ENT

Question 1

Where are most salivary gland tumours and are they mainly benign of malignant

Answer 1

80% in the parotid gland
80% benign - does not invade the facial nerve

Question 2

What are the types of benign parotid gland tumour and how do you differentiate between them

Answer 2

Benign pleomorphic adenoma (80%) - young pt, slow-growing, poorly encapsulated

Warthin tumour - most common BILATERAL neoplasm, lymphocytic infiltrate, cystic epithelial proliferation

Monomorphic adenoma - Slow growing, only one cell type

Haemangioma - Seen in children, hypervascular imaging, may spontaneously regress

Question 3

What are the malignant parotid diseases and how do you tell the difference between them

Answer 3

Mucoepidermoid carcinoma (30%), can be low or high grade

Adenoid cystic carcinoma - perineural spread, distant mets common

Mixed tumour - from a previously benign lesion

Acinic cell carcinoma - perineural invasion, low chance of mets

Adenocarcinoma - from secretory portions

Lymphoma - large and rubbery

Question 4

What is the management for a benign pleomorphic adenoma

Answer 4

Superficial parathryoidectomy

Question 5

What investigations should be done for suspected parotid gland disease

Answer 5

Plain XR (exclude calculi)
Sialography (delineate ductal anatomy)
FNA of mass
CT/MRI: staging

Question 6

What are the differentials for parotid gland tumours

Answer 6

Stone blocking the parotid duct (rapid small → large mass)
Sarcoidosis (bilateral, non-tender)
HIV (multi-cystic, bilateral)
Sjogren’s (bilateral, non-tender, F>M, dry mouth, dry eyes)