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Gen Surgery > Approach To Salivary Tumours > Flashcards

Approach To Salivary Tumours Flashcards

1
Q

Types of adenomas of the salivary gland

A
  • pleomorphic adenoma
  • adenolymphoma
  • other adenomas
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2
Q

Types of carcinoma of the salivary gland

A
  • acinic cell
  • mucuepidermoid
  • adenoid cystic
  • polymorphous low grade
  • ex pleomorphic
  • undifferentiated
  • squamous
  • adenocarcinoma
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3
Q

Histopathological classification of neoplasms of salivary gland

A
  • adenomas
  • carcinomas
  • non epithelial (vascular, lymphatic, neural origin)
  • malignant lymphomas
  • secondary mets
  • unclassified tumours
  • tumour like lesions
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4
Q

Where do parotid tumours most commonly occur

A

Superficial lobe

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5
Q

What may cause enlargement of parotid lymph nodes

A
  • cancer metastases
  • lymphoma
  • infection e.g. Tuberculosis
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6
Q

Differentials of parotid tumours

A
  • primary
  • lymphoma (especially with HIV)
  • metastases
  • originating from other local tissue (blood vessels, nerves , fat
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7
Q

Most common beneign parotid tumour

A

Pleomorphic adenoma

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8
Q

Top 3 parotid malignancies in South Africa

A
  • squamous cell ca of the skin
  • mucoepidermoid carcinoma
  • malignant melanoma of the skin
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9
Q

Skin cancer of which areas metastasize to the parotid gland

A

Facial, temporal and auricular skin

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10
Q

Which cancer metastasize to the parotid gland

A
  • skin (most common)

- rarely: cancers of the eye and even distant sites such as breast cancer

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11
Q

Clinical pointers of malignancy of the parotid gland

A
  • Previous skin cancers of the head and neck
  • Irradiation to the parotid region many years previously
  • Rapid growth
  • Pain
  • Local invasion
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12
Q

What is the local invasion of parotid malignancy

A
  • Trismus: Invasion of muscles of mastication or temporomandibular joint
  • Skin infiltration
  • Fixity of the mass to deeper tissues
  • facial nerve weakness or paralysis
  • Metastases to cervical lymph nodes or lungs
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13
Q

Why may a surgeon request CT scanning of a parotid tumour

A

To determine the relationship of the tumour mass to the facial nerve (by visualising the retromandibular vein) and to exclude deep extension to the parapharyngeal space

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14
Q

when may fine needle aspiration cytology be useful

A
  • Exclude inflammatory disease eg TB sarcoidosis
  • Exclude lymphoma
  • Exclude metastasis from skin cancers (these patients require neck dissection)
  • patients who do not wish for or are unfit to have surgery
  • Inoperable tumours
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15
Q

When is trucut/open biopsy done

A
  • Inoperable cases before committing a patient to radiation therapy
  • FNAC is suggestive of lymphoma
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16
Q

Treatment of parotid tumors

A

All surgically resectable parotid tumours, other than lymphoma are removed by partial or total parotidectomy with preseveration of the facial nerve under general anaesthesia. This is done to remove the tumour and to obtain histological diagnosis

17
Q

Consequences of parotidectomy

A
  • Scar
  • Greater auricular nerve: Permanent loss of skin sensation of the lower half of the external ear and parotid area; may develop neuroma years later
  • Facial nerve: Temporary weakness of the face, permanent weakness is unusual
  • Frey’s syndrome (gustatory sweating)
18
Q

What is the postoperative radiation therapy given to parotid neoplasms

A
  • Complete resection: no radiation
  • Microscopic residual: Photons
  • Macroscopic residual: Neutrons/ photons
19
Q

What is the follow-up for patients with salivary tumours

A

Patients need to be followed up lifelong and require an annual CXR

20
Q

Other than neoplasm, what are other causes of enlarged submandibular glands

A
  • Sialolithiasis
  • Sialadenitis
  • Enlarged submandibular lymph nodes
21
Q

How do differentiate between an enlarged lymph node and enlarged submandibular gland on bimanuel examination?

A

With one finger on the floor of the mouth and the other on the skin overlying the mass:

  • Lymph node: Palpable with the outside finger
  • Enlarged gland: Palpable with both fingers
22
Q

Which nerves pass close to the submandibular gland

A
  • Hypoglossal
  • Lingual
  • Marginal mandibular nerves
23
Q

How do sublingual gland neoplasms present

A

Smooth or ulcerated mass in the anterior floor of the mouth, just behind the mandible

24
Q

How should a sublingual neoplasm be treated

A

Mass should be biopsied in the oral cavity prior to resection

25
Q

How do minor salivary gland neoplasms present and how should they be managed

A

-These tumours present anywhere in the mucosal lining of the upper aero digestive tract as a smooth or ulcerated mass. These should be biopsied prior to excision

26
Q

What conditions are associated with Parotid cysts

A
  • Traumatic sialocoeles
  • Salivary cysts
  • Lymphangiomas
  • Haemangiomas
  • Tuberculous cold abscess
  • Sjogrens disease
  • Hydatid disease
  • Metastatic skin cancer
  • Melanoma
27
Q

How do HIV lymphoepithelial cysts of the parotid gland present

A

Present as multiple, bilateral cysts and there are usually associated cervical lymph nodes. Cysts typically increase in size with time, may become uncomfortable and are cosmetically disfiguring

28
Q

How are HIV parotid Lymphoepithelial cysts treated

A
  • Cysts usually decrease in size with ARV therapy

- If patients do not qualify for ARV therapy- cysts should be aspirated and sclerosant such as 90 % injected

Gen Surgery (31 decks)

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