Salivary Gland Tumours
These diagrams and illustrations have been designed to help you learn, memorise and recall key information.
HISTORY
Lump? - Tumours typically present as a localised painless lump +/- fixity.
Age - Parotid tumours are more common in adults but can occur in children
Pain - Associated with:- Maligancy, Infection, Inflammation or Stones.
Growth - Rapid growth suggests carcinoma.
Facial n. - Involvement is a strong indicator of malignancy.
Bleeding - From the duct is a strong indicator of malignancy.
DIFFERENTIAL
All pre-auricular masses are considered parotid in origin until proven otherwise.
BENIGN CAUSES OF A LUMP
Sebaceous cyst (punctum), Lipoma, Nerve, Fibroma
Sialolithiasis (salivary stones) - whole gland is usually swollen. Relates to eating.
Autoimmune conditions (eg Sjogren’s or Lymphoma) - Lymphadenopathy?
Sarcoidosis (can present with nerve palsy)
Infection:- TB
Benign Parotid Tumour :- Pleomorphic Adenoma, Warthins Tumour, Oncocytoma
MALIGNANT CAUSES OF A LUMP
Secondary (more common) e.g. Melanoma, SCC, Lymphoma
Primary (less common)
- Adenoid Cystic (aggressive)
- Mucoepidermoid
- Mixed malignant tumour
- Adenocarcinoma
- Acinic cell carcinoma
EXAMINATION
Examining the Lump
Need gloves and a tongue depressor. Examine intra-orally and bimanually.
If the tumour is involving the deep lobe there will be swelling in the oropharnx!
- This means trouble!
Check the duct.
General H&N exam
Facial Nerve & Ext. auditory meatus + LNs + Scalp
INVESTIGATIONS
Biopsy?
FNA +/- US-guided If FNA is non diagnostic this rings alarm bells for malignancy
Parotid - often not necessary if pleomorphic adenoma is suspected.
Minor slaivary glands - biopsy is frequently necessary.
IMAGING
“Cross-sectional imaging” i.e. CT / MRI with gadolinium contrast (Head; Neck & Chest).
Sialography.
SURGERY
Need hypotension and no paralysis - to monitor facial nerve
Limited superficial parotidectomy - remove tumour + cuff of normal tissue (for benign dis.).
Formal superficial parotidectomy - for malignant disease confined to this area.
Total parotidectomy - for T3 tumors or those in the deep lobe.
Facial nerve can sometimes be preserved if not involved (this may involve splitting the tumor).
If the pathology is uncertain sup. parotidectomy is sometimes an option with frozen section.
If this is positive it is then possible to proceed to a total parotidectomy.
Blair incision is used. Facial nerve can be identified ...
A) Antegrade - Facial n. is 1cm deep to the tragal pointer (in triangle formed by diagastric & SCM).
B) Retrograde - via subcutaneous dissection over the parotid. Incise SMAS.
H&N surgeon tends to go for the cervical & MM branches (easy to find)
Facial palsy surgeon tends to go for the buccal branch.
RISKS OF SURGERY
Infection, Bleeding & Haematoma and Scars.
Nerve Injury - Facial palsy, Numb Ear (Great auricular n.), Frey’s syn (treat with botox).
Salivary Fistula.
Recurrence.
RADIOTHERAPY
For malignant tumours (or benign tumours that are incomplete or if capsule is breached).
LND
For any node-positive neck.
CHEMOTHERAPY
Adjuvant chemotherapy is sometimes effective
PROGNOSIS
Poor with high grade, elderly, nerve involvement, pain and local invasion.
