22. Tumours of the salivary glands (benign and malignant)

• 70% are benign
• Most are in parotid
• Ultrasound – modality of choice for salivary gland
• The smaller the gland, the higher risk that the tumor is malignant
• Lateral parotidectomy
  • Superficial – with large margin
  • As early as possible
  • Complete
  • Complications:
    • Facial nerve injury
    • Gustatory sweating
    • Gustatory hyperlacrimation
• Benign tumours
  • Clinical features
    • Slow growth
    • Painless
    • Soft or tense
    • Mobile nodule
    • No additional symptoms
  • Pleiomorphic adenoma
    • 85% of benign
    • Radiation, occupational exposure
    • Firmer tumour
    • Diagnosis
      • Histology – pleiomorphic cells
    • 5% can turn malignant
    • 5% recur
    • Treatment
      • Superficial parotidectomy
  • Warthin tumor
    • Older males
    • 10% of benign
    • Etiology
      • Radiation
      • Smoking
    • Softer tumour
    • Treatment
      • Complete surgical excision while preserving facial n.
• Malignant tumours
  • Etiology
    • Radiation
  • Clinical features
    • Rapid growth
    • Painless, fixed nodule
    • Enlarged lymph nodes
    • Infiltration of facial nerve
  • Diagnosis
    • FNAB
    • CT for infiltration
  • Types
    • Mucoepidermoid carcinoma
      • Most common in children
      • Most are low-grade
      • Painless swelling -> later becomes painful
    • Acinar cell carcinoma
      • Locally invasive
      • Older women
    • Adenoid cystic carcinoma
      • Locally invasive
      • Poor radiosensitivity
  • Treatment
    • As complete as possible removal -> radiation