Tumors of the Parotid Gland - How to Manage
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Tumors of the Parotid GlandHow to Manage
Reynaldo O. Joson, MD, MSc Surg
April 18, 2014
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Tumors of the Parotid GlandHow to Manage
Managing tumors of the parotid gland will always be a challenge!
Inexactness of medicine as a scienceNo two patients are the same
No two physicians are the same
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Tumors of the Parotid GlandHow to Manage
Managing tumors of the parotid gland will always be a challenge!
toPrimary Health Care Physicians
General Surgeons – Head and Neck SurgeonsOther Head and Neck Surgeons and Specialists
PathologistsRadiologists
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Tumors of the Parotid GlandHow to Manage
Managing tumors of the parotid gland will always be a challenge!
toPrimary Health Care Physicians
•Know how to recognize tumors and refer to Head and Neck Specialist•Know how to recognize mump-parotitis and manage with analgesics and watchful waiting
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Tumors of the Parotid GlandHow to Manage
Managing tumors of the parotid gland will always be a challenge!
ToRadiologists
•Know how to detect tumors on imaging procedures and determine extent or boundary in the head and neck area•Know how to describe lesions with utmost clarity without making more unnecessary comments such as pathologic diagnosis and need for additional tests and follow-up
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Tumors of the Parotid GlandHow to Manage
Managing tumors of the parotid gland will always be a challenge!
ToPathologists
•Know how to determine the pathology with utmost accuracy – malignant, nonmalignant, inflammatory disorders and specific type•Know how to describe the grading of malignant tumors with utmost accuracy
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Tumors of the Parotid GlandHow to Manage
Managing tumors of the parotid gland will always be a challenge!
to General Surgeons – Head and Neck Surgeons
Other Head and Neck Surgeons and Specialists
Greatest Challenge Clinician – Diagnostician – Therapist - Adviser
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• Presence of an unusual bulge in the periauricular area - start of suspicion of a parotid tumor
• Determine whether the bulge is normal or abnormal (whether a swelling or mass). (see more notes)
• Determine the organ or tissue of origin of the swelling or mass – parotid or other. (see more notes)
• If parotid in origin, determine the disorder and disease and extent. (see more notes)
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• Presence of an unusual bulge in the periauricular area - start of suspicion of a parotid tumor
• Determine whether the bulge is normal or abnormal (whether a swelling or mass). • A more prominent ipsilateral part of the jaw,
muscle, or soft tissue in the periauricular area may be unusual but still considered as normal.
• If bulge is abnormal, is there a dominant mass that causes the bulge? If none, then consider swelling.
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• Presence of an unusual abnormal bulge in the periauricular area - start of suspicion of a parotid tumor
• Determine the organ or tissue of origin of the swelling or mass – parotid or other. • Assess for probability of other organ or tissue
before settling for parotid
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis• Determine the organ or tissue of origin of the swelling
or mass – parotid or other. • Assess for probability of other organ or tissue
before settling for parotid• Skin tumor – at skin level• Bony tumor – bony hard• Lymph node – presence of inciting source (naso-
oropharynx, mouth, face, scalp, others)• Soft tissue tumor – more superficial than
parotid with telltale pattern recognition for common tumors like epidermal cyst and lipoma
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• If parotid in origin, determine the disorder and disease and extent. • Use pattern recognition and prevalence processes
for diagnosis of disorder and disease• Use physical signs and symptoms for extent of
disease such as fixation and cervical lymph nodes
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• Use pattern recognition and prevalence processes for diagnosis of disorder and disease
PATTERN RECOGNITION-realization that the patient’s presentation conforms to a previously learned picture or pattern of disease
PREVALENCE- choice of a diagnosis is based on the frequency of occurrence of the disease in a certain locality, in a certain age and sex group, and in the affected organ and system
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Tumors of the Parotid GlandHow to Manage
Clinical DiagnosisPattern Recognition
Parotitis, acuteParotitis, chronicParotid abscessParotid hemangioma / lymphangiomaParotid cystParotid mass, benign pleomorphic adenomaParotid mass, Warthins’ tumor, papillary cystadenoma
lymphomatosumParotid cancerParotid lymphomaothers
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• If parotid in origin, determine the disorder and disease and extent. • Use pattern recognition and prevalence processes
for diagnosis of disorder and disease• Look for pattern for inflammatory tumors –
swelling with no dominant mass, pus, erythema, severe tenderness (parotitis, parotid abscess)
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• If parotid in origin, determine the disorder and disease and extent. • Use pattern recognition and prevalence processes
for diagnosis of disorder and disease• If no pattern for inflammatory tumors, look for
pattern for malignant tumors – fixation, cervical lymph nodes, facial nerve paralysis, ill-defined border of parotid mass, extremely hard in consistency.
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis
• If parotid in origin, determine the disorder and disease and extent. • Use pattern recognition and prevalence processes
for diagnosis of disorder and disease• If no pattern for malignant tumors, settle for
nonmalignant or benign tumors (especially so if the tumor feels cystic – parotid cyst)
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Tumors of the Parotid GlandHow to Manage
Clinical Diagnosis• If parotid in origin, determine the disorder and disease
and extent. • Use pattern recognition and prevalence processes for
diagnosis of disorder and disease• After determining the most probable disorder,
determine the specific disease if possible.• Examples: • Parotitis, right• Parotid abscess, left• Parotid cyst, right• Parotid tumor, left, benign pleomorphic adenoma• Parotid tumor, left, malignant with neck mets
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Tumors of the Parotid GlandHow to Manage
Clinical DiagnosisAfter using the clinical diagnostic process, come out with
primary and secondary clinical diagnoses.
Examples:Primary: Parotid tumor, right, parotid abscessSecondary: Parotid tumor, right, malignant
Primary: Parotid tumor, left, benign, pleomorphic adenomaSecondary: Parotid tumor, left, malignant
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Tumors of the Parotid GlandHow to Manage
Clinical DiagnosisAfter using the clinical diagnostic process, come out with
primary and secondary clinical diagnoses.
Examples:Primary: Parotid tumor, left, benign, pleomorphic adenomaSecondary: Soft tissue mass, preauricular, left, lipoma
Primary: Parotid tumor, left, benign, pleomorphic adenomaSecondary: Lymph node, preauricular, left, metastatic from
nasopharyngeal ca
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Tumors of the Parotid GlandHow to Manage
Clinical DiagnosisAfter using the clinical diagnostic process, come out with
primary and secondary clinical diagnoses and then quantitate certainty (certain: ≥ 90%; not certain < 90%)
Examples:Primary: Parotid tumor, left, benign, pleomorphic adenoma
(90%)Secondary: Soft tissue mass, preauricular, left, lipoma
(10%)
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Tumors of the Parotid GlandHow to Manage
Clinical DiagnosisAfter using the clinical diagnostic process, come out with
primary and secondary clinical diagnoses and then quantitate certainty (certain: ≥ 90%; not certain < 90%)
Examples:Primary: Parotid tumor, left, benign, pleomorphic adenoma
(90%)Secondary: Parotid tumor, left, malignant (10%)
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Tumors of the Parotid GlandHow to Manage
Clinical DiagnosisAfter using the clinical diagnostic process and coming with
primary and secondary clinical diagnoses with degree of certainty,
ADVISE patient and relative on the
clinical diagnoses with bases and degree of certainty.
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Tumors of the Parotid GlandHow to Manage
Paraclinical Diagnosis
Diagnosis derived after the clinical diagnosis with the use of paraclinical diagnostic procedures.
Decision-making:• Indication• Selection• Interpretation
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Paraclinical Diagnostic Process - Indication
PROCESSING OF DATA
CERTAINTY OF CLINICAL Dx 1O Dx 60% 99%
needed not needed
TREATMENT PLAN FOR 1O & 2O DxDifferent Sameneeded not needed
Tumors of the Parotid GlandHow to Manage
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Tumors of the Parotid GlandHow to Manage
Paraclinical Diagnosis
After analyzing on need or no need for paraclinical diagnostic procedure,
ADVISE patient and relative on recommendation and bases and
SECURE an informed consent.
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Paraclinical Diagnostic Process - SelectionSELECTION PROCESS
Options Benefit Risk Cost Availability123
Tumors of the Parotid GlandHow to Manage
OBJECTIVES: Increase degree of certainty of diagnosis and extent
OUTPUT EXPECTEDMOST COST-EFFECTIVE DIAGNOSTIC PROCEDURE (with room
for “initial” testing and respect for patient’s concerns)
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Paraclinical Diagnostic Process - Selection
SELECTION PROCESS
Options Benefit Risk Cost Availability1- Watchful monitoring2- Needle Evaluation + Biopsy3- Open Biopsy4- Frozen-section Biopsy5- Ultrasound6- X-ray7-Sialography8- CT Scan9- MRI
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Paraclinical Diagnostic Process - Selection
Tumors of the Parotid GlandHow to Manage
Objective: To increase the degree of certainty of diagnosis.Parotid Tumor, benign vs malignant
Benefit Risk Cost* Availability**
Type of exam
Potential Info Info Yield
Watchful monitoring
Indirect exam
Course and behavior of mass
99% Time lag (years) Consult feeP600
RA
Needle evaluation + biopsy
Direct exam
Gross character and biopsy (benign vs malignant)
90% Pain, infection, seeding
Procedure Expense P6T
RA
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Paraclinical Diagnostic Process - Selection
Tumors of the Parotid GlandHow to Manage
Objective: To increase the degree of certainty of diagnosis.Parotid Tumor, benign vs malignant
Benefit Risk Cost* Availability**
Type of exam
Potential Info Info Yield
Needle evaluation + biopsy
Direct exam
Gross character and biopsy (benign vs malignant)
90% Pain, infection, seeding
Procedure Expense P6T
RA
Open biopsy(non-frozen)
Direct exam
Gross character and biopsy (benign vs malignant)
98% Scar,pain, infection, seeding
P15T RA
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Paraclinical Diagnostic Process - Selection
Tumors of the Parotid GlandHow to Manage
Objective: To increase the degree of certainty of diagnosis.Parotid Tumor, benign vs malignant
Benefit Risk Cost* Availability**
Type of exam
Potential Info Info Yield
Open biopsy(non-frozen)
Direct exam
Gross character and biopsy (benign vs malignant)
98% Scar,pain, infection, seeding
P15T RA
Frozen biopsy
Direct exam
Gross character and biopsy (benign vs malignant)
98% Scar,pain, infection, seeding
P30T(lab, anesthesia, operating room)
RA
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Paraclinical Diagnostic Process - Selection
Tumors of the Parotid GlandHow to Manage
Objective: To increase the degree of certainty of diagnosis.Parotid Tumor, benign vs malignant
Benefit Risk Cost* Availability**Type of exam
Potential Info Info Yield
X-ray Indirect exam-
Calcification- stone
1% Radiation P300 RA
Sialography Indirect exam
Stone; obstructed duct
1% Radiation, pain P9TNRA
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Paraclinical Diagnostic Process - Selection
Tumors of the Parotid GlandHow to Manage
Objective: To increase the degree of certainty of diagnosis.Parotid Tumor, benign vs malignant
Benefit Risk Cost* Availability**Type of exam
Potential Info Info Yield
Ultrasound Indirect exam
Cystic – benignIll-bordered solid - malignant
60% Necrosis P2T RA
CT Scan Indirect exam
Border and extent
70% Radiation, dye reaction, if usedclaustrophobia
P10T RA
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Paraclinical Diagnostic Process - Selection
Tumors of the Parotid GlandHow to Manage
Objective: To increase the degree of certainty of diagnosis.Parotid Tumor, benign vs malignant
Benefit Risk Cost* Availability**Type of exam
Potential Info Info Yield
CT Scan Indirect exam
Border and extent
70% Radiation, dye reaction, if usedclaustrophobia
P10T RA
MRI Indirect exam
Border and extent
80% Side effect of magnet Dye reaction
P15T RA
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryWatchful monitoring
•If suspicion for malignancy is low – below 10%•If there is patient’s informed refusal for other diagnostic procedures
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryNeedle Evaluation + Biopsy
•If a parotid cyst is probable and can be treated with needle aspiration•If total parotidectomy has to be done if mass turns out to be malignant
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryOpen Biopsy
•If there is a need for a definitive histologic diagnosis
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryFrozen-section Biopsy
•If there is a need for a definitive intraop histologic diagnosis•If there is a patient’s informed refusal for a preop needle and open biopsy (non-frozen) – such as fear of pain of the procedure and willing to pay higher cost of frozen-biopsy
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryX-ray
•If sialolithiasis is suspected•If there is a need to assess involvement of the adjacent bone structure by the parotid mass with a procedure of lesser expense compared to CT Scan and MRI
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisorySialography
•If sialolithiasis is suspected•If there is a need to assess the ductal system of the parotid gland
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryUltrasound
•If the organ or tissue of origin of the periauricular mass is uncertain•If there is a need to have an imaging evaluation of the parotid mass to increase degree of certainty of clinical diagnosis without having to do preop biopsy and also to have an idea of the depth and extent of the mass
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryCT-Scan
•If there is a need for highly refined information compared to those that will be gotten from ultrasound to assist in assessment of resectability and extent of resection to be done•
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process – Selection
Indication AdvisoryMRI
•If there is a need for highly refined information compared to those that will be gotten from ultrasound and CT Scan to assist in assessment of resectability and extent of resection to be done
Tumors of the Parotid GlandHow to Manage
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Paraclinical Diagnostic Process - SelectionSELECTION PROCESS
Options Benefit Risk Cost Availability123
Tumors of the Parotid GlandHow to Manage
OBJECTIVES: Increase degree of certainty of diagnosis and extent
OUTPUT EXPECTEDMOST COST-EFFECTIVE DIAGNOSTIC PROCEDURE (with room
for “initial” testing and respect for patient’s concerns)
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Tumors of the Parotid GlandHow to Manage
Paraclinical Diagnosis
After analyzing the BRCA for the options on paraclinical diagnostic procedure,
ADVISE patient and relative on recommendation and bases and
SECURE an informed consent.
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Paraclinical Diagnostic Process - Interpretation
DATA NEEDED
PRIMARY CLINICAL DIAGNOSISSECONDARY CLINICAL DIAGNOSIS
RESULT OF PARACLINICAL DIAGNOSTIC PROCEDURE
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Paraclinical Diagnostic Process - Interpretation
INTERPRETATION PROCESS
CORRELATE RESULT OF PARACLINICAL DIAGNOSTIC PROCEDURE
WITH PRIMARY AND SECONDARY CLINICAL DIAGNOSIS
CONGRUENT - ACCEPTINCONGRUENT - MAKE A DECISION!
(Accept or Hold!)
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Paraclinical Diagnostic Process - InterpretationINTERPRETATION PROCESS
INCONGRUENT - MAKE A DECISION!(Accept or Hold!)
Tumors of the Parotid GlandHow to Manage
HOLD Advisory:
•Paraclinical diagnosis is a clinical diagnosis least considered.•Paraclinical diagnosis does not jibe with the clinical picture or diagnosis.
Possible Actions: Discuss with physician-diagnostician; Discuss with patient; Repeat test; Go to higher-level test.
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Tumors of the Parotid GlandHow to Manage
Paraclinical Diagnosis
After interpreting the result of the paraclinical diagnostic procedure and correlating with clinical diagnoses,
ADVISE patient and relative on
PRETREATMENT DIAGNOSIS (if available already) or
recommendation for another paraclinical diagnostic procedure and bases and
SECURE an informed consent.
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Treatment Process - Selection
DATA NEEDED
PRETREATMENT DIAGNOSISSEVERITY OR STAGE
GOALS AND OBJECTIVESTREATMENT OPTIONS
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Treatment Process - Selection
SELECTION PROCESS
Options Benefit Risk Cost Availability123
Tumors of the Parotid GlandHow to Manage
OBJECTIVE: To resolve the patient’s health problem
OUTPUT EXPECTEDMOST COST-EFFECTIVE TREATMENT PROCEDUREACHIEVEMENT OF GOALS OF PATIENT MANAGEMENT!
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MANAGEMENT OF A PATIENTPROBLEM-SOLVING AND DECISION-MAKING
GOALS
RESOLUTION OF HEALTH PROBLEM
LIVE PATIENT
NO COMPLICATION
NO DISABILITY
SATISFIED PATIENT
NO MEDICOLEGAL SUIT
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Treatment Process - Selection
SELECTION PROCESS
Treatment Benefit Risk Cost (PhP) AvailabilityOptions
1 most effective acceptable 2000 available2 effectivity <1 >3 acceptable 3000 available3 least effective acceptable 4000 available
Which is the most cost-effective treatment option?
Option 1
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Treatment Process - Selection
SELECTION PROCESS Treatment Benefit Risk Cost (PhP) AvailabilityOptions
1 as effective as 2 acceptable 8000 available2 as effective as 1 acceptable 4000 available
Which is the more cost-effective treatment option?
Option 2
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Treatment Process - Selection
SELECTION PROCESS Treatment Benefit Risk Cost (PhP) AvailabilityOptions
1 as effective as 2 more complication 8000 available2 as effective as 1 acceptable 4000 available
Which is the more cost-effective treatment option?
Option 2
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotitis, acuteParotitis, chronicParotid abscessParotid hemangioma / lymphangiomaParotid cystParotid mass, benign pleomorphic adenomaParotid mass, Warthins’ tumor, papillary cystadenoma
lymphomatosumParotid cancerParotid lymphomaothers
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotitis, acuteViral – mumps
NO antibiotics neededSymptomatic treatment
Non-pharmacologic – warm compress for pain; sponge bath for fever; etc.
Pharmacologic prn – analgesics; antipyreticsSoft diet if there is pain on chewing Rest and watchful waiting for spontaneous recovery from infection
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotitis, acuteBacterial
Antibiotics (BRCA) – Gram (+) and Gram (-) microbesInvestigate and remove cause (example: sialolithiasis)Symptomatic treatment
Non-pharmacologic – warm compress for pain; sponge bath for fever; etc.
Pharmacologic prn – analgesics; antipyreticsSoft diet if there is pain on chewing Rest and watchful waiting for recovery from infection
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotitis, chronic, nonspecific Antibiotics (BRCA) – Gram (+) and Gram (-) microbes, if neededInvestigate and remove cause (example: sialolithiasis)Symptomatic treatment
Non-pharmacologic – warm compress for pain; sponge bath for fever; etc.
Pharmacologic prn – analgesics; antipyreticsSoft diet if there is pain on chewing Rest and watchful waiting for recovery from infection
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotid abscess, bacterial DrainAntibiotics (BRCA) – Gram (+) and Gram (-) microbes Investigate and remove cause (example: sialolithiasis)Symptomatic treatment
Non-pharmacologic – warm compress for pain; sponge bath for fever; etc.
Pharmacologic prn – analgesics; antipyreticsSoft diet if there is pain on chewing Rest and watchful waiting for recovery from infection
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotid tumor, benign Watchful waiting, if chosenExcision – subtotal parotidectomy; total parotidectomy if whole gland is involved
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotid tumor, malignant, resectableWide Excision – subtotal parotidectomy; total parotidectomy if whole gland is involved
Neck dissection if metastatic cervical lymph nodes present or strongly suspected – classical radical neck dissection for extensive nodes; otherwise modified radical neck dissection
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotid tumor, malignant, resectableWide Excision – subtotal parotidectomy; total parotidectomy if whole gland is involved
Neck dissection if metastatic cervical lymph nodes present or strongly suspected – classical radical neck dissection for extensive nodes; otherwise modified radical neck dissection
Postop adjuvant treatment – radiotherapy vs chemotherapy
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Tumors of the Parotid GlandHow to Manage
TreatmentGuidelines
Parotid tumor, malignant, difficult or non-resectableRadiotherapy vs chemotherapySurgery if lesion becomes resectable
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Treatment Process - Selection
Tumors of the Parotid GlandHow to Manage
Parotid Cancer, Mucoepidermoid, Superficial Lobe, ResectableObjective: To resolve the cancer completely with small chance of local recurrence and with least complication
Benefit Risk Cost Availability
Resolve Survival Rate
Surgery 98% Longest LLLL
Operation AnesthesiaFacial nerve palsy
P100T RA
Radiotherapy 70% LLL Radiation P100T RA
Chemotherapy 30% LL Side effects drug
P120T RA
Alternative medicine
1% ShortestL
Side effects P120T RA
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Treatment Process - Selection
Tumors of the Parotid GlandHow to Manage
Parotid Cancer, Mucoepidermoid, Superficial Lobe, ResectableObjective: To extirpative the cancer completely with small chance of local recurrence and with least complication
Benefit Risk Cost Availability
Recurrence Rate (local)
Survival Rate
Subtotal parotidectomy (with good margin)
10% Same Facial nerve palsy (10%)
Less expensive by P10T
RA
Total parotidectomy
5% Same Facial nerve palsy (90%)
More expensive
RA
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Tumors of the Parotid GlandHow to Manage
Treatment
After the options of the treatment have been analyzed,
ADVISE patient and relative on
Proposed treatment with bases and
SECURE an informed consent.
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Referral - When to Refer?
All physicians, both certified and not yet certified, must know their limitations.
Only they themselves can determine their own limitations.
They must realize their limitations so that they do not cause undue harm to their patients and so that they know when to refer to colleagues.
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Referral - To Whom to Refer?
Referral must be made to somebody who may or can solve the patient’s health
problem rationally, effectively, efficiently, and
humanely, andwho has a good track record of handling the kind of problem on hand.
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Tumors of the Parotid GlandHow to Manage
Referral
After the options of referral have been analyzed,
ADVISE patient and relative on
need of referral if needed and with bases and
SECURE an informed consent.
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Tumors of the Parotid GlandHow to Manage
Surgical Treatment
Assuming a surgical treatment will be done.How to manage it!
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Surgical Treatment Process
PREOP PREPARATION
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Surgical Treatment Process - Preop Preparation
INFORMED CONSENT PSYCHOSOCIAL SUPPORT OPTIMIZATION SCREENING OPERATIVE MATERIALS
Tumors of the Parotid GlandHow to Manage
See Preoperative and Preanesthetic Evaluation or Risk Assessment and Management
PCS Guidelines (Non-cardiac surgery)ASA Practice Advisory for Preanesthetic Evaluation (2011) – No routine!
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Surgical Treatment Process - Preop Preparation
INFORMED CONSENT PSYCHOSOCIAL SUPPORT
Tumors of the Parotid GlandHow to Manage
Risk Information - parotidectomyFacial nerve palsy (temporary or permanent)Frey’s SyndromeNumbness of ear (great auricular nerve transection)BleedingInfectionAnesthestic
Risk Information – neck dissectionNumbness
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Management of a Surgical Patient [Process]
Surgical Treatment Process
INTRAOP MANAGEMENT
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Surgical Treatment Process - Intraop MgtPHASES
INCISION EXPOSURE INTRAOP EVALUATION OPERATIVE PROCEDURE PROPER HEMOSTASIS CHECK CORRECT COUNT WOUND CLOSURE
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Surgical Treatment Process - Intraop Mgt
Quality Standards:
GENTLE
METICULOUS and PRECISE
NO IATROGENIC INJURIES
NO UNNECESSARY MOVESEVERY MOVE HAS A REASON!
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Surgical Treatment Process
POSTOP CARE
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Surgical Treatment Process - Postop Care
•SUPPLY BASIC NEEDS OF PATIENT COMFORT ANALGESICS FLUID AND ELECTROLYTES NUTRITION
SUPPORT ORGAN FUNCTION WOUND CAREMONITORING FOR COMPLICATIONSADVICE ON
HOME CARE FOLLOW-UP PLAN
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Surgical Treatment Process
POSTOP FOLLOW-UP PLAN
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Surgical Treatment Process - Postop Follow-up Plan
OBJECTIVES:
EVALUATE TREATMENT OUTCOME PROVIDE PSYCHOSOCIAL SUPPORT
MONITORING GUIDELINE:
PHYSICAL EXAMINATIONSYMPTOM-DIRECTED
INVESTIGATION
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Surgical Treatment Process - Postop Follow-up Plan
FF-UP FREQUENCY GUIDELINES: CONSIDER USUAL COURSE OF DISEASE PERSONALITY OF PATIENT PATIENT’S CONVENIENCE
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Tumors of the Parotid GlandHow to Manage
Reynaldo O. Joson, MD, MSc Surg
0918-804-03-04