TUMORS OF THE SALIVARY GLANDS

TUMORS OF THE SALIVARY TUMORS OF THE SALIVARY GLANDSGLANDS

TUMORS OF THE SALIVARY GLANDS TUMORS OF THE SALIVARY GLANDS MASSESMASSES

DIFFERENTIAL DIAGNOSIS OF A SALIVARY GLAND MASS:

–INFLAMMATION (PAROTIDITIS)–MUMPS–CALCULI

–NEOPLASM

TUMORS OF THE SALIVARY GLANDSTUMORS OF THE SALIVARY GLANDSINCIDENCE: 3/100,000INCIDENCE: 3/100,0003%ALL BODY TUMORS3%ALL BODY TUMORS

LOCATION OF SALIVARY GLAND TUMORS: 85% LOCATION OF SALIVARY GLAND TUMORS: 85% PAROTID, 10% SUBMANDIBULAR, 1% SUBLINGUAL, 4-PAROTID, 10% SUBMANDIBULAR, 1% SUBLINGUAL, 4-5% MINOR SALIVARY GLANDS5% MINOR SALIVARY GLANDS

TUMORS OF THE SALIVARY GLANDS TUMORS OF THE SALIVARY GLANDS BENIGN MASSESBENIGN MASSES

80%OF ALL BENIGN LESIONS ARISE IN THE 80%OF ALL BENIGN LESIONS ARISE IN THE LATERAL (TAIL) OF THE PAROTID GLANDLATERAL (TAIL) OF THE PAROTID GLAND..

SUPERFICIAL PAROTIDECTOMY WITH SUPERFICIAL PAROTIDECTOMY WITH PRESERVATION OF THE FACIAL NERVEPRESERVATION OF THE FACIAL NERVE

TOTAL SUBMANDIBULAR AND SUBLINGUAL TOTAL SUBMANDIBULAR AND SUBLINGUAL GLAND RESECTIONGLAND RESECTION


PLEOMORPHIC ADENOMAPLEOMORPHIC ADENOMA

BENIGN MIXED TUMORBENIGN MIXED TUMOR

MYOEPITHELIAL AND EPIDERMOID CELL ORIGINMYOEPITHELIAL AND EPIDERMOID CELL ORIGIN

MOST COMMON NEOPLASM IN THE PAROTID MOST COMMON NEOPLASM IN THE PAROTID GLAND ACCOUNTS FOR 65% OF ALL OF THE GLAND ACCOUNTS FOR 65% OF ALL OF THE PAROTID TUMORSPAROTID TUMORS..


PLEOMORPHIC ADENOMAPLEOMORPHIC ADENOMA

TREATMENT: WIDE RESECTION OF THE TUMORTREATMENT: WIDE RESECTION OF THE TUMOR

AVOID SHELLING OUT THE LESIONAVOID SHELLING OUT THE LESION

RECURRENCE: PRIMARY DUE TO INADEQUATE RECURRENCE: PRIMARY DUE TO INADEQUATE RESECTIONRESECTION

LESIONS ARE MORE AGGRESSIVE WHEN THEY LESIONS ARE MORE AGGRESSIVE WHEN THEY RECURRECUR..


WARTHINWARTHIN’’S TUMOR (ADENOLYMPHOMA)S TUMOR (ADENOLYMPHOMA)SECOND MOST COMMON PAROTID TUMORSECOND MOST COMMON PAROTID TUMOR

MALE : FEMALE 5 : 1MALE : FEMALE 5 : 1

BILATERAL 10%BILATERAL 10%

PRIMARILY LOCATED IN THE LATERAL GLAND HOWEVER PRIMARILY LOCATED IN THE LATERAL GLAND HOWEVER MULTICENTRICITY IS DESCRIBEDMULTICENTRICITY IS DESCRIBED..

PEA SOUP BROWN MUCOID MATERIAL ON SECTIONINGPEA SOUP BROWN MUCOID MATERIAL ON SECTIONING

TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTIONTREATMENT: LATERAL OR TOTAL GLANDULAR RESECTION


WARTHINWARTHIN’’S TUMOR (ADENOLYMPHOMA)S TUMOR (ADENOLYMPHOMA)

90%CURED WITH RESECTION90%CURED WITH RESECTION

10%RECUR DUE TO MULTICENTRICITY OR 10%RECUR DUE TO MULTICENTRICITY OR INADEQUATE RESECTIONINADEQUATE RESECTION..

TUMORS OF THE SALIVARY GLANDS TUMORS OF THE SALIVARY GLANDS BENIGN MASSESBENIGN MASSESONCOCYTOMAONCOCYTOMA

PRINCIPALLY A PAROTID GLAND TUMORPRINCIPALLY A PAROTID GLAND TUMOR

5TH DECADE5TH DECADE

PROBABLY DUE TO HYPERPLASIA FROM AGINGPROBABLY DUE TO HYPERPLASIA FROM AGING

>>1%SALIVARY GLAND TUMORS1%SALIVARY GLAND TUMORS

CYSTIC COMPONENT HAS BEEN IDENTIFIEDCYSTIC COMPONENT HAS BEEN IDENTIFIED..


BASAL CELL ADENOMABASAL CELL ADENOMA

COMMON IN THE LATERAL PAROTID AND THE COMMON IN THE LATERAL PAROTID AND THE SUBMUCOSAL GLANDS IN THE UPPER LIPSUBMUCOSAL GLANDS IN THE UPPER LIP..

TREATMENT: LATERAL OR TOTAL GLANDULAR TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTIONRESECTION..

TUMORS OF THE SALIVARY GLANDS TUMORS OF THE SALIVARY GLANDS BENIGN MASSESBENIGN MASSESHEMANGIOMAHEMANGIOMA

50%OF ALL PAROTID TUMORS IN CHILDREN50%OF ALL PAROTID TUMORS IN CHILDREN

TREATMENT: ENVOLUTION BY THE AGE OF 5 IS TREATMENT: ENVOLUTION BY THE AGE OF 5 IS COMMONCOMMON

CN VII: SUPERFICIAL LOCATION IN CHILDREN CN VII: SUPERFICIAL LOCATION IN CHILDREN THUS OPERATIVE INTERVENTION SHOULD BE THUS OPERATIVE INTERVENTION SHOULD BE AVOIDED AND LET ENVOLUTION PROCEED AVOIDED AND LET ENVOLUTION PROCEED UNLESS THERE IS UNCONTROLLED BLEEDINGUNLESS THERE IS UNCONTROLLED BLEEDING..

STEROID THERAPYSTEROID THERAPY


LIPOMALIPOMA4%OF ALL PAROTID TUMORS4%OF ALL PAROTID TUMORS

MALE PREDOMINANCEMALE PREDOMINANCE4-5%TH DECADE4-5%TH DECADE

TREATMENT: LATERAL OR TOTAL GLANDULAR TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTIONRESECTION


MYXOMAMYXOMA

SLOW GROWINGSLOW GROWING

INFILTRATIVEINFILTRATIVE

TREATMENT: WIDE RESECTION OR TOTAL TREATMENT: WIDE RESECTION OR TOTAL GLANDULAR REMOVALGLANDULAR REMOVAL

TUMORS OF THE SALIVARY GLANDS TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESMALIGNANT MASSES

PROGNOSIS: PALATE > PAROTID > SUBMANDIBULAR / PROGNOSIS: PALATE > PAROTID > SUBMANDIBULAR / SUBLINGUAL GLANDSUBLINGUAL GLAND

5TH-6TH DECADE5TH-6TH DECADE

RATE OF GROWTH DOES NOT CORRELATE WITH THE RATE OF GROWTH DOES NOT CORRELATE WITH THE DEGREE OF MALIGNANCYDEGREE OF MALIGNANCY

LUNG/BONE: PRIMARY METASTATIC SITESLUNG/BONE: PRIMARY METASTATIC SITES

PRIOR RADIOTHERAPY INCREASES THE RISK OF A PRIOR RADIOTHERAPY INCREASES THE RISK OF A SALIVARY GLAND MALIGNANCYSALIVARY GLAND MALIGNANCY..

TUMORS OF THE SALIVARY GLANDS MALIGNANT TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESMASSES

MUCOEPIDERMOID CARCINOMAMUCOEPIDERMOID CARCINOMA

MUCOUS AND EPIDERMOID CELL ORIGINMUCOUS AND EPIDERMOID CELL ORIGIN6%OF ALL PAROTID TUMORS - MOST COMMON 6%OF ALL PAROTID TUMORS - MOST COMMON

MALIGNANCYMALIGNANCY65%FOUND IN THE PAROTID GLAND65%FOUND IN THE PAROTID GLAND

18%OF ALL MALIGNANT TUMORS OF THE 18%OF ALL MALIGNANT TUMORS OF THE SALIVARY GLANDSSALIVARY GLANDS



LOW, INTERMEDIATE AND HIGH GRADESLOW, INTERMEDIATE AND HIGH GRADES

4-6TH DECADE4-6TH DECADE

8%CN VII INVOLVEMENT AT THE TIME OF 8%CN VII INVOLVEMENT AT THE TIME OF PRESENTATIONPRESENTATION

10%LYMPH NODE METASTASIS10%LYMPH NODE METASTASIS

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESTUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESMUCOEPIDERMOID CARCINOMAMUCOEPIDERMOID CARCINOMA

TREATMENT: TOTAL GLANDULAR RESECTION +/- TREATMENT: TOTAL GLANDULAR RESECTION +/- NECK NODE DISSECTIONNECK NODE DISSECTION

CN VII: SPARE NERVE UNLESS INVOLVED WITH CN VII: SPARE NERVE UNLESS INVOLVED WITH TUMORTUMOR..

POSTOPERATIVE RADIOTHERAPY DEPENDING ON POSTOPERATIVE RADIOTHERAPY DEPENDING ON MARGINS, EXTRACAPSULAR EXTENSION FROM MARGINS, EXTRACAPSULAR EXTENSION FROM LYMPH NODES, PERINEURAL INVOLVEMENT, OR LYMPH NODES, PERINEURAL INVOLVEMENT, OR INVOLVEMENT OF SURROUNDING STRUCTURESINVOLVEMENT OF SURROUNDING STRUCTURES



RECURRENCE RATE 15-25%, USUALLY DUE TO RECURRENCE RATE 15-25%, USUALLY DUE TO INADEQUATE RESECTIONINADEQUATE RESECTION..

WHEN MUCUOEPIDERMOID CARCINOMA IS WHEN MUCUOEPIDERMOID CARCINOMA IS LOCATED IN THE SUBMANDIBULAR GLAND, THE LOCATED IN THE SUBMANDIBULAR GLAND, THE TUMOR IS MORE AGGRESSIVETUMOR IS MORE AGGRESSIVE..

RARELY INVOLVES THE SUBLINGUAL GLANDRARELY INVOLVES THE SUBLINGUAL GLAND


ADENOID CYSTIC CARCINOMA (CYLINDROMA)ADENOID CYSTIC CARCINOMA (CYLINDROMA)MOST COMMON MALIGNANT TUMOR OF THE MOST COMMON MALIGNANT TUMOR OF THE

SUBMANDIBULAR GLANDS AND THE SECOND SUBMANDIBULAR GLANDS AND THE SECOND MOST COMMON PAROTID MALIGNANCYMOST COMMON PAROTID MALIGNANCY

25-30%CN VII PARALYSIS/PARESIS ON 25-30%CN VII PARALYSIS/PARESIS ON PRESENTATIONPRESENTATION

PERINEURAL INVASION IS COMMONPERINEURAL INVASION IS COMMON

GRAY PINK WITH CRIBRIFORM HISTOLOGYGRAY PINK WITH CRIBRIFORM HISTOLOGY

TUMORS OF THE SALIVARY GLANDS TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES MALIGNANT MASSES

ADENOID CYSTIC CARCINOMA (CYLINDROMA)ADENOID CYSTIC CARCINOMA (CYLINDROMA)

UNPREDICTABLE TUMORUNPREDICTABLE TUMOR

SLOW GROWING, HOWEVER, RELENTLESS SLOW GROWING, HOWEVER, RELENTLESS DISEASEDISEASE

LUNG METASTASIS COMMONLUNG METASTASIS COMMON

LYMPH NODE INVOLVEMENT NOT COMMONLYMPH NODE INVOLVEMENT NOT COMMON


ADENOID CYSTIC CARCINOMA (CYLINDROMA)ADENOID CYSTIC CARCINOMA (CYLINDROMA)

TREATMENT: SURGICAL RESECTION OF THE TREATMENT: SURGICAL RESECTION OF THE GLAND WITH POSSIBLE NERVE RESECTION IF GLAND WITH POSSIBLE NERVE RESECTION IF INVOLVEDINVOLVED

POSTOPERATIVE RADIOTHERAPYPOSTOPERATIVE RADIOTHERAPY

MALIGNANT PLEOMORPHIC ADENOMA MALIGNANT PLEOMORPHIC ADENOMA (MALIGNANT MIXED TUMOR (MALIGNANT MIXED TUMOR

OR CARCINOMA EX PLEOMORPHIC ADENOMA)OR CARCINOMA EX PLEOMORPHIC ADENOMA)ETIOLOGY: MALIGNANT TRANSFORMATION OF A ETIOLOGY: MALIGNANT TRANSFORMATION OF A

PLEOMORPHIC ADENOMAPLEOMORPHIC ADENOMA5-6TH DECADE5-6TH DECADE

AVERAGE DURATION OF THE LESION IS AVERAGE DURATION OF THE LESION IS PRESENT 10 YEARS BEFORE BEING PRESENT 10 YEARS BEFORE BEING DIAGNOSEDDIAGNOSED

TREATMENT: GLANDULAR RESECTION WITH TREATMENT: GLANDULAR RESECTION WITH NERVE RESECTION IF INVOLVED WITH TUMORNERVE RESECTION IF INVOLVED WITH TUMOR

ACINOUS (ACINIC) CELL CARCINOMAACINOUS (ACINIC) CELL CARCINOMA

LOW, INTERMEDIATE AND HIGH GRADELOW, INTERMEDIATE AND HIGH GRADEINTRAVASCULAR EXTENSIONINTRAVASCULAR EXTENSION

3RD-6TH DECADE3RD-6TH DECADEMETASTASIS TO THE LUNG AND BONE (VERTEBRAE)METASTASIS TO THE LUNG AND BONE (VERTEBRAE)

TREATMENT: GLANDULAR RESECTIONTREATMENT: GLANDULAR RESECTIONRADIOTHERAPY IS RADIOTHERAPY IS NOT NOT EFFECTIVE EFFECTIVE


SQUAMOUS CELL CARCINOMASQUAMOUS CELL CARCINOMA

IS IT A METASTATIC LESIONIS IT A METASTATIC LESION??1/3HAVE FACIAL NERVE INVOLVEMENT AT THE 1/3HAVE FACIAL NERVE INVOLVEMENT AT THE

TIME OF PRESENTATIONTIME OF PRESENTATION

MALE > FEMALEMALE > FEMALE

6TH DECADE6TH DECADETOTAL GLANDULAR RESECTIONTOTAL GLANDULAR RESECTION

10YEAR SURVIVAL: 45%10YEAR SURVIVAL: 45%

ADENOCARCINOMAADENOCARCINOMA

USUALLY FIXED TO THE SURROUNDING STRUCTURESUSUALLY FIXED TO THE SURROUNDING STRUCTURESMALE > FEMALEMALE > FEMALE

3RD - 6TH DECADE3RD - 6TH DECADE22%FACIAL NERVE INVOLVEMENT AT THE TIME OF PRESENTATION22%FACIAL NERVE INVOLVEMENT AT THE TIME OF PRESENTATION

25%METASTASIS AT THE TIME OF PRESENTATION25%METASTASIS AT THE TIME OF PRESENTATIONGLANDULAR RESECTION WITH NERVE RESECTION IF INVOLVED GLANDULAR RESECTION WITH NERVE RESECTION IF INVOLVED

WITH TUMORWITH TUMORNECK DISSECTIONNECK DISSECTION

POSTOPERATIVE RADIOTHERAPYPOSTOPERATIVE RADIOTHERAPY


UNDIFFERENTIATED CARCINOMAUNDIFFERENTIATED CARCINOMA7TH-8TH DECADE7TH-8TH DECADE

33%FACIAL NERVE INVOLVEMENT AT THE TIME 33%FACIAL NERVE INVOLVEMENT AT THE TIME OF PRESENTATIONOF PRESENTATION

HIGHLY MALIGNANTHIGHLY MALIGNANT

TREATMENT: GLANDULAR RESECTION, NECK TREATMENT: GLANDULAR RESECTION, NECK DISSECTION, POSTOPERATIVE RADIOTHERAPYDISSECTION, POSTOPERATIVE RADIOTHERAPY

NERVE RESECTION IF INVOLVEDNERVE RESECTION IF INVOLVED

TUMORS OF THE SALIVARY GLANDS TUMORS OF THE SALIVARY GLANDS COMPLICATIONS OF SURGICAL INTERVENTIONCOMPLICATIONS OF SURGICAL INTERVENTION

ORAL FISTULASORAL FISTULASFACIAL NERVE INJURYFACIAL NERVE INJURY

LOSS OF EAR SENSATIONLOSS OF EAR SENSATIONFREY’S SYNDROME (GUSTATORY SWEATING)FREY’S SYNDROME (GUSTATORY SWEATING)

SKIN NECROSISSKIN NECROSIS

TUMORS OF THE SALIVARY GLANDS

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