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Questions and Answers
What is a common clinical presentation of a salivary gland tumor involving the deep lobe?
Which diagnostic tool is expressly important for salivary gland tumors and can provide definitive diagnosis?
Which statement correctly distinguishes between benign and malignant tumors in the context of salivary gland tumors?
What surgical approach is recommended when both superficial and deep lobes of the parotid gland are involved?
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What is a significant complication associated with salivary gland tumors, specifically regarding recurrence?
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What is the typical clinical presentation of a salivary gland stone?
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What is a common complication associated with the surgical treatment of salivary gland issues?
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Which investigation is primarily used to diagnose salivary gland issues?
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Which treatment approach can be taken if a salivary stone is located in the duct?
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Which type of fistula from the parotid gland is likely to show only minimal discharge?
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Study Notes
Parotid Gland Tumours
- Parotid gland tumours can involve the superficial lobe, the deep lobe, or both.
- Deep lobe involvement can present as swelling in the lateral wall of the pharynx or the soft palate.
- Parotid tumours can recur in 5-50% of cases.
- Malignancy in parotid tumours can occur in 10% of cases with a duration of 15 or more years.
Parotid Gland Tumour Investigations
- Fine Needle Aspiration Cytology (FNAC) is the primary diagnostic tool for parotid tumours.
- CT scan and MRI are used to assess deep lobe involvement, local extension, and spread.
- Incision biopsy of parotid tumours is contraindicated due to the high risk of seeding and recurrence.
Parotid Gland Tumour Treatment
- Superficial parotidectomy is the surgical treatment for superficial lobe involvement.
- Total conservative parotidectomy is performed for involvement of both lobes.
- Enucleation is avoided due to a high recurrence rate.
Adenolymphoma (Warthin’s Tumour, Papillary Cystadenolymphomatosum)
- Adenolymphoma is a benign tumour that occurs exclusively in the parotid gland.
- It is most commonly found in the lower pole of the parotid gland.
- Adenolymphoma occurs in a 1:1 male to female ratio and can occur at any age.
- It can be associated with Sjogren's syndrome and occupations that require chronic increase in intraoral pressure.
- It presents as a painless, smooth, soft, fluctuant, non-transilluminating swelling that increases in size during mastication.
Adenolymphoma Investigations
- Sialography is diagnostic and shows grape-cluster-like dilatations.
- Adenolymphoma shows a “hot spot” in a 99Technetium scan.
Adenolymphoma Treatment
- Treatment for adenolymphoma is mainly conservative.
- Excision of the gland is done in complicated cases.
Submandibular Salivary Gland Tumours
- FNAC is used for diagnosis of submandibular salivary gland tumours.
- Adenolymphoma does not transform into malignancy.
Parotid Fistula
- Parotid fistula can arise from the parotid gland, duct, or ductules.
- It can be internal or external.
- Parotid fistula can be caused by tumours, stones, drainage of parotid abscess, rupture of parotid abscess, superficial parotidectomy, biopsy, or trauma.
- Fistula from the duct has profuse discharge.
- Fistula from the gland often shows only minimal discharge.
Sialosis
- Sialosis is a condition thought to be due to trapping of jugular lymph sacs in the parotid gland during development.
- It is composed of double layers of columnar epithelium with papillary projections into cystic spaces with lymphoid tissues in the stroma.
- It affects 10% of the population and 10% are bilateral.
- It is more common in males (4:1) and in older individuals over 60 years old.
- Sialosis usually involves only the superficial lobe, but it can also be multicentric.
Sialosis Clinical Features
- Sialosis presents as a slow-growing, smooth, soft, cystic, fluctuant swelling in the lower pole of the gland, often bilateral, and is non-tender.
- It can involve the skin and lead to ulceration.
- It may involve the masseter muscle.
- Sialosis may cause lower facial nerve palsy.
- It can involve neck lymph nodes.
Pleomorphic Adenoma
- Long-standing pleomorphic adenomas have a risk of transforming into carcinoma (carcinoma in situ pleomorphic adenoma).
Pleomorphic Adenoma Clinical Features
- Pleomorphic adenomas may increase in size recently.
- Patients may experience pain and nodularity.
- It can involve the masseter muscle.
- It may cause lower facial nerve palsy.
- It can involve the skin, resulting in ulceration.
- It can involve neck lymph nodes.
Submandibular Salivary Gland
- The rule of 2 applies to submandibular salivary gland surgery:
- Incision should be 2-4 cm below the mandible.
- Facial artery ligation should be performed in 2 places.
- There are 2 superficial nerves: cervical and mandibular branch of facial nerves.
- There are 2 deep nerves: lingual and hypoglossal nerves.
Submandibular Salivary Gland Surgery Complications
- Haemorrhage
- Infection
- Injury to marginal mandibular nerve, lingual nerve, and hypoglossal nerves.
- Anaesthesia over submental skin due to injury to the nerve to mylohyoid.
- Fistula
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Description
This quiz covers essential information about parotid gland tumours, including types, investigations, and treatment options. Understand the implications of superficial and deep lobe involvement, as well as the diagnostic tools used. Learn about the surgical approaches and various characteristics of these tumours.
