TUMORS OF THE SALIVARY GLANDS TUMORS OF THE

TUMORS OF THE SALIVARY GLANDS

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

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

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

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

TUMORS OF THE SALIVARY GLANDS ANATOMY - SUBMANDIBULAR GLAND PAIRED STRUCTURES n THE LIES ALONG THE POSTERIOR BORDER OF THE MYLOHYOID MUSCLE. WHARTON’S DUCT - TRAVELS ALONG THE n 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. n

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

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

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

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

TUMORS OF THE SALIVARY GLANDS INCIDENCE: 3/100, 000 n 3%ALL BODY TUMORS n LOCATION OF SALIVARY GLAND TUMORS: 85% n PAROTID, 10% SUBMANDIBULAR, 1% SUBLINGUAL, 45% MINOR SALIVARY GLANDS

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

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

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

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

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

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

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

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. n n

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

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

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

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

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

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

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

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

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 n n GRAY PINK WITH CRIBRIFORM HISTOLOGY n n

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

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

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

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

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

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

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

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