Pleomorphic adenoma is a benign tumor that most commonly arises in the salivary glands, especially the parotid gland. The symptoms of pleomorphic adenoma generally develop slowly and are often subtle at first, making early detection challenging. The hallmark symptom is a **painless, slow-growing lump or swelling** in the region of the affected salivary gland, typically near the jaw, in front of or just below the ear, or inside the mouth if minor salivary glands are involved.
This lump is usually **firm but mobile**, meaning it can be moved slightly under the skin or mucosa, and it does not cause discomfort initially. Because the tumor grows gradually over months or years, patients often notice the swelling incidentally or when it becomes large enough to be visible or palpable. The size can vary from a small nodule to a large mass, but it rarely causes pain in the early stages.
As the tumor enlarges, it may cause **visible facial asymmetry** due to the swelling. In most cases, there is no associated redness, warmth, or signs of infection. The overlying skin or mucosa typically remains normal unless the tumor becomes very large or ulcerates, which is uncommon in benign pleomorphic adenomas.
In some cases, if the tumor compresses or involves nearby structures, patients may experience additional symptoms:
– **Facial nerve weakness or paralysis:** Although rare in benign pleomorphic adenoma, if the tumor grows large enough or invades the facial nerve branches, it can cause weakness or paralysis of facial muscles on the affected side. This symptom is more commonly associated with malignant transformation but can occasionally occur in large benign tumors.
– **Numbness or altered sensation:** Pressure on sensory nerves near the tumor may cause numbness or tingling in the skin around the ear, cheek, or jaw.
– **Difficulty swallowing (dysphagia) or opening the mouth (trismus):** If the tumor extends into deeper tissues or the oral cavity, it may interfere with normal mouth movements or swallowing.
– **Dry mouth (xerostomia):** Rarely, involvement of salivary gland tissue may reduce saliva production, leading to dryness.
Pain is generally **not a feature** of pleomorphic adenoma unless there is secondary infection, rapid growth, or malignant transformation. A sudden increase in size or onset of pain should raise suspicion for carcinoma ex pleomorphic adenoma, a malignant form arising from a long-standing benign tumor.
In summary, the typical symptoms of pleomorphic adenoma include:
– Painless, slow-growing lump or swelling near the jaw, ear, or inside the mouth
– Firm, mobile mass under the skin or mucosa
– Facial asymmetry due to swelling
– Rarely, facial nerve weakness or numbness if nerves are involved
– Uncommon symptoms such as difficulty swallowing or dry mouth in advanced cases
Because the tumor is benign and slow-growing, many patients live with it for years before seeking medical attention. Early diagnosis often relies on recognizing the characteristic painless swelling and confirming with imaging and biopsy. If left untreated, the tumor can continue to enlarge, potentially causing cosmetic concerns and, in rare cases, functional problems due to nerve involvement.
