Ch02. Salivary Glands Flashcards
Venous drainage from parotid gland
Superficial temporal vein + maxillary vein -> retromandibular vein
Retromandibular vein -> passes deep to the facial nerve -> anterior and posterior branches
Anterior retromandibular vein + facial vein -> common facial vein -> IJ
Posterior retromandibular vein (over SCM) -> EJ
Parotid gland innervation
Parasympathetic innervation:
Inferior salivatory nucleus (medulla) -> glossopharynegal nerve (Jacobson’s nerve) -> lesser (superficial) petrosal nerve -> otic ganglion -> postganglionic parasympathetic fibers -> carried by auriculotemporal branch of CN V3 -> parotid gland
Percentage of parotid tumors benign
Percentage of salivary neoplasms located in the parotid
80% for both
The most common salivary gland tumor
Pleomorphic adenoma
Warthin’s is second most common salivary gland tumor
Define pleomorphic adenoma
Benign heterogeneous tumor composed of variable epithelial and myoepithelial components
Margin for pleomorphic adenoma surgery
Need wide margin for pseudopod extensions to prevent recurrence
Define Warthin’s tumor
AKA papillary cystadenoma lymphomatosum.
Entrapped lymphoid tissue, ectopic ductal epithelium that develops within intraparotid lymph nodes, or hypersensitivity disease resulting in metaplasia of the duct
Percentage bilateral
Percentage multicentric
of Warthin’s tumor
Both 10%
Define oncocytoma
AKA oxyphilic adenoma.
Rare, benign tumor exclusively of oncocytic cells (1% of salivary gland tumors)
What are oncocytic cells?
Large, distinctly bordered metaplastic epithelial cells with granular cytoplasm from large number of mitochondria
Define monomorphic adenoma
Similar to pleomorphic adenoma except no mesenchymal stromal component, predominantly an epithelial component or (rarely) the myoepithelial component
Define mucoepidermoid carcinoma
Epidermoid and mucinous components with intermediate cells, high and low-grade tumors
Most common salivary gland malignancy in children and adults
Mucoepidermoid carcinoma
What are the two types of mucoepidermoid carcinoma?
Low-grade/well-diff: more mucinous cystic elements
High-grade/poorly-diff: less mucinous elements, more solid nests of cells
Define acinic cell carcinoma
Malignant tumors of basophilic, bland cells similar to acinar cells
Histopathology of acinic cell carcinoma
Serous acinar cells or clear cytoplasm cells, several configurations (microcystic, papillary, solid, follicular), lymphoid infiltrate
What are the facial nerve markers?
ID by 6 ways.
- Tragal pointer: facial nerve may be located 1cm anterior, inferior and deep from tragal cartilage
- Tympanomastoid suture line: facial nerve is 6-8 mm deep to the inferior end of the tympanomastoid suture line
- Digastric attachment to Digastric ridge: identifies the plane of the facial nerve
- Retrograde dissection from distal branches
- Stylomatoid foramen
- Mastoidectomy, ID from the vertical segment
Treatment for salivary fistula
Spontaneously resolves in 2-3 weeks.
Rx: probe wound to release fluid (aspiration), pressure dressing, surgical closure for prolonged drainage (may consider tympanic neurectomy)
Frey syndrome
AKA gustatory sweating.
Injury to the auriculotemporal nerve (sympathetic fibers) rseults in aberrant innervation of cutaneous sweat glands by postganglionic parasympathetic fibers
