Salivary Glands Flashcards
What is the 80% rule in salivary gland tumours?
80% of salivary gland tumours are in parotid gland
80% of parotid gland tumours are benign
80% of benign tumours are pleomorphic adenoma
The bigger the salivary gland…
The less likely the tumour is malignant
Causes of salivary gland tumours
Painful vs painless
Painless
Benign
- Pleomorphic adenoma
- Warthin’s tumour
- Monomorphic adenoma
Malignant
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
- Acinic cell
Others:
- Lipoma, sebaceous cyst
- Lymph node
Systemic
- Alcoholic liver disease (2’ infiltration)
- DM
- Pancreatitis
- Autoimmune: Sjogren’s syndrome
Painful
- Sialolithiasis
- Sialadenitis
- Mumps viral infection
Pleomorphic adenoma
- Equal sex ratio, Younger <50
- Firm in consistency
- Nodular
- Unilateral
- Recurrence if not completely excised (2%)
- Risk of malignancy (1-6%) to become SCC
- FNAC: Heterogenous epithelial cells + islands of chondromyxoid, myoepithelial cells
- Perform parotidectomy
Warthin’s tumour
- Elderly > 60 y/o, Male
- A/w smoking
- Soft in consistency (doughy)
- Smooth
- Bilateral (10%)
- No recurrence
- No risk of malignancy
- FNAC: Lymphoid cells, multifocal
- Leave tumour alone
Most common Ca of the parotid gland
Mucoepidermoid Carcinoma
Sialolithiasis
Stones in gland or duct
- P/w pain aggravated by eating or anticipation of eating, esp sour foods
- Intermittent swelling in submandibular triangle or angle of jaw during meal times
- Palpate to see if pus/saliva can be expressed from the parotid duct
Complication
- Sialadenitis: Purulent discharge from duct (Staph aureus, Strep viridans)
- Abscess formation
Where is the parotid duct opening located?
Opening of the parotid duct (Stenson’s) is located opposite the 2nd upper molar
Investigations to do in salivary gland tumour
- FNAC
- MRI to determine extent of tumour
- X-ray for stones
Management of parotid tumour
Tumour involves superficial lobe only: superficial parotidectomy
If benign tumour involves the facial nerve or deep lobe → total parotidectomy, with facial nerve preservation
Tumour involves deep lobe or facial nerve: total parotidectomy with radical lymph node dissection if nodes positive, adjuvant therapy
What is the structure that runs between the superficial and deep lobe of parotid gland?
Facial nerve
Branches of the facial nerve responsible for closing eyes and smiling?
Closing eyes: Zygomaticus nerve –> Orbicularis oculi
Smiling: Mandibular nerve –> Zygomatic major
Complications of parotidectomy
- Immediate/Intra-operative
- Early
- Late
Immediate/Intra-operative complications of parotidectomy
Facial nerve (CN VII) lesion –> LMN facial nerve palsy
Early complications of parotidectomy
- Neuropraxia of facial nerve due to traction injury –> Temporary facial weakness
- Division of great auricular nerve –> Loss of sensation over pinna
- Infection
- Hemorrhage/ Hematoma
Late complications of parotidectomy
- Facial synkinesis after facial nerve palsy
- Eye closure with contraction of mouth muscles
- Bogorad’s syndrome: hyperlacrimation provoked by eating - Frey’s syndrome
- Flushing/ erythema and sweating on cheek in preauricular area when patient eats or thinks about food - Parotid fistula
- If operation for pleomorphic adenoma → can recur due to incomplete excision as the tumour is not encapsulated
Management of parotid stones
Conservative
- Diet: Adequate hydration, soft diet, good oral hygiene
- Local therapy: Massage gland, milk duct, application of moist hot towel
- Analgesia: NSAIDs
- Abx if sialadenitis is present (Strep and Staph coverage)
Surgical
- REMOVAL OF STONE and marsupialization of duct
- Transoral removal of stones
- Partial gland resection
Purpose of palpating a parotid mass intra-orally
To determine involvement of deep parotid lobe
*whatever that can be felt externally involves superficial parotid lobe
What are the borders of the parotid gland?
· Anterior: Masseter
· Posterior: Sternocleidomastoid muscle (SCM)
· Superior: Zygomatic arch
· Inferior: Inferior border of the mandible
Besides facial nerve, what other nerve should be checked for?
Greater auricular nerve (sensation to ear lobe and angle of mandible)
Sialadenitis
- Painful swelling in submandibular △ / angle of jaw
I- ntermittent, fluctuant - Triggered by meals which cause production of secretions
RFs
Dehydration
Malnutrition
Poor oral hygiene
Recent major Sx
Sjogren’s disease
Radioiodine Tx
Direct trauma
