surgical excision of a huge pleomorphic adenoma at a tertiary care center in bihar.

1. GIANT
PLEOMORPHIC
ADENOMA OF
PAROTID GLAND -
A CASE REPORT

2. DR MANUPRITA AGRAWAL
M S ENT PGT(FINAL YEAR)
MGM MEDICAL COLLEGE,
KISHANGANJ
BIHAR
UNDER THE GUIDANCE OF:
DR ALOKE BOSE MAJUMDER
ASSOCIATE PROF.
PRESENTED BY

4. Patients name- Birendra Rishi
Age – 40 years
Sex – Male
Address – Katihar, Bihar
IPD no.- 14439

5. FRONTAL
VIEW

6. LATERAL
VIEW

7. OBLIQUE VIEW

8.  Massive swelling of the right side of
the face since 5years.
 On examination- a huge, firm to hard
lobulated mobile mass measuring six
by eight inches.
 There was no facial palsy, no regional
lymphadenopathy.
 The skin over the swelling was quite
healthy but thinned out and
pigmented.
 There was no intraoral or
parapharyngeal involvement.

9. FNAC was done
which reported
PLEOMORPHIC
ADENOMA. The
patient could
not afford a C T
scan. After
routine
investigations
and pre
anesthetic
evaluation a
total excision
was planned.

10. SINCE THE
SKIN WAS
PIGMENTED
AND THINNED
OUT, IT WAS
NOT INCLUDED
IN THE FLAP. A
WIDE
ENCIRCLING
INCISION WAS
GIVEN.

11. Posterior part of the incision
marked out. The tumor was
gradually dissected from
below upwards and posterior
to anterior by sparing the
branches of the facial nerve.

12. FEEDING
VESSELS WERE
CLAMPED AND
LIGATED.

13. THE TUMOUR BEING DISSECTED OUT OF THE CAROTID SHEATH AND
LIFTED OUT OF THE DIGASTRIC TRIANGLE
DIGASTRIC TRIANGLE

14. Major
feeding
vessels to
the
undersurface
of the tumor
dissected
and being
ligated.

15. Major feeding
vessels
clamped and
cut, tumor
delivered.

16. Defect
after
removal of
the
specimen.

17. SPECIMENAFTERREMOVAL
WEIGHT 1.125KGS

18. supra
clavicular
release
incision
required
to bridge
the raw
area.

19. retromandibular
raw area left
after
advancing the
lower neck
flap.

20. Gel foam
placed
over the
raw area.

21. PATIENT
EXAMINED
ON 25TH
POST-OP
DAY
RAW
SURFACE
HEALED
BY
GRANULA
TION

22. Giant benign parotid tumours
usually spare the facial nerve
and the great vessels. Hence
need a conservative excision
of the tumour. Ideally a
superficial parotidectomy with
enbloc resection of the mass
is done. The resultant defect
needed second stage skin
grafting for closure. Surgery
was successful and
cosmetically rewarding.

24. ACKNOWLEDGEMENTS
Grateful and Highly Obliged to:
 Dr. Dilip Kumar Jaiswal
 Dr. B.K.Bhattacharya
 Dr. Soumendu Guha
 DR. ARUP SENGUPTA
 Dr. Alok Bose Mazumdar
 DR. SANTOSH RAMAN
 MY
FRIENDS,COLLEAGUES,PARENTS……
and my PATIENTS.

25. THANKYOU