{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T09:36:01Z","timestamp":1790501761721,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pleomorphic adenomas (PAs) are the most common salivary gland tumors, with a known risk of recurrence, especially after inadequate surgical excision. Understanding how surgical approach influences recurrence remains essential to optimize management. This study aimed to synthesize recurrence rates of PAs based on different surgical techniques and to illustrate the implications of surgical strategy through a representative case of multifocal deep lobe recurrence. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for studies published in the last ten years, reporting recurrence rates of PAs by surgical approach. Data were extracted on recurrence, complications, and tumor characteristics. Additionally, a complex clinical case of recurrent deep lobe PA (DLPA) was presented to contextualize the findings. Results: Fifteen studies were included, comprising a total of 2095 patients. Recurrence rates were 3.27% after extracapsular dissection (ED), 0.73% after partial superficial parotidectomy (PSP), and 2.41% after superficial parotidectomy (SP). Recurrent PA (RPA) is often multifocal and associated with increased risks of facial nerve palsy and positive surgical margins. The presented case involved five surgical procedures, with ultimate total parotidectomy and facial nerve preservation despite infiltrative recurrence in the prestyloid space. Conclusions: Techniques such as ED and PSP have demonstrated their efficacy and safety compared to more invasive approaches, although their application should be carefully evaluated based on tumor size and location. RPA remains a challenging entity to treat. Avoiding outdated techniques and ensuring evidence-based decision making may improve long-term outcomes in PA management.<\/jats:p>","DOI":"10.3390\/jcm14134541","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T03:33:25Z","timestamp":1750995205000},"page":"4541","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Systematic Review and Case Report on the Surgical Management of Pleomorphic Adenomas: Lessons on Recurrence and Error Prevention"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0983-9640","authenticated-orcid":false,"given":"Giulio","family":"Pagnani","sequence":"first","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Odontostomatological and Maxillofacial Sciences, University of Rome \u201cLa Sapienza\u201d, University Hospital Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Palma","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Odontostomatological and Maxillofacial Sciences, University of Rome \u201cLa Sapienza\u201d, University Hospital Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Bozza","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, NESMOS Department, Faculty of Medicine and Psychology, S. Andrea Hospital, University of Rome \u201cLa Sapienza\u201d, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Marsigli Rossi Lombardi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Psychology, University of Rome \u201cLa Sapienza\u201d, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Becelli","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, NESMOS Department, Faculty of Medicine and Psychology, S. Andrea Hospital, University of Rome \u201cLa Sapienza\u201d, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s12105-022-01420-1","article-title":"Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Salivary Glands","volume":"16","author":"Hyrcza","year":"2022","journal-title":"Head Neck Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s12105-014-0581-1","article-title":"Functional Histology of Salivary Gland Pleomorphic Adenoma: An Appraisal","volume":"9","author":"Triantafyllou","year":"2014","journal-title":"Head Neck Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/hed.2890080309","article-title":"Salivary neoplasms: Overview of a 35-year experience with 2,807 patients","volume":"8","author":"Spiro","year":"1986","journal-title":"Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.jcms.2015.03.017","article-title":"Meta-analysis of surgical approaches to the treatment of parotid pleomorphic adenomas and recurrence rates","volume":"43","author":"Colella","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/0002-9610(75)90484-5","article-title":"Experience with 1,360 primary parotid tumors","volume":"130","author":"Woods","year":"1975","journal-title":"Am. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1097\/00005537-200212000-00004","article-title":"The significance of the margin in parotid surgery for pleomorphic adenoma","volume":"112","author":"Witt","year":"2002","journal-title":"Laryngoscope"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1002\/bjs.18004519314","article-title":"The treatment of parotid tumours in the light of a pathological study of parotidectomy material","volume":"45","author":"Patey","year":"1958","journal-title":"Br. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1080\/00016489.2025.2480687","article-title":"Differential diagnosis between pleomorphic adenoma and carcinoma ex pleomorphic adenoma: Focus on clinical and MR findings","volume":"145","author":"Sato","year":"2025","journal-title":"Acta Oto-Laryngologica"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"102590","DOI":"10.1016\/j.amjoto.2020.102590","article-title":"The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results","volume":"42","author":"Seyhun","year":"2021","journal-title":"Am. J. Otolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3307","DOI":"10.1007\/s00405-016-3916-6","article-title":"Classification of parotidectomies: A proposal of the European Salivary Gland Society","volume":"273","author":"Quer","year":"2016","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of inter ventions","volume":"355","author":"Sterne","year":"2016","journal-title":"Br. Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1177\/01455613211068574","article-title":"An institutional review of recurrent pleomorphic adenoma of the parotid gland","volume":"103","author":"Brar","year":"2022","journal-title":"Ear, Nose Throat J."},{"key":"ref_14","first-page":"1027","article-title":"Comparison of parotidectomy with observation for treatment of pleomorphic adenoma in adults","volume":"146","author":"Kligerman","year":"2020","journal-title":"Arch. Otolaryngol. Neck Surg."},{"key":"ref_15","first-page":"E445","article-title":"Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow-up","volume":"131","author":"Schapher","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"718","DOI":"10.3109\/00016489.2015.1020394","article-title":"The role of partial parotidectomy for benign parotid tumors: A case-control study","volume":"135","author":"Plaza","year":"2015","journal-title":"Acta Oto-Laryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1017\/S0022215118000245","article-title":"Segmental superficial parotidectomy in the surgical treatment of benign parotid tumours","volume":"132","author":"Eski","year":"2018","journal-title":"J. Laryngol. Otol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1017\/S0022215123001767","article-title":"The extracapsular dissection technique in the management of benign tumours of the parotid gland: Our experience in 194 patients","volume":"138","author":"Allevi","year":"2023","journal-title":"J. Laryngol. Otol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2853","DOI":"10.1002\/hed.27840","article-title":"Parotidectomy for deep lobe pleomorphic adenomas is associated with higher rates of complications and recurrence","volume":"46","author":"Levyn","year":"2024","journal-title":"Head Neck"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"156","DOI":"10.14639\/0392-100X-2307","article-title":"Repeatedly recurring pleomorphic adenoma: A therapeutic challenge","volume":"39","author":"Aro","year":"2019","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3313","DOI":"10.1007\/s00405-016-3921-9","article-title":"Stationary facial nerve paresis after surgery for recurrent parotid pleomorphic adenoma: A follow-up study of 219 cases in Denmark in the period 1985\u20132012","volume":"273","author":"Andreasen","year":"2016","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ejso.2021.08.030","article-title":"Functional gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland","volume":"48","author":"Roh","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1007\/s00405-024-09002-3","article-title":"Feasibility and safety of preauricular incision for extracapsular dissection in benign parotid tumors","volume":"282","author":"Roh","year":"2025","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1111\/ans.19261","article-title":"Outcomes of a modified technique of partial parotidectomy and novel parotid tumour position classification from a single surgeon prospective database","volume":"94","author":"Serpell","year":"2024","journal-title":"ANZ J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1002\/jso.24392","article-title":"Recurrent Pleomorphic Adenoma of the Parotid Gland: Institutional Experience and Review of the Literature","volume":"114","author":"Mizrachi","year":"2016","journal-title":"J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.bjoms.2019.08.008","article-title":"Postoperative complications after removal of pleomorphic adenoma from the parotid gland: A long-term follow up of 297 patients from 2002 to 2016 and a review of publications","volume":"57","author":"Maglitto","year":"2019","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3329","DOI":"10.1007\/s00405-023-07897-y","article-title":"Clinico-histopathological review of 255 patients who underwent parotidectomy for pleomorphic adenoma: A 10-year retrospective study-a proposal for an optimal diagnostic and therapeutic algorithm for patients with recurrent pleomorphic adenoma","volume":"280","author":"Zoccali","year":"2023","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_28","first-page":"457","article-title":"Three hundred mixed tumors of the salivary glands, of which sixty-nine recurred","volume":"63","author":"McFarland","year":"1936","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1288\/00005537-198403000-00006","article-title":"Capsular significance in parotid tumor surgery: Reality and myths of lateral lobectomy","volume":"94","author":"Donovan","year":"1984","journal-title":"Laryngoscope"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1002\/bjs.1800831227","article-title":"Clinical significance of the tumour capsule in the treatment of parotid pleomorphic adenomas","volume":"83","author":"McGurk","year":"1996","journal-title":"Br. J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1177\/014556130508400517","article-title":"Minimally invasive surgery for parotid pleomorphic adenoma","volume":"84","author":"Witt","year":"2005","journal-title":"Ear Nose Throat J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.oraloncology.2014.02.007","article-title":"A systematic review of 1143 parapharyngeal space tumors reported over 20 years","volume":"50","author":"Riffat","year":"2014","journal-title":"Oral Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"104872","DOI":"10.1016\/j.oraloncology.2020.104872","article-title":"Selection of the surgical approach for lesions with parapharyngeal space involvement: A single-center experience on 153 cases","volume":"109","author":"Lombardi","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/MOO.0000000000000134","article-title":"Recent advances in surgical management of para pharyngeal space tumors","volume":"23","author":"Paderno","year":"2015","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1002\/lary.29458","article-title":"Endoscopy-Assisted Transoral Approach to Resect Parapharyngeal Space Tumors: A Systematic Review and Meta-Analysis","volume":"131","author":"Chen","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"104581","DOI":"10.1016\/j.oraloncology.2020.104581","article-title":"Trans-oral robotic surgery in the management of parapharyngeal space tumors: A systematic review","volume":"103","author":"Costantino","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_37","first-page":"4247","article-title":"Postoperative radiation therapy for parotid pleomorphic adenoma with close or positive margins: Treatment outcomes and toxicities","volume":"34","author":"Patel","year":"2014","journal-title":"Anticancer Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.ijrobp.2006.06.036","article-title":"Recurrent pleomorphic adenoma of the parotid gland: Long-term outcome of patients treated with radiation therapy","volume":"66","author":"Chen","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1002\/bjs.1800730803","article-title":"Should radiotherapy be used routinely in the management of benign parotid tumours?","volume":"73","author":"Watkin","year":"1986","journal-title":"Br. J. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.amjoto.2012.08.002","article-title":"Radiotherapy for pleomorphic adenoma","volume":"34","author":"Wallace","year":"2013","journal-title":"Am J. Otolaryngol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e449","DOI":"10.1097\/SCS.0b013e318262d291","article-title":"Recurrent pleomorphic adenoma of the parotid gland: Role of neutron radiation therapy","volume":"23","author":"Becelli","year":"2012","journal-title":"J. Craniofacial Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"287","DOI":"10.4103\/ams.ams_362_20","article-title":"Long-term follow-up after extracapsular dissection of parotid pleomorphic adenomas: A retrospective study","volume":"11","author":"Colangeli","year":"2021","journal-title":"Ann. Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4541\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:59:12Z","timestamp":1760032752000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":42,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134541"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134541","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]}}}