Question
Ramavati a 40 years old female presented with a progressively increasing lump in the parotid region. On oral examinations, the tonsil was pushed medially. Biopsy showed it to be pleomorphic adenoma. The appropriate treatment is ‑
| A. |
Superficial parotidectomy
|
| B. |
Lumpectomy
|
| C. |
Conservative total parotidectomy
|
| D. |
Enucleation
|
Show Answer
|
Correct Answer » C
Explanation
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|
The most important clue in this question is “Tonsil was pushed medially.”
This indicates that the tumor is arising from the deep lobe of the parotid gland and extending into the parapharyngeal space.
Pleomorphic adenoma is the most common benign tumor of the parotid gland.
Management According to Lobe Involved
Superficial Lobe Tumor
- Treatment: Superficial parotidectomy
- Facial nerve is preserved.
Deep Lobe Tumor
- Treatment: Conservative total parotidectomy
- Both superficial and deep lobes are removed while preserving the facial nerve.
Since the tonsil is displaced medially, the tumor involves the deep lobe, making conservative total parotidectomy the treatment of choice.
Why Other Options are Incorrect
A. Superficial Parotidectomy
- Appropriate only when the tumor is confined to the superficial lobe.
- Not adequate for deep lobe involvement.
B. Lumpectomy
- Inadequate procedure.
- Higher recurrence rate.
D. Enucleation
- Contraindicated.
- Pleomorphic adenoma has microscopic pseudopod-like extensions beyond its capsule.
- Associated with a high recurrence rate.
