Podcast Beta
Questions and Answers
Which of the following is NOT a feature of malignancy associated with mixed malignant tumor/carcinoma ex-pleomorphic adenoma?
Malignant transformation is common in Warthin's tumor.
False
What is the most common parotid tumor?
Warthin's tumor
The most common salivary gland malignancy in children is __________.
Signup and view all the answers
Match the following tumors with their key characteristics:
Signup and view all the answers
What procedure is performed for Fine Needle Aspiration Cytology (FNAC)?
Signup and view all the answers
The half-life of 18-Fluorodeoxy glucose (18-FDG) is 110 minutes.
Signup and view all the answers
What condition is a dentigerous cyst commonly associated with?
Signup and view all the answers
The treatment for a dental cyst is the removal of the ______ tooth.
Signup and view all the answers
Match the cancer-related terms with their descriptions:
Signup and view all the answers
What is the primary duct associated with the parotid gland?
Signup and view all the answers
The superficial lobe of the parotid gland makes up approximately 80% of the gland.
Signup and view all the answers
Which imaging technique is used to identify salivary gland stones?
Signup and view all the answers
The accessory parotid gland may need removal during __________.
Signup and view all the answers
Match the following ducts with their corresponding salivary glands:
Signup and view all the answers
Which salivary gland tumors are most commonly benign?
Signup and view all the answers
The most common tumor of the parotid gland is malignant.
Signup and view all the answers
What are the two key investigations used for parotid tumors?
Signup and view all the answers
The benign tumor that is the most common in the parotid gland is called _____ ______________.
Signup and view all the answers
Match the following salivary glands with their most common tumor type:
Signup and view all the answers
What is the most common site for sialolithiasis?
Signup and view all the answers
Recurrent parotitis in childhood typically presents with a rapid swelling of both glands.
Signup and view all the answers
What is the common composition of salivary stones in sialolithiasis?
Signup and view all the answers
In recurrent parotitis, symptoms typically last for approximately ___ week before a quiescent period.
Signup and view all the answers
Match the treatment options for sialolithiasis with their appropriate usage:
Signup and view all the answers
What is the initial management for low-grade parotid tumors?
Signup and view all the answers
Adenoid cystic carcinoma commonly presents with pain due to perineural invasion.
Signup and view all the answers
What imaging techniques are used for investigating faciomaxillary surgery cases?
Signup and view all the answers
In managing high-grade tumors with an infiltrative margin, the treatment involves __________ and __________.
Signup and view all the answers
Match the following investigations to their corresponding findings or uses:
Signup and view all the answers
What is the common management approach for a plunging ranula?
Signup and view all the answers
Marsupialization is the preferred treatment for a ranula.
Signup and view all the answers
What imaging techniques are useful for investigating a plunging ranula?
Signup and view all the answers
The most common benign condition of minor salivary glands is a ______.
Signup and view all the answers
Match the following conditions with their characteristics:
Signup and view all the answers
Which of the following complications of neck dissection can lead to shoulder dysfunction?
Signup and view all the answers
The pectoralis major myocutaneous flap is the least common flap used for head and neck reconstruction surgery.
Signup and view all the answers
What is one potential consequence of a carotid artery blowout following a neck dissection?
Signup and view all the answers
In a neck dissection, level VI is removed during a __________.
Signup and view all the answers
Match the following nerves with their related complications or functions:
Signup and view all the answers
What is the main indication for using the radial artery forearm flap in surgery?
Signup and view all the answers
Neoadjuvant chemo-radiation is used to shrink advanced tumors before surgery.
Signup and view all the answers
What is the purpose of performing Allen's test before creating a forearm flap?
Signup and view all the answers
Extranodal extension and involved margins are major indications for __________.
Signup and view all the answers
Match the following treatment types with their descriptions:
Signup and view all the answers
What is the risk of malignancy associated with a diagnosis of AUS (Atypia of Undetermined Significance)?
Signup and view all the answers
The usual management for a benign neoplasm under the FNAC Milan system is surgery.
Signup and view all the answers
What condition is described as a mucus extravasation cyst involving the sublingual gland?
Signup and view all the answers
In the FNAC Milan system, non-diagnostic results are categorized as type ___ with a risk of malignancy at ___%.
Signup and view all the answers
Match the following salivary gland conditions with their descriptions:
Signup and view all the answers
Study Notes
Salivary Gland Management
- Superficial parotidectomy is used for managing mixed malignant tumors/Carcinoma ex-pleomorphic adenoma, Warthin's Tumor/Adenoma lymphomatosum.
- These tumors can be diagnosed via Fine Needle Aspiration Cytology (FNAC).
- Malignant transformation of Warthin's tumor occurs rarely.
- Radiotherapy is required after surgery for mixed malignant tumors/Carcinoma ex-pleomorphic adenoma.
Mucoepidermoid Carcinoma
- Most common salivary gland malignancy in children and young adults.
- Peak incidence occurs in the second decade of life.
- Risk factor: Radiation/Chemotherapy during childhood.
Miscellaneous
- Metastasis from Unknown Primary: Enlarged cervical lymph node, FNAC is performed.
- Cancer Investigation: Radiological examination and investigation are performed to identify the primary source of the tumor. The search for the primary source includes investigating specific areas such as the retromolar trigone, base of tongue, tonsillar fossa, fossa of Rosenmuller, and pyriform sinus.
PET-CT Analysis
- Positron Emission Tomography (PET-CT) is used to locate the primary tumor.
- 18-Fluorodeoxy glucose (18-FDG) is the isotope used for the scan and has a half-life of 110 minutes.
Cyst Analysis
- Dentigerous Cyst: A cyst associated with an unerupted tooth, most commonly the third molar. Treatment involves surgical removal (enucleation).
- Dental Cyst: A cyst associated with a carious (decayed) tooth. Treatment requires removal of the carious tooth.
Ameloblastoma
- A tumor of the mandible (jaw bone).
- Characterized by a bony hard swelling.
- Diagnosed through Orthopantomogram (OPG).
- Treatment involves wide local excision (WLE).
Anatomy
- Origin of Salivary Glands: Parotid - Ectodermal; Submandibular & Sublingual - Endodermal
- Ducts: Parotid - Stenson's duct opens opposite the crown of the upper second molar; Submandibular - Wharton's duct opens on either side of the frenulum.
- Lobes of Parotid Gland: Divided into superficial (20%) and deep (80%) lobes by a fasciovenous plane.
- Accessory Parotid Gland: Present in 21-61% of cases, may need removal during parotidectomy, potential complications include sialocele and fistula formation.
Investigations
- Imaging: CECT to differentiate inflammatory lesions from neoplasms, NCCT to identify salivary gland stones, MRI to differentiate benign from malignant lesions, High Resolution USG to guide FNAC.
Salivary Gland Tumors
- Larger glands: Benign tumors are more common.
- Smaller glands: Malignant tumors are more common.
Parotid Tumors: Features
- Swelling on the side of the face.
- Lifting of the ear lobule.
- Most frequent location: Superficial lobe.
- Pain due to capsule/fascia stretching.
- Deep lobe enlargement: Tonsillar fossa is pushed medially.
Parotid Tumors: Investigations
- CT/MRI
- Fine Needle Aspiration Cytology (FNAC)
Pleomorphic Adenoma
- Most common parotid gland tumor.
- Affects women in their 5th decade.
- Clinical features: Slow-growing parotid swelling, commonly involves the superficial lobe.
- Histopathology reveals epithelial/myoepithelial components in a myxoid background.
- IHC: CK7 shows strong and diffuse patterns, myoepithelial cells express p63, S-100, SOX10, SMA.
Management
- I&D using Hilton's method for abscess management, forceps are opened parallel to vital structures (Facial Nerve), transverse facial incision is used.
Recurrent Parotitis in Childhood
- Affects children aged 3-6 years, rapid swelling of one or both glands, aggravated by chewing and eating, symptoms last for a week followed by a quiescent period and recurrence, USG shows snowstorm appearance.
- Treatment: Long course of antibiotics and endoscopic washouts.
Sialolithiasis
- Stones in salivary glands, more common in submandibular gland due to antigravity drainage and viscous secretions.
- Composition: Ca(PO₄) (most common).
- Presentation: Post-prandial painful neck swelling.
- Investigation: NCCT (80% are radiopaque).
- Treatment: Endoscopic management for 5 mm distal stone, duct slitting, ESWL for non-palpable/non-visualized stone, gland excision as a last resort.
Faciomaxillary Surgery
- Clinical Features: Fast-growing parotid swelling, potential facial nerve involvement.
- Investigations: Imaging (CT/MRI), IOC: FNAC.
- Management:
- Low Grade: Parotidctomy
- Intermediate Grade (Infiltrative margin +): Surgery + Radiotherapy
- High Grade (Infiltrative margin +): Surgery + Radiotherapy
Adenoid Cystic Carcinoma
- Clinical Features: Parotid swelling, pain due to perineural invasion.
- Investigations: IOC: FNAC, HPE shows Swiss cheese pattern, IHC: Ductal cells - ckit (+), myoepithelial cells - p63 and SMA.
- Management: Surgery + Radiotherapy
Treatment Principles for Malignant Tumors
- Margin: 0.5 cm.
- T3/T4 tumors.
- High-grade tumors.
- Adjuvant RT: Stage 3 & 4 tumors, high-grade tumors, positive margins, PNI/LVI, extra-nodal spread.
- Elective SOHND.
Faciomaxillary Surgery (Management)
- Excision of Ranula: Along with the sublingual gland, structures injured: Submandibular duct, Lingual nerve, avoid incision & drainage, marsupialization is used.
- Plunging Ranula: High recurrence rate, clinical features: Intraoral + Neck swelling, investigation: Imaging (CT/MRI), FNAC, management: Excision of intraoral swelling & sublingual gland, aspirate neck swelling.
Benign Conditions of Minor Salivary Glands
- Mucus Retention Cyst: Most common, resolves spontaneously, no reduction, simple excision.
- Acute Necrotising Sialometaplasia: Mostly affects palate, swelling with central crater and rolled-out margins, biopsy is done to rule out cancer, heals in a few weeks.
Parotid Abscess
- Risk factors: Immunocompromised individuals (diabetics).
- Clinical features: Painful parotid swelling, excruciating pain, fever, inflammation, fluctuation (late sign), diagnosis: Clinical diagnosis/USG.
Oral Cancers
- Central Neck Dissection: Level VI removed.
Complications of Neck Dissection
- Bleeding, infection, Injury to nerves: Marginal mandibular nerve/ramus mandibularis (supplies the angle of the mouth), Spinal accessory nerve (shoulder dysfunction, drooping of the shoulder, pain), Hypoglossal nerve, Phrenic nerve, Carotid artery blowout.
FLAPS
- Pectoralis major myocutaneous flap: Most common flap used for head and neck reconstruction surgery, used for lip and angle of mouth reconstruction.
Free Flaps
- Flaps moved from one site to another, Allen's test is performed before creating a forearm flap, radial artery forearm flap is used in mandibular reconstruction for edentulous patients.
Adjuvant Therapy
- Chemotherapy/Radiotherapy: Indications: High-risk features - extra-nodal extension, lymphovascular invasion, perineural invasion, involved margins.
- Indications for Radiotherapy: Major - Extranodal extension & involved margins, Minor - Close margins, multiple involved nodes lymph node invasion, perineural invasion.
- Concurrent Chemo-radiation: Advantages - improved response to treatment, chemoagent acts as a radiosensitizer.
- Neoadjuvant Chemo-radiation: Chemotherapy/Radiotherapy given before surgery, indication: Advanced tumors - shrinks the tumor.
- Immunotherapy: PDL-1 Inhibitors, indication: Recurrent or metastatic Squamous Cell Carcinoma (SCC), lymph node status: Important prognostic factor.
FNAC Milan System for Salivary Gland Cytopathology
-
Diagnostic Criteria and Risk of Malignancy:
- I Non-diagnostic: 25% risk of malignancy, clinical and radiological correlation/Repeat FNAC under imaging guidance.
- II Non-neoplastic: 10% risk of malignancy, clinical follow-up and radiological correlation.
- III AUS (Atypia of Undetermined Significance): 20% risk of malignancy , repeat FNAC or surgery.
- IV Neoplasm:
- IV A Benign: 90% risk of malignancy, surgery (extent depends on type and grade of malignancy).
Benign Conditions
- Stafne Bone Cyst: Cyst in the mandible, most common site for ectopic salivary tissue.
- Ranula: Literal translation: Frog's belly, mucus extravasation cyst involving the sublingual gland, clinical features: Fluctuant swelling in the floor of the mouth, brightly transilluminant.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers the management of salivary gland tumors, including superficial parotidectomy for malignant tumors and the characteristics of mucoepidermoid carcinoma. It also addresses the diagnostic methods such as FNAC and the investigations required for cancer assessment. Test your understanding of these critical topics in salivary gland pathology.
