1. Salivary Glands
Three paired glands Parotid; largest of the major salivary glands
Two Lobes divided by facial nerve
Submandibular gland Deep to mylohyoid, superficial to hyoglossus
Sublingual; Smallest of the salivary glands
Common surgical disease; infection/calculi

2. Salivary Glands {Benign conditions}
Mumps:
Acute painful parotitis
Viral in aetiology
Self limiting
Mikulicz’s Syndrome
Bilateral enlargement of salivary & lacrimal glands
Sjogren’s Syndrome
Triad of dry eyes, dry mouth, dry joints
Autoimmune
Lymphocytic infiltration
Pyogenic parotitis
Surgical, debilitated patients
Staphylococcus
Swollen, painful parotid glands
Pus from stensen’s duct

3. Salivary glands {Benign Tumours}
Comprise 3% - 6% of all head & neck tumours
Pleomorphic Adenoma
Commonest tumour (53% - 71%)
Slowly growing, painless, solitary, firm, smooth, moveable without nerve involvement
Both mesenchymal/epithelial elements
FNA, CT, MRI
Superficial parotidectomy

4. Salivary Glands Tumours
Warthin’s tumour(adenolymphoma, papillary cystadenoma lymphomatosum)
6% - 10%
Benign, bilateral, parotid gland only,
Older age group
Superficial location
Malignant potential non existent

5. Salivary Glands MalignantTumours
Locally aggressive
Grow along neural pathways, may access skull base and brain eventually
Also lymphatic and haematogenous spread

6. Salivary Galnds Malignant Tumours
Mucoepidermoid Carcinoma
Commonest malignant tumour
50% of all salivary gland malignancies
Parotid involved in 40% - 50%
75% are low grade & have good prognosis
1 – 5 year survival 85%
High grade mucoepidermoid carcinomas invade locally, spread regionally & distant mets
5 year survival drops 30%

7. Salivary Glands Adenocystic carcinoma(Cylindroma)
Commonly involves submandibular (35% - 40%), only 7% of parotid malignancies
Slowly growing
Perineural invasion
30% lymph node mets, 50% distant mets
5 year survival 75%
10 year survival 30%
20 year survival 13%

8. Salivary Glands Mixed malignant tumour
Long standing pleomorphic adenoma
Older age group
Worse prognosis
Lymph node mets 15%
Distant mets 30%
5 year survival 40% - 50%
15% year survival 20%

9. Salivary Glands Acinic cell carcinoma Low grade Slow growing
10% of malignant parotid tumour
Lymph node mets 10%
Aggressive tumours
Radical parotidectomy

10. Salivary Glands Squamous cell carcinomas Infrequent occurrence 1% - 5%
May have skin infiltration
Total radical parotidectomy_

11. Salivary Glands Evaluation & Diagnosis
History & clinical examination
Sialography – of no value
CT scans
CT sialography for retromandibular/parapharayngeal
MRI
Incisional biopsy containdicated
FNAC

12. Salivary Glands Staging System
T0 no clinical evidence of primary tumour
T1 0.1 – 2.0 cms diameter without significant local extension
T – 4 cms without local extension
T3 4.1 – 6.0 cms without local extension
T4a >6 cms without local extension
T4b tumour of any size with significant extension

13. Salivary Glands Staging system
N0 no evidence of regional nodal involvement
N1 evidence of regional nodal involvement
Nx regional nodes not assessed
M0 no distant mets
M1 distant mets eg., bone, lung, etc.

14. Salivary Glands Surgical complications
Flap necrosis
Seromas & haematomas
Oropharangeal cutaneous fistulas
Carotid rupture
Thoracic duct fistula
Pneumothorax
Airway obstruction, dysphagia, oedema, loss of tongue mobility, superoir laryngeal nerve damage

15. Neck swellings Differential diagnosis
Neck divided into ant. And posterior triangle by sternocleidomastoid
Cervical lymphadenopathy commonest cause of neck swelling

16. Neck Swellings D/D (benign)
Congenital swellings; branchial cleft swellings, thyroglossal duct cyst, laryngocoele, haemangiomas, cystic hygromas, dermoid.
Inflammatory: acute & chronic lymphadenitis( infectious mononucleosis, toxoplasmosis, cat scratch fever, actinomycosis, histoplasmosis, tuberculosis
traumatic: aneurysms, av malformation, torticollis, etc
Pharyngeal pouch, cervical ribs, thyroid, etc

17. Neck swellings Branchial cleft cyst
Remnants of incompletely obliterated branchial clefts/pouches
Located anterior & deep to sternomastoid
Painless swelling
Young adults
M= F ratio
Unilateral, 75% on left side

18. Neck swellings Thyroglossal duct cyst 70% of all congenital cysts
Arrested migration of thyroid
Painless midline swelling
Sistrunk operation

19. Neck swellings Csytic hygroma Collection of lymph sacs
Present at the root of neck(post. Triangle), arm, groin.
Pharyngeal pouch
Pulsion divertuculum
Uncoordinated swallowing
Sternomastoid tumour
Birth trauma, infarcted segment , fibrosis, torticollis

20. Neck swellings Cervical rib Extra cervical rib < 1% population
Neurological and vascular problems
Ranula
Mucous containing cyst in floor of mouth
Painless midline, spherical, smooth, fluctuant, transillumanant
Dermoid cyst
Midline, asymtomatic, painful when infected
Laryngocoele
Diverticulum of laryngeal ventricle
Lined by epithelium
Common in glass blowers/wind instruments musicians, etc

21. Neck swellings Tumours
Benign; Carotid body tumour, lipoma, soft tissue tumour
Malignant: skin tumours( SCC, BCC, melanomas), thyroid tumours, salivary gland tumours
Carotid body tumour
Sporadic occurrence 90%
Familial 10%
Unilateral, but bilateral/multicentric 10% sporadic, 50% bilateral familial
Grows 0.5 cms/year

22. Schedule of Lectures V Med
Salivary glands & Neck Swellings
Skin & soft tissue tumours
Benign & Malignant breast diseases
Thyroid, parathyroid disorders, carcinoid, phaechromocytoma, MEN syndrome
Oesophageal & gastric disorders
Small bowel obstruction, Crohn’s disease, meckel’s, etc
Colon & rectal diseases
Hepatobiliary disorders

23. Lectures Pancreatic disorders Hernias Arterial & venous disorders
Osteoarthritis Rheumatoid arthritis
Fluid & electrolyte balance, nutrition
Preoperative preparation, haemostasis & blood transfusion
Trauma & burn Management
Common urological problems
Common orthopaedic problems
Common cardiothoracic problems
Common neurosurgical problems