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

From greek.doctor
  • 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