Radical Resection and Deltopectoral Flap Reconstruction Solving the Dilemma of Repeatedly Recurring Submandibular Pleomorphic Adenoma: A Case Report

Pleomorphic adenoma is regarded as the most prevalent salivary gland neoplasm, constituting approximately 80% of all salivary gland tumors. Incomplete surgical resection and/or tumor pseudopodia have been identified as risk factors for recurrence, which can occur despite adequate surgical intervention. The surgical management of recurrence remains challenging, with the complexity of the procedure increasing with subsequent recurrences. With each recurrence, surgical management becomes more challenging. While a considerable number of cases of recurrent parotid pleomorphic adenoma have been documented in the literature, reports of recurrent submandibular gland pleomorphic adenoma are comparatively rare. A 71-year-old female patient with a history of pleomorphic adenoma of the submandibular gland with a seventh recurrence of the malignancy. This recurrence posed significant challenges to the surgical team during the resection process. The patient exhibited 30 years of recurrent symptoms following left submandibular sialadenectomy, with subsequent surgical interventions for management. The surgical intervention involved radical resection, followed by reconstruction of the defect using a tunneled de-epithelialized deltopectoral flap. The patient exhibited a seamless postoperative recovery trajectory, with discharge occurring three days after the procedure. Two years post-surgery, the patient exhibited no evidence of local recurrence. It is hypothesized that radical resection, in conjunction with reconstruction, should be considered a valid surgical intervention to address the surgical dilemma in these cases.