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Untitled Quiz
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Untitled Quiz

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Questions and Answers

What is the most common tumor of salivary glands?

  • Acinic cell carcinoma
  • Pleomorphic adenoma (correct)
  • Adenoid cystic carcinoma
  • Mucoepidermoid carcinoma

    • What is the characteristic of the capsule of pleomorphic adenoma?

  • It is not seen in pleomorphic adenoma
  • It is infiltrative and destroys surrounding tissues
  • It is complete and well-defined
  • It is incomplete and allows extension of the neoplastic epithelium (correct)

    • At what age does pleomorphic adenoma typically occur?

  • Fifth decade of life
  • Second decade of life
  • Third decade of life
  • Fourth decade of life (correct)

    • What is the distribution of pleomorphic adenoma between males and females?

    <p>Equal between males and females</p> Signup and view all the answers

    What is Warthin's tumor also known as?

    <p>Adenolymphoma</p> Signup and view all the answers

    Where is Warthin's tumor usually found?

    <p>Lower part of the parotid gland</p> Signup and view all the answers

    What is the growth rate of pleomorphic adenoma?

    <p>Slow and non-infiltrative</p> Signup and view all the answers

    What is the risk of pleomorphic adenoma turning into carcinoma?

    <p>Low and rare</p> Signup and view all the answers

    What is the presentation of carcinoma ex pleomorphic adenoma?

    <p>A painless swelling that has been stationary for years and is now getting bigger</p> Signup and view all the answers

    What is the impact of preserving the facial nerve during parotid surgery?

    <p>Facial nerve weakness commonly develops due to neurapraxia</p> Signup and view all the answers

    What is the most useful method for assessment of salivary neoplasms?

    <p>CT and MRI</p> Signup and view all the answers

    What is a contraindication for salivary gland tumors?

    <p>Open surgical biopsy</p> Signup and view all the answers

    What is the commonest cause of submandibular sialadenectomy?

    <p>Stone in the gland</p> Signup and view all the answers

    What is a unique feature of adenolymphoma and oncocytoma?

    <p>They show a hot spot on isotopic scanning</p> Signup and view all the answers

    During which procedure can 3 nerves be injured?

    <p>Submandibular sialadenectomy</p> Signup and view all the answers

    What is the goal of treatment for low-grade mucoepidermoid carcinoma?

    <p>Preserve the facial nerve</p> Signup and view all the answers

    How many minor salivary glands are found in the oral cavity?

    <p>600-1000</p> Signup and view all the answers

    What is the location of the parotid gland?

    <p>In front of and below the lower half of the ear</p> Signup and view all the answers

    What is the diameter of the parotid duct?

    <p>5 mm</p> Signup and view all the answers

    How many major salivary glands are there?

    <p>3</p> Signup and view all the answers

    During which weeks of gestation do the salivary glands develop?

    <p>6th-8th weeks</p> Signup and view all the answers

    What is the name of the duct that arises from the anterior border of the parotid?

    <p>Stensen's duct</p> Signup and view all the answers

    What is unique about the parotid gland among the major salivary glands?

    <p>It is the last to become encapsulated</p> Signup and view all the answers

    What is the location of the parotid fascia?

    <p>Within the investing layer of the deep fascia of the neck</p> Signup and view all the answers

    What is a characteristic of a parotid salivary fistula?

    <p>Increased salivary discharge by meals and sucking of a lemon</p> Signup and view all the answers

    What is the primary goal of using atrropine derivatives in parotid gland fistula treatment?

    <p>To decrease salivation</p> Signup and view all the answers

    What is a possible complication of avulsion of the auriculotemporal nerve in parotid gland fistula treatment?

    <p>Atrophy</p> Signup and view all the answers

    What is the percentage of salivary neoplasms that are benign?

    <p>80%</p> Signup and view all the answers

    What is the percentage of parotid neoplasms that are malignant?

    <p>25%</p> Signup and view all the answers

    What is the percentage of sublingual and minor salivary glands neoplasms that are malignant?

    <p>70%</p> Signup and view all the answers

    What is the percentage of salivary neoplasms that arise in the parotid gland?

    <p>80%</p> Signup and view all the answers

    What is the primary location of parotid gland fistula in relation to the gland?

    <p>Lower pole</p> Signup and view all the answers

    Where is the parotid duct located in relation to the arch?

    <p>1.5 cm inferior to the inferior margin</p> Signup and view all the answers

    What is the direction of the parotid duct after it runs superficial to the masseter muscle?

    <p>It turns medially to pierce the buccinator muscle</p> Signup and view all the answers

    What nerve runs with the parotid duct?

    <p>Facial nerve</p> Signup and view all the answers

    What is the surface anatomy of the parotid duct opening?

    <p>Middle 1/3 of a line extending from the tragus of the ear to the midpoint of the ala of the nose and angle of mouth</p> Signup and view all the answers

    What structure is the deepest in the parotid gland?

    <p>External carotid artery</p> Signup and view all the answers

    What divides the parotid gland into major superficial and small deep lobes?

    <p>Facial nerve</p> Signup and view all the answers

    What nerve supplies secretomotor fibers to the parotid gland?

    <p>Glossopharyngeal nerve</p> Signup and view all the answers

    What structures are revealed after complete removal of the parotid gland?

    <p>VANS (vein, artery, nerves, and styloid structures)</p> Signup and view all the answers

    Study Notes

    Salivary Glands

    • There are two main types of salivary glands: major and minor.
      • Major salivary glands: parotid, submandibular, and sublingual.
      • Minor salivary glands: multiple scattered glands (around 600-1000) located in the submucosa of the oral cavity, hard and soft palate, nasal cavity, nasal and paranasal sinuses, pharynx, and larynx.

    Embryology

    • Salivary glands develop between the 6th and 8th weeks of gestation.
    • The parotid gland is the first to develop and grows in a posterior direction, surrounding the facial nerve.
    • The parotid gland is the last to become encapsulated, after the lymphatics develop, resulting in entrapment of lymphatics in the parenchyma of the gland.

    Anatomy of Parotid Gland

    • Location: in front of and below the lower half of the ear, wrapped around the vertical ramus of the mandible, and projecting forward on the surface of the masseter.
    • The gland can only be felt in pathological conditions.
    • The parotid duct (Stensen's duct) arises from the anterior border of the parotid gland and parallels the zygomatic arch.
    • The duct measures 5 cm in length and 5 mm in diameter, and opens into the oral cavity at the level of the second maxillary molar teeth.

    Surface Anatomy of Parotid Duct Opening

    • Located at the level of the second maxillary molar teeth, where the duct opens into the oral cavity.

    Structures Within the Parotid Gland

    • External carotid artery and its two terminal branches (maxillary and superficial temporal arteries).
    • Retromandibular (posterior facial) vein.
    • The facial nerve and its branches.
    • Parotid lymph nodes are embedded in the gland beneath the parotid fascia.

    Relations of Parotid Gland

    • Nerve supply: secretomotor fibers are originally supplied by the glossopharyngeal nerve and reach the gland through the auriculotemporal branch of the trigeminal nerve.

    Parotid Salivary Fistula

    • May be connected to the duct or gland.
    • Fistula related to the gland is usually related to the lower pole of the parotid.
    • Salivary discharge is increased by meals and sucking of a lemon.

    Treatment of Parotid Salivary Fistula

    • Treatment options include:
      • Atropine derivatives to decrease salivation.
      • Irradiation needle inside the fistula to cause fibrosis.
      • Avulsion of the auriculotemporal nerve to cause atrophy.
      • Excision of the fistula with the lower part of the gland and closure of the fascia.
      • Conservative superficial parotidectomy may be done.

    Types and Treatment of Parotid Duct Fistula

    • Treatment options include:
      • Excision and end-to-end anastomosis.
      • Slitting the opening of the duct proximal to the site of the fistula.
      • Reimplantation of the fistulous opening to the inner side of the cheek.
      • If the fistula affects the distal 2 cm of the duct, a rectangular pedicle flap of mucosa from the inner aspect of the cheek is used.
      • If the above options fail, superficial parotidectomy may be done.

    Salivary Neoplasms

    • Incidence: 1.2% of all neoplasms and 5% of head and neck tumors.
    • The majority of salivary neoplasms are benign and most commonly arise in the parotid gland.
    • The incidence of malignancy varies inversely with the size of the gland.

    Classification of Salivary Neoplasms

    • Benign:
      • Pleomorphic adenoma (mixed salivary tumor).
      • Monomorphic adenoma.
      • Warthin's tumor (adenolymphoma).
      • Oncocytoma (oxyphil adenoma).
    • Malignant:
      • Mucoepidermoid carcinoma.
      • Adenoid cystic carcinoma (cylindroma).
      • Acinic cell carcinoma.
      • Adenocarcinoma.
      • Carcinoma ex pleomorphic adenoma.
      • Epidermoid carcinoma (squamous cell carcinoma).
      • Lymphoma.

    Pathology of Benign Salivary Neoplasms

    • Pleomorphic adenoma:
      • The commonest tumor of salivary glands.
      • Represent 75% of parotid and 50% of submandibular gland neoplasms.
      • Distribution is equal between males and females.
      • It occurs in the fourth decade of life, but any age and sex may be affected.
      • Pathology: epithelial, myoepithelial, and stromal components with wide variations in cellular and architectural morphology.
      • The tumor is characterized by an incomplete capsule that allows extension of the neoplastic epithelium into the surrounding tissues.
    • Warthin's tumor:
      • Is usually found in the lower part of the parotid gland.
      • The classical signs of facial palsy or lymph node enlargement occur with advanced disease.

    Notes

    • Salivary neoplasms:
      • Carcinoma ex pleomorphic adenoma presents as a painless swelling that has been stationary for years and is now getting bigger.
      • Pleomorphic adenoma of the parotid raises the lobule of the ear and does not affect the facial nerve.
      • Open surgical biopsy of the major salivary glands is contraindicated; FNAC is safer.
      • For tumors of the minor salivary glands of the mouth cavity, excision biopsy is feasible.
      • CT and MRI are the most useful methods for assessment.
      • Even if the facial nerve is preserved in parotid surgery, nerve weakness commonly develops because of neurapraxia that recovers spontaneously a few months after the operation.
      • The majority of tumors that arise in the parotid gland are superficial to the facial nerve.
      • During submandibular sialadenectomy, 3 nerves can be injured (mandibular division of facial N, lingual, and hypoglossal nerves).
      • The commonest cause of submandibular sialadenectomy is a stone in it.
      • For low-grade mucoepidermoid carcinoma, an attempt to preserve the facial nerve is warranted.
      • For tumors that are clinically malignant, treatment is modified according to the aggressiveness of the tumor.

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