OBJECTIVE: To describe the therapeutic approach in a case of recurrent pleomorphic adenoma of large size. Case Study: frame of 5 years of evolution of tumor growth in the left parotid region without signs of inflammation that has been worsening over the past two years, following the voice is nasal, mild dysphagia to solids rather than liquids. Operated in 1978 from the same tumor smaller, partial parotidectomy with sequellae of facial paralysis which improved after treatment with diagnosis of pleomorphic adenoma. Physical exam: mild facial paralysis at the level of the left oral commissure. Oroscopy: it turns out tumor displacing the left lateral wall of the mouth, the anterior pillar and tonsillary bed to the middle line, a tumor in the parotid region that extends to the left sub maxillary region of stony consistency, painless edge net connected to the deep layers of 10 cm in diameter. Has a Computed Tomography: left parotid tumor that extends from the base of the skull, moves midline structures in the oropharynx, parapharyngeal space of approximately 11 x 9.5 x 6.5 cm with micro calcifications without apparent alteration of cranial nerves. Incisional biopsy was performed which returns pleomorphic adenoma. Given the size and extent of the tumor has decided to radiotherapy provided, surgery to decrease tumor size and post-surgery. CONCLUSION: Pleomorphic adenoma is the most common benign tumor of major salivary glands; treatment is surgical and should be made to the same total extirpation to prevent recurrence.