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TUMORS OF THE SALIVARY GLANDS

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

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TUMORS OF THE SALIVARY GLANDS

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  1. TUMORS OF THE SALIVARY GLANDS

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

  5. TUMORS OF THE SALIVARY GLANDSANATOMY - 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 GLANDSANATOMY - 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 GLANDSANATOMY - SUBMANDIBULAR GLAND • INNERVATED BY THE LINGUAL NERVE • SYMPATHETIC PLEXUS FROM THE FACIAL ARTERY • PARASYMPATHETICS FROM THE SUBMANDIBULAR GANGLION

  8. TUMORS OF THE SALIVARY GLANDSANATOMY - 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 GLANDSANATOMY - SUBLINGUAL GLAND • SYMPATHETIC PLEXUS: FROM THE SUBLINGUAL ARTERY • PARASYMPATHETICS: FROM THE SUBMANDIBULAR GANGLION

  10. TUMORS OF THE SALIVARY GLANDSANATOMY - 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 MASSESPLEOMORPHIC 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 MASSESPLEOMORPHIC 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 MASSESWARTHIN’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 MASSESWARTHIN’S TUMOR (ADENOLYMPHOMA) • 90%CURED WITH RESECTION • 10%RECUR DUE TO MULTICENTRICITY OR INADEQUATE RESECTION.

  18. TUMORS OF THE SALIVARY GLANDS BENIGN MASSESONCOCYTOMA • 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 MASSESBASAL 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 MASSESHEMANGIOMA • 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 MASSESLIPOMA • 4%OF ALL PAROTID TUMORS • MALE PREDOMINANCE • 4-5%TH DECADE • TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTION

  22. TUMORS OF THE SALIVARY GLANDS BENIGN MASSESMYXOMA • 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.

  24. TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESMUCOEPIDERMOID 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

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

  26. TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESMUCOEPIDERMOID 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

  27. TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESMUCOEPIDERMOID 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

  28. TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESADENOID 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

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

  30. TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESADENOID CYSTIC CARCINOMA (CYLINDROMA) • TREATMENT: SURGICAL RESECTION OF THE GLAND WITH POSSIBLE NERVE RESECTION IF INVOLVED • POSTOPERATIVE RADIOTHERAPY

  31. 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

  32. 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

  33. TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESSQUAMOUS 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%

  34. 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

  35. TUMORS OF THE SALIVARY GLANDS MALIGNANT MASSESUNDIFFERENTIATED 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

  36. 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

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