Transcript TUMORS OF THE SALIVARY GLANDS

TUMORS OF THE SALIVARY
GLANDS
TUMORS OF THE SALIVARY GLANDS
ANATOMY
ARISE FROM THE INGROWTH OF ECTODERM
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PAROTID/SUBMANDIBULAR - 6TH FETAL WEEK
SUBLINGUAL - 8TH FETAL WEEK
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MINOR SALIVARY - 3RD FETAL MONTH
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TUMORS OF THE SALIVARY GLANDS
ANATOMY - PAROTID
LARGEST GLAND
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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.
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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
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ARTIFICIAL DIVISION BETWEEN THE DEEP AND
SUPERFICIAL LOBE.
FACIAL NERVE DIVIDES THESE “LOBES”.
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TUMORS OF THE SALIVARY GLANDS
ANATOMY - FACIAL NERVE
EXITS FROM THE STYLOMASTOID FORAMEN.
DIVIDES INTO A TEMPOROFACIAL AND
CERVICOFACIAL BRANCH.
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FIVE GROUPS OF TERMINAL BRANCHES:
TEMPORAL/FRONTAL –
ZYGOMATICO-ORBITAL –
BUCCAL –
MANDIBULAR –
CERVICAL –
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TUMORS OF THE SALIVARY GLANDS
ANATOMY - SUBMANDIBULAR GLAND
PAIRED STRUCTURES
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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.
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TUMORS OF THE SALIVARY GLANDS
ANATOMY - SUBMANDIBULAR GLAND
INNERVATED BY THE LINGUAL NERVE
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SYMPATHETIC PLEXUS FROM THE FACIAL ARTERY
PARASYMPATHETICS FROM THE SUBMANDIBULAR
GANGLION
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TUMORS OF THE SALIVARY GLANDS
ANATOMY - SUBLINGUAL GLAND
BOUNDARIES ON THE LINGUAL SURFACE OF THE
ANTEROLATERAL MANDIBLE
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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.
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TUMORS OF THE SALIVARY GLANDS
ANATOMY - SUBLINGUAL GLAND
SYMPATHETIC PLEXUS: FROM THE SUBLINGUAL
ARTERY
PARASYMPATHETICS: FROM THE
SUBMANDIBULAR GANGLION
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TUMORS OF THE SALIVARY GLANDS
ANATOMY - MINOR SALIVARY GLANDS
LOCATED ON THE LIPS, PALATE, BUCCAL 
MUCOSA, TONGUE, AND FLOOR OF THE MOUTH.
TUMORS OF THE SALIVARY GLANDS
INCIDENCE: 3/100,000 
3%ALL BODY TUMORS 
LOCATION OF SALIVARY GLAND TUMORS: 85% 
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 –
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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
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TUMORS OF THE SALIVARY GLANDS
BENIGN MASSES
PLEOMORPHIC ADENOMA
BENIGN MIXED TUMOR
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MYOEPITHELIAL AND EPIDERMOID CELL ORIGIN
MOST COMMON NEOPLASM IN THE PAROTID
GLAND ACCOUNTS FOR 65% OF ALL OF THE
PAROTID TUMORS.
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TUMORS OF THE SALIVARY GLANDS
BENIGN MASSES
PLEOMORPHIC ADENOMA
TREATMENT: WIDE RESECTION OF THE TUMOR
AVOID SHELLING OUT THE LESION
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RECURRENCE: PRIMARY DUE TO INADEQUATE
RESECTION
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LESIONS ARE MORE AGGRESSIVE WHEN THEY
RECUR.
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TUMORS OF THE SALIVARY GLANDS
BENIGN MASSES
WARTHIN’S TUMOR (ADENOLYMPHOMA)
SECOND MOST COMMON PAROTID TUMOR
MALE : FEMALE 5 : 1
BILATERAL 10%
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PRIMARILY LOCATED IN THE LATERAL GLAND HOWEVER
MULTICENTRICITY IS DESCRIBED.
PEA SOUP BROWN MUCOID MATERIAL ON SECTIONING
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TREATMENT: LATERAL OR TOTAL GLANDULAR RESECTION
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TUMORS OF THE SALIVARY GLANDS
BENIGN MASSES
WARTHIN’S TUMOR (ADENOLYMPHOMA)
90%CURED WITH RESECTION
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10%RECUR DUE TO MULTICENTRICITY OR
INADEQUATE RESECTION.
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TUMORS OF THE SALIVARY GLANDS
BENIGN MASSES
ONCOCYTOMA
PRINCIPALLY A PAROTID GLAND TUMOR
5TH DECADE
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PROBABLY DUE TO HYPERPLASIA FROM AGING
>1%SALIVARY GLAND TUMORS
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CYSTIC COMPONENT HAS BEEN IDENTIFIED.
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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.
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TUMORS OF THE SALIVARY GLANDS
BENIGN MASSES
HEMANGIOMA
50%OF ALL PAROTID TUMORS IN CHILDREN
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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
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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
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TUMORS OF THE SALIVARY GLANDS
BENIGN MASSES
MYXOMA
SLOW GROWING
INFILTRATIVE
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TREATMENT: WIDE RESECTION OR TOTAL
GLANDULAR REMOVAL
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TUMORS OF THE SALIVARY GLANDS
MALIGNANT MASSES
PROGNOSIS: PALATE > PAROTID > SUBMANDIBULAR /
SUBLINGUAL GLAND
5TH-6TH DECADE
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RATE OF GROWTH DOES NOT CORRELATE WITH THE
DEGREE OF MALIGNANCY
LUNG/BONE: PRIMARY METASTATIC SITES
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PRIOR RADIOTHERAPY INCREASES THE RISK OF A SALIVARY
GLAND MALIGNANCY.
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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
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TUMORS OF THE SALIVARY GLANDS
MALIGNANT MASSES
MUCOEPIDERMOID CARCINOMA
LOW, INTERMEDIATE AND HIGH GRADES
4-6TH DECADE
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8%CN VII INVOLVEMENT AT THE TIME OF
PRESENTATION
10%LYMPH NODE METASTASIS
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TUMORS OF THE SALIVARY GLANDS
MALIGNANT MASSES
MUCOEPIDERMOID CARCINOMA
TREATMENT: TOTAL GLANDULAR RESECTION +/NECK NODE DISSECTION
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CN VII: SPARE NERVE UNLESS INVOLVED WITH
TUMOR.
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POSTOPERATIVE RADIOTHERAPY DEPENDING
ON MARGINS, EXTRACAPSULAR EXTENSION
FROM LYMPH NODES, PERINEURAL
INVOLVEMENT, OR INVOLVEMENT OF
SURROUNDING STRUCTURES
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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
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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
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GRAY PINK WITH CRIBRIFORM HISTOLOGY
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TUMORS OF THE SALIVARY GLANDS
MALIGNANT MASSES
ADENOID CYSTIC CARCINOMA (CYLINDROMA)
UNPREDICTABLE TUMOR
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SLOW GROWING, HOWEVER, RELENTLESS
DISEASE
LUNG METASTASIS COMMON
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LYMPH NODE INVOLVEMENT NOT COMMON
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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
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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
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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 
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
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6TH DECADE 
TOTAL GLANDULAR RESECTION
10YEAR SURVIVAL: 45% 
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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 
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TUMORS OF THE SALIVARY GLANDS
MALIGNANT MASSES
UNDIFFERENTIATED CARCINOMA
7TH-8TH DECADE 
33%FACIAL NERVE INVOLVEMENT AT THE TIME
OF PRESENTATION
HIGHLY MALIGNANT
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TREATMENT: GLANDULAR RESECTION, NECK 
DISSECTION, POSTOPERATIVE RADIOTHERAPY
NERVE RESECTION IF INVOLVED
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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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