awareness in the preoperative setting, and proposing an optimal follow-up. Methods: The retrospective review included 72 patients treated with revision surgery in a single centre. The demographics, clinicopathologic variables, and operative details were analysed. Results: Recurrent pleomorphic adenoma (PA)was the main reason for reoperation (66.7%), followed by new monomorphic adenoma (13.9%), resection extension (12.5%), and malignancy recurrence (6.9%). Time to revision surgery was on average 68.6 months and was the shortest for extended resection cases (average 1.9 months). The period was substantially longer in recurrent PA (90.8 months). The final facial nerve function according to the House-Brackmann scale (HBS) decreased in 37% of patients after reoperation. The number of recurrences per patient ranged from one in 61% of cases to eight in a solitary case. Conclusions: The rate of revision parotid surgery was 8.4%. Negative margins at the first resection were not of protective significance. Recurrent PA was the main cause of revision surgery and over one-third of this cohort had a subsequent relapse. As many as 37% of patients experienced a decrease in facial nerve function following revision surgery.