TUMORS OF THE SALIVARY GLANDS

TUMORS OF THE SALIVARY GLANDS ANATOMY ARISE FROM THE INGROWTH OF ECTODERM PAROTID/SUBMANDIBULAR - 6TH FETAL WEEK SUBLINGUAL - 8TH FETAL WEEK MINOR SALIVARY - 3RD FETAL MONTH

TUMORS OF THE SALIVARY GLANDS ANATOMY - PAROTID LARGEST GLAND BOUNDARIES ARE THE EXTERNAL AUDITORY CANAL, RAMUS OF THE MANDIBLE AND MASTOID PROCESS STENSEN’S DUCT - ANTERIOR BORDER OF THE MASSETER MUSCLE THROUGH THE BUCCINATOR MUSCLE AND EXITS INTRAORALLY ALONG SIDE THE MAXILLARY SECOND MOLAR.

TUMORS OF THE SALIVARY GLANDS ANATOMY - PAROTID THE PAROTID DUCT LIES ON AN IMAGINARY LINE BETWEEN THE EXTERNAL NARES AND THE TRAGUS OF THE EAR. GLAND IS ENCASED IN A SHEATH ARTIFICIAL DIVISION BETWEEN THE DEEP AND SUPERFICIAL LOBE. FACIAL NERVE DIVIDES THESE “LOBES”.

TUMORS OF THE SALIVARY GLANDS ANATOMY - FACIAL NERVE EXITS FROM THE STYLOMASTOID FORAMEN. DIVIDES INTO A TEMPOROFACIAL AND CERVICOFACIAL BRANCH. FIVE GROUPS OF TERMINAL BRANCHES: TEMPORAL/FRONTAL ZYGOMATICO-ORBITAL BUCCAL MANDIBULAR CERVICAL

TUMORS OF THE SALIVARY GLANDS ANATOMY - SUBMANDIBULAR GLAND PAIRED STRUCTURES THE LIES ALONG THE POSTERIOR BORDER OF THE MYLOHYOID MUSCLE. WHARTON’S DUCT - TRAVELS ALONG THE POSTERIOR BORDER OF THE MYLOHYOID MUSCLE AND OPENS INTRAORALLY AT THE IPSILATERAL SUBLINGUAL PAPILLA ADJACENT TO THE ANTERIOR MIDLINE ON THE FLOOR OF THE MOUTH.

TUMORS OF THE SALIVARY GLANDS ANATOMY - SUBMANDIBULAR GLAND INNERVATED BY THE LINGUAL NERVE SYMPATHETIC PLEXUS FROM THE FACIAL ARTERY PARASYMPATHETICS FROM THE SUBMANDIBULAR GANGLION

TUMORS OF THE SALIVARY GLANDS ANATOMY - SUBLINGUAL GLAND BOUNDARIES ON THE LINGUAL SURFACE OF THE ANTEROLATERAL MANDIBLE 20DUCTS WHICH DRAIN INTO THE ANTERIOR FLOOR OF THE MOUTH BARTHOLIN DUCT - COALESCENCE OF SOME OF THESE DUCTS INTO A MORE DEFINED DUCT. BARTHOLIN’S DUCT MAY EMPTY INTO WHARTON’S DUCT.

TUMORS OF THE SALIVARY GLANDS ANATOMY - SUBLINGUAL GLAND SYMPATHETIC PLEXUS: FROM THE SUBLINGUAL ARTERY PARASYMPATHETICS: FROM THE SUBMANDIBULAR GANGLION

TUMORS OF THE SALIVARY GLANDS ANATOMY - MINOR SALIVARY GLANDS LOCATED ON THE LIPS, PALATE, BUCCAL MUCOSA, TONGUE, AND FLOOR OF THE MOUTH.

TUMORS OF THE SALIVARY GLANDS INCIDENCE: 3/100,000 3%ALL BODY TUMORS LOCATION OF SALIVARY GLAND TUMORS: 85% PAROTID, 10% SUBMANDIBULAR, 1% SUBLINGUAL, 4-5% MINOR SALIVARY GLANDS

TUMORS OF THE SALIVARY GLANDS MASSES DIFFERENTIAL DIAGNOSIS OF A SALIVARY GLAND MASS: INFLAMMATION (PAROTIDITIS) MUMPS CALCULI NEOPLASM

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES 80%OF ALL BENIGN LESIONS ARISE IN THE LATERAL (TAIL) OF THE PAROTID GLAND. SUPERFICIAL PAROTIDECTOMY WITH PRESERVATION OF THE FACIAL NERVE TOTAL SUBMANDIBULAR AND SUBLINGUAL GLAND RESECTION

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES PLEOMORPHIC ADENOMA BENIGN MIXED TUMOR MYOEPITHELIAL AND EPIDERMOID CELL ORIGIN MOST COMMON NEOPLASM IN THE PAROTID GLAND ACCOUNTS FOR 65% OF ALL OF THE PAROTID TUMORS.

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES PLEOMORPHIC ADENOMA TREATMENT: WIDE RESECTION OF THE TUMOR AVOID SHELLING OUT THE LESION RECURRENCE: PRIMARY DUE TO INADEQUATE RESECTION LESIONS ARE MORE AGGRESSIVE WHEN THEY RECUR.

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES WARTHIN’S TUMOR (ADENOLYMPHOMA) SECOND MOST COMMON PAROTID TUMOR MALE : FEMALE 5 : 1 BILATERAL 10% PRIMARILY LOCATED IN THE LATERAL GLAND HOWEVER MULTICENTRICITY IS DESCRIBED. PEA SOUP BROWN MUCOID MATERIAL ON SECTIONING TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTION

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES WARTHIN’S TUMOR (ADENOLYMPHOMA) 90%CURED WITH RESECTION 10%RECUR DUE TO MULTICENTRICITY OR INADEQUATE RESECTION.

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES ONCOCYTOMA PRINCIPALLY A PAROTID GLAND TUMOR 5TH DECADE PROBABLY DUE TO HYPERPLASIA FROM AGING >1%SALIVARY GLAND TUMORS CYSTIC COMPONENT HAS BEEN IDENTIFIED.

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES BASAL CELL ADENOMA COMMON IN THE LATERAL PAROTID AND THE SUBMUCOSAL GLANDS IN THE UPPER LIP. TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTION.

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES HEMANGIOMA 50%OF ALL PAROTID TUMORS IN CHILDREN TREATMENT: ENVOLUTION BY THE AGE OF 5 IS COMMON CN VII: SUPERFICIAL LOCATION IN CHILDREN THUS OPERATIVE INTERVENTION SHOULD BE AVOIDED AND LET ENVOLUTION PROCEED UNLESS THERE IS UNCONTROLLED BLEEDING. STEROID THERAPY

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES LIPOMA 4%OF ALL PAROTID TUMORS MALE PREDOMINANCE 4-5%TH DECADE TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTION

TUMORS OF THE SALIVARY GLANDS BENIGN MASSES MYXOMA SLOW GROWING INFILTRATIVE TREATMENT: WIDE RESECTION OR TOTAL GLANDULAR REMOVAL

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES PROGNOSIS: PALATE > PAROTID > SUBMANDIBULAR / SUBLINGUAL GLAND 5TH-6TH DECADE RATE OF GROWTH DOES NOT CORRELATE WITH THE DEGREE OF MALIGNANCY LUNG/BONE: PRIMARY METASTATIC SITES PRIOR RADIOTHERAPY INCREASES THE RISK OF A SALIVARY GLAND MALIGNANCY.

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES MUCOEPIDERMOID CARCINOMA MUCOUS AND EPIDERMOID CELL ORIGIN 6%OF ALL PAROTID TUMORS - MOST COMMON MALIGNANCY 65%FOUND IN THE PAROTID GLAND 18%OF ALL MALIGNANT TUMORS OF THE SALIVARY GLANDS

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES MUCOEPIDERMOID CARCINOMA LOW, INTERMEDIATE AND HIGH GRADES 4-6TH DECADE 8%CN VII INVOLVEMENT AT THE TIME OF PRESENTATION 10%LYMPH NODE METASTASIS

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES MUCOEPIDERMOID CARCINOMA TREATMENT: TOTAL GLANDULAR RESECTION +/- NECK NODE DISSECTION CN VII: SPARE NERVE UNLESS INVOLVED WITH TUMOR. POSTOPERATIVE RADIOTHERAPY DEPENDING ON MARGINS, EXTRACAPSULAR EXTENSION FROM LYMPH NODES, PERINEURAL INVOLVEMENT, OR INVOLVEMENT OF SURROUNDING STRUCTURES

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES MUCOEPIDERMOID CARCINOMA RECURRENCE RATE 15-25%, USUALLY DUE TO INADEQUATE RESECTION. WHEN MUCUOEPIDERMOID CARCINOMA IS LOCATED IN THE SUBMANDIBULAR GLAND, THE TUMOR IS MORE AGGRESSIVE. RARELY INVOLVES THE SUBLINGUAL GLAND

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES ADENOID CYSTIC CARCINOMA (CYLINDROMA) MOST COMMON MALIGNANT TUMOR OF THE SUBMANDIBULAR GLANDS AND THE SECOND MOST COMMON PAROTID MALIGNANCY 25-30%CN VII PARALYSIS/PARESIS ON PRESENTATION PERINEURAL INVASION IS COMMON GRAY PINK WITH CRIBRIFORM HISTOLOGY

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES ADENOID CYSTIC CARCINOMA (CYLINDROMA) UNPREDICTABLE TUMOR SLOW GROWING, HOWEVER, RELENTLESS DISEASE LUNG METASTASIS COMMON LYMPH NODE INVOLVEMENT NOT COMMON

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES ADENOID CYSTIC CARCINOMA (CYLINDROMA) TREATMENT: SURGICAL RESECTION OF THE GLAND WITH POSSIBLE NERVE RESECTION IF INVOLVED POSTOPERATIVE RADIOTHERAPY

ETIOLOGY: MALIGNANT TRANSFORMATION OF A PLEOMORPHIC ADENOMA MALIGNANT PLEOMORPHIC ADENOMA (MALIGNANT MIXED TUMOR OR CARCINOMA EX PLEOMORPHIC ADENOMA) ETIOLOGY: MALIGNANT TRANSFORMATION OF A PLEOMORPHIC ADENOMA 5-6TH DECADE AVERAGE DURATION OF THE LESION IS PRESENT 10 YEARS BEFORE BEING DIAGNOSED TREATMENT: GLANDULAR RESECTION WITH NERVE RESECTION IF INVOLVED WITH TUMOR

ACINOUS (ACINIC) CELL CARCINOMA LOW, INTERMEDIATE AND HIGH GRADE INTRAVASCULAR EXTENSION 3RD-6TH DECADE METASTASIS TO THE LUNG AND BONE (VERTEBRAE) TREATMENT: GLANDULAR RESECTION RADIOTHERAPY IS NOT EFFECTIVE

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES SQUAMOUS CELL CARCINOMA IS IT A METASTATIC LESION? 1/3HAVE FACIAL NERVE INVOLVEMENT AT THE TIME OF PRESENTATION MALE > FEMALE 6TH DECADE TOTAL GLANDULAR RESECTION 10YEAR SURVIVAL: 45%

ADENOCARCINOMA USUALLY FIXED TO THE SURROUNDING STRUCTURES MALE > FEMALE 3RD - 6TH DECADE 22%FACIAL NERVE INVOLVEMENT AT THE TIME OF PRESENTATION 25%METASTASIS AT THE TIME OF PRESENTATION GLANDULAR RESECTION WITH NERVE RESECTION IF INVOLVED WITH TUMOR NECK DISSECTION POSTOPERATIVE RADIOTHERAPY

TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSES UNDIFFERENTIATED CARCINOMA 7TH-8TH DECADE 33%FACIAL NERVE INVOLVEMENT AT THE TIME OF PRESENTATION HIGHLY MALIGNANT TREATMENT: GLANDULAR RESECTION, NECK DISSECTION, POSTOPERATIVE RADIOTHERAPY NERVE RESECTION IF INVOLVED

TUMORS OF THE SALIVARY GLANDS COMPLICATIONS OF SURGICAL INTERVENTION ORAL FISTULAS FACIAL NERVE INJURY LOSS OF EAR SENSATION FREY’S SYNDROME (GUSTATORY SWEATING) SKIN NECROSIS