2. Sjogren’s syndrom  It is an autoimmune disease causing destruction of the salivary and the lachrymal g  Either primary or secondary to C T disease.  Middle age female >male (10:1).  Causing xerostomia(dry mouth) and keratoconjuctivitis sicca(dry eye).  Higher risk of lymphoma.

3. Treatment  Artificial tear to protect the cornea.  Artificial saliva or frequent drinking water.

4. Benign lymphoepithelial lesion  The same as S S. (both has lymphocytic infilitration, acinar atrophy.  Clinically :firm, painful and 20%bilateral.  20% develop lymphoma.  It is not benign.  Treated by parotidectomy recurence may occure with changes of lymphoma.

5. Mikulicz’s disease  A benign symmetrical asymptomatic enlargement of the salivary and lachrymal gs.  Dryness of the mouth

6. Tumours of the salivary gland  Comprise 5%of head and neck tumours.  70% benign,70% in parotid and 70% pleomorphic adenoma.  Malignancy less common in parotid g.(15%),about 30% in submandibular g. and more common in minor salivary g.(50%).

7. WHO classification 1- Non epithelial tumours : - Haemangiomas and lymphangiomas - Neurofibromas and neurilimmomas - Lipomas and lymphomas.

8. 2- Epithelial tumours(benign & malignant) Benign :pleomorphic adenoma,monomorphic adenoma,ad enolymphoma and oncocytoma. Malignant :-Mucoepidermoid carcinoma. - Adenoid cyst carcinoma. - Acinic cell tumour. - adenocarcinoma. - Ca in pleomorphic adenoma. - lymphoepithlioma.

11. Pleomorphic adenoma  It is mixed parotid tumour  Commonest benign tumour of parotid gland.  At any age and sex.  Microscopically :arises from ductal myoepithelial cells. And has incomplete capsule with projections to surrounding tissues.

14. Cinically  Painless mass and firm.  Irregular surface lobulated.  No facial n pulsy.  Slowly growing tumour (years).

16. Adenolymphoma (warthins tumour)  Affect only parotid gland.10%bilateral.  Origin thought to arise from heterotopic salivary tissue in the parotid LN.

17. Clinically  Recently related to cigarette.  Affect elderly male around 60 y but now increase in female.  Painless soft cystic lower pole parotid mass.  No facial n. pulsy.  Does not undergo malignant change.

18. Malignant tumours  Mucoepidermoid carcinoma : - commonest malignancy - affect all age group even children - usually parotid g. - histologically :3 grades. - low grade is the commonest &affect chidren.

21. Adenoid cyst carcinoma  Commonest malignancy of minor salivary gland.  Consist of malignant cells arranged in cribriform pattern.  Slowly growing.  Perineural spread along cranial nerves.  Local recurrence is common but rarely distant metastasis.  Aggressive malignant T. with poor prognosis.

23. Features of benign neoplasm  Painless slowly growing even years.  Not tender,firm hemispherrical swelling.  Smooth or bosselated surface.  It neither infiltrate skin nor deep structures.  Tumours arise from deep part may bulge to oropharynx.  No facial n pulsy.  No cervical LN and no metastasis.

24. Features of malignancy  Pain that may radiate to ear after mastication.  Recent rapid enlargement of pre existing nodule.  Hard,irregular, warm, mildly tender mass.  Skin ulceration.  Facial nerve palsy.  Cervical LN enlargement with salivary tumour.  Rarely metastasis (lung,brain).

25. Parotid lump? Either extra parotid : 1- LN 2- Sebaceous cyst 3- Lipoma 4- Tumours of maxilla,mandible. 5- Masseter hypertrophy in dentures. Or true parotid : Non neoplastic or neoplastic

26. Investigations of salivary neoplasm -Biopsy : 1- FNAC (90%) 2-Trucut 3- punch for minor salivary g -CT &MRI: -Sialography: -Tc 99isotope scan

27. Treatment  Surgery is the only treatment.  In parotid,warning for possibility of facial palsy is important.

30. Tumors that are benign  Risk of change to malignancy.  Treated by superficial parotidectomy.  Preservation of F N.  Local implantation may lead to recurrence.  If FN injured accidentally so repair by suture or n graft (G A N).

31. Tumour that are clinically malignant  Consent for scarifying the FN.  Radical parotidectomy+/- masseter,mandible,FN.  Neck dissection (lymphatic metastasis)+radiotherapy.

32. Complications of surgery  Early : 1- bleeding. 2- infection. 3- skin flap necrosis. 4- trismus. 5- salivary fistulae. 6- nerve palsy.

33. Late complications 1- frey’s syndrome 50%(sweating of face during eating due to regeneration of post ganglionic parasympathatic fibers to the skin sweat glands. 2-hypersthesia of skin. 3-cosmetic defect. 4- tumour recurrence.

34. Thanks