Pleomorphic adenoma is the most common parotid gland tumour. It is benign, usually presents as a painless, slow-growing lump near the jaw, and was first described by surgeon Theodor Billroth in 1859. In Episode 112, ENT surgeon Dr Rowan Valentine explains how it is assessed and managed.

Meet the mixed tumour. In 1859, German-born Austrian surgeon Theodor Billroth gave the first medical description of a slow-growing, painless, encapsulated tumour that occurs mainly in the parotid gland, beside the jaw. Under the microscope it showed a mix of tissue types, so he called it a “mixed tumour”. Today we know it as a pleomorphic adenoma.

Billroth also performed the first laryngectomy and the first successful partial gastrectomy for gastric cancer, and he was a friend of the composer Johannes Brahms. Dr Travis Brown tells his story at the start of the episode.

Jaw lumps raise worry. Dr Valentine walks through what he asks, what he examines, and what he recommends when a patient presents with a parotid lump.

• History: how long the lump has been there, whether it hurts, whether it changes in size, and whether the patient has noticed any weakness of the face.
• Examination: mobility of the lump, the overlying skin, tenderness, sensation near the ear, and the function of each branch of the facial nerve.
• Red flags: pain, skin involvement, a history of skin cancer excisions on the head and neck, and facial nerve paralysis.
• Biopsy limits: in Dr Valentine’s words, fine needle aspirates and core biopsies have about 90% accuracy in separating benign from cancerous lumps.
• Surgery: what the operation involves, how the facial nerve is protected, and the risks Dr Valentine quotes to patients.
• Follow-up: why recurrence can follow if the capsule of the tumour is breached, and how that shapes surveillance.

Long-standing lumps are easy to set aside. Dr Valentine explains why a lump that has been present for years still deserves a plan, and his closing advice for doctors is that a parotid lump is cancerous until proven otherwise. The episode introduces you to the questions, examination findings and red flags an ENT surgeon looks for, so you can feel more prepared for the patient who says, “I’ve had this for years.”

This is the story of pleomorphic adenomas.

Our Special Guest:

Dr Rowan Valentine is an adult and paediatric ear, nose and throat (ENT) surgeon. He trained in Adelaide, completed a PhD during his surgical training, and spent a year at the University of Florida on an anatomy fellowship. He supervises surgical trainees and medical students, and he is a regular guest on This Medical Life.

Listen:

This Medical Life podcast is available on all podcasting services, Apple Podcasts, YouTube, and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.