1. TUMORS OF THE SALIVARY GLANDS

2. 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

3. 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.

4. 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”.

5. 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

6. 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.

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

8. 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.

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

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

11. 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

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

13. 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

14. 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.

15. 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.

16. 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

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

18. 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.

19. 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.

20. 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

21. 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

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

23. 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.

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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%

35. 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

36. 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

37. 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