Parotid Tumours

Question 1

Salivary tumours are uncommon.

Malignant salivary tumours affects older patients.

Benign salivary tumours peak ~40 years

Answer 1

INFO CARD

Question 2

What proportion of parotid tumours are benign and malignant?

Answer 2

Benign : 80%

Malignant : 20%

Question 3

What are parotid tumours?

Answer 3

Parotid glands sit in front of the ears.

Parotid glands are the most common gland for tumours

Question 4

What is the clinical presentation of parotid tumour?

Answer 4

=> Slowly enlarging, non-painful mass of the face or jaw

=> Numbness

=> Burning / prickling sensation

If malignant:

i. Facial nerve palsy
* Adenoid cystic carcinoma = greatest tendency to cause perineural invasion, resulting in facial nerve palsy

ii. Erythema / ulceration

iii. Pain due to
=> suppuration
=> haemorrhage into the mass
=> infiltration of malignancy into surrounding structures

Larger salivary malignancies:

i. Airway obstruction
ii. Dysphagia
iii. Hoarseness

Question 5

How do you examine for parotid cancer?

Answer 5

Examine swelling for:

=> Tenderness

=> Mobility

=> Cervical lymphadenopathy

=> Examine oral mucosa (salivary malignancies can invade into oral mucosa)

=> Facial nerve palsy

Question 6

What investigations are carried out for parotid tumours?

Answer 6

Routine bloods: FBC, CRP, U&Es

Fine needle aspiration cytology or core needle biopsy for suspicious lesions => confirms tumour type

Ultrasound => tumour location, margins and vascularity

If malignancy is confirmed => staging CT scan of neck and thorax to determine extent of disease

Question 7

What are the differentials for parotid cancer?

Answer 7

Sialoliathiasis

Chronic sialedenitis

Autoimmune disease i.e. Sjögren’s disease

Lymphoproliferative disorders

HIV if diagnosis uncertain

Question 8

How do you treat parotid tumours?

Answer 8

1. Superficial parotidectomy - removing tumour part of the gland + some of the healthy tissue around and leaving the rest
2. Total parotidectomy - for larger tumours
3. More extensive surgery if tumours has spread to bone, muscle etc
4. Radiation therapy - used in malignancy alongside surgery
5. Chemotherapy - not common in parotid cancer but may be used in combination with radiotherapy in parotid cancers high risk of spreading

Question 9

Parotid gland is accessed from near the ear so need to be careful of facial nerve damage.

Answer 9

If facial nerve must be cut to remove the parotid cancer => surgeons can repair facial nerve using nerves from other areas of body or processed nerve grafts from donors

Question 10

What are the post operative complication in parotid tumours?

Answer 10

Haematoma

Facial nerve injury

Frey’s syndrome : stimulus to salivate results in inappropriate redness and sweating - faulty autonomic fibres

Question 11

What is the prognosis for parotid tumours?

Answer 11

Benign parotid tumours = excellent outcome