High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
Benign and malignat tumors of salivary gland
1. Neoplasms of salivary glands
Dr. Ramesh Parajuli, MS
Chitwan Medical College Teaching Hospital,
Chitwan, Nepal
2. • Major salivary glands: paired
1. Parotid
2. Submandibular
3. Sublingual
• Minor salivary glands: multiple,
submucosal, upper
aerodigestive tract eg. from
nasal cavity and lips down to
the esophagus and trachea
Salivary gland anatomy
5. Neoplams of salivary glands
• Tumors of salivary glands –
uncommon
• 3% to 6% of all tumors of head
& neck region
• Proportion of malignant and
benign varies with gland of
origin
• Larger the size of salivary
gland, more the chance of
tumor being benign
6. • Distribution
– Parotid: 80% overall; 80% benign (80% pleomorphic
adeoma) i.e. “Rule of 80”
– Submandibular: 15% overall; 50% benign
– Sublingual/Minor salivary gland: 5% overall; 40% benign
• Incidence of malignancy is higher in neoplasm of minor
salivary glands. i.e.
Parotid- 25%
Submandibular- 50%
Minor salivary gland- 75%
9. Pleomorphic adenoma(mixed tumor)
• Mixed tumor: contains both epithelial
and mesenchymal elements
• Most common benign tumor of
salivary glands
• Can arise from parotid,
submandibular
• Parotid: usually arises from its tail,
deep lobe
• Encapsulated
• Slow growing tumor
10. • Signs:
Swelling in front, below & behind ear
Raises ear lobule
Retromandibular groove is obliterated
• Any swelling which raises ear lobule is due to
parotid gland neoplasm unless proved otherwise
• It sends ‘pseudopods’ into surrounding gland
surgical excision of the tumor should include
normal tissue around it
• Superficial parotidectomy
11. Oncocytoma (oxyphil adenoma)
• Rare: 2.3% of benign salivary tumors
• 6th
decade
• Usually benign; malignant oncocytoma- less common
•
• Major salivary glands: Parotid,Submandibular gland
• Minor salivary glands: palate, buccal mucosa, tongue
• Superficial parotidectomy
12. Warthin’s tumor(adenolymphoma)
• Encapsulated
• Exclusively in parotid gland
• Parotid tail
• Commonly seen btw 5th
– 7th
decade
• Male: female (7:1)
• About 7% of salivary gland tumor
• Usually Fluctuant, slow growing
• 10% bilateral
• Histologically: epithelial & lymphoid
elements
• Never malignant
• Wide local excision
13. Hemangioma & lymphangioma
• Haemangioma: Most common benign tumors of
the parotid in children
• May involute spontaneously
• Soft, painless and increase in size with crying or
straining
• Surgical excision if do not regress
• Lymphangioma:
• Less common
• Soft, cystic on palpation
• Do not regress spontaneously surgical excision
15. Mucoepidermoid carcinoma
• Most common salivary gland malignancy
• Not encapsulated
• Commonly in parotid gland
Clinical features:
Slow growing
Facial nerve palsy
Presentation Low-grade: Slow growing, painless mass
High-grade: Rapidly enlarging, +/- pain
Treatment:
Total conservative parotidectomy
16. Adenoid cystic carcinoma(Cylindroma)
• 2nd
most common salivary gland
malignancy
• Slow growing
• Infiltrates widely into the tissue
planes & muscles
• Perineural spread
• Commonly in submandibular
gland, sublingual or minor salivary
glands
• Less commonly in parotid gland
• Occasionally lymph node
metastasis
• Local recurrence after surgical
excision(perineural and lymphatic
17. Treatment
• Radical parotidectomy
• Post-operative radiotherapy
• Wide local excision of palate: for tumors of
palate
Adenoid Cystic Carcinoma of right hard
palate
18. Carcinoma ex-pleomorphic adenoma
• Usually from pre-existing
pleomorphic adenoma
(only 1% arise ab-initio)
• Malignancy takes about
10 years to develop in an
adenoma
19. • Malignancy should be suspected when:-
-Rapid growth
-Facial nerve palsy
-Painful
-Skin infiltration
-Get fixed to massester muscletrismus
-Feels stony hard
-Presence of lymph nodes in neck
20. Adenocarcinoma & Squamous cell carcinoma
• Rare
• Highly aggressive
• Rapidly growing tumors
• Local and distant metastases
• Prognosis- very poor
• Squamous cell ca (SCC): Rule out metastasis in
the parotid gland from neighbouring skin cancer or
other head and neck tumor
22. Landmarks for facial nerve during parotid surgery
1.Tympano-mastoid suture:
6-8 mm deep to this suture
2.Groove between mastoid & bony
EAC: bisected by facial nerve
3.Tragal pointer: 1 cm anteroinfero-
medial is facial nerve
3.Styloid process: lateral lies facial
nerve
4.Posterior belly of digastric:
superior & parallel lies facial
nerve
23.
24. Complications of parotid surgery (5 F’s)
1. Flap necrosis: avoid acute bending(angle) of the
incision & use gentle retraction
2. Facial nerve palsy: nerve identification
3. Fluid collection: blood or seromadrain should be
kept
4. Fistula (salivary): duct should be ligated
5. Frey’s syndrome (gustatory sweating): in 10% cases
25. Frey’s syndrome
• Several months after parotid surgery
• Sweating and flushing of the preauricular skin during
mastication
• Auriculotemporal nerve provides both
-Parasympathetic innervation to Parotid gland
-Sympathetic innervation to Sweat glands & Subcutaneous
blood vessels
Neurotransmitter to both fibers: Acetylcholine
Frey’s syndrome is due to regrowth of parasympathetic
secretomotor fibers into distal cut ends of the sympathetic
fibers of skin
Whenever patients eats reflex salivation occurs, the skin
blood vessels dilate and sweat gland secretes