SALIVARY GLAND TUMOURS Both benign and malignant tumours can develop in salivary glands. The tumours may involve the parotid gland, the submandibular gland, sublingual gland, or the minor salivary glands. WHAT ARE THE DIFFERENT KINDS OF SALIVARY GLAND TUMOURS? Here’s an overview of the types of salivary gland tumours: BENIGN SALIVARY GLAND TUMOURS Pleomorphic Adenoma (Mixed Tumour) Essential details of Pleomorphic Adenoma include: Prevalence: It stands out as the most frequently diagnosed benign salivary gland tumour. Site of Occurrence: The parotid gland, located in front of the ear, is the primary site of this tumour’s appearance. However, it is also known to manifest in the submandibular gland, albeit less frequently. Growth Rate: Pleomorphic Adenoma has a reputation for its indolent nature, meaning it tends to grow at a leisurely pace. Histological Features: The tumour’s name ‘pleomorphic’ reflects its diverse histology. Microscopically, it displays an eclectic mix of epithelial cells forming gland-like structures coexisting with varying amounts of myxoid, chondroid, or even osseous stroma. This mixed appearance gives it the alternative name, ‘Mixed Tumour’. Symptoms: Often, it manifests as a painless, firm, and mobile mass. However, its size can increase over time, leading to discomfort or cosmetic concerns. Malignant Transformation: Although benign, one of the concerns with Pleomorphic Adenoma is its potential for malignant transformation if neglected. There is an approximate 1% risk per year of this tumour turning malignant, emphasising the importance of timely intervention. Treatment: The primary management strategy for Pleomorphic Adenoma is surgical excision. Ensuring complete removal is crucial to prevent recurrence and reduce the risk of malignant transformation. Postoperative Care: Regular follow-up after surgery is crucial to monitor for any signs of recurrence and ensure the patient’s well-being. Warthin’s Tumour (Papillary Cystadenoma Lymphomatosum) Key characteristics of Warthin’s Tumour include: Location: While it predominantly manifests in the parotid gland, it can occasionally appear in other salivary glands. Demographics: Older men are more frequently diagnosed with Warthin’s Tumour than women. Bilateral or Multifocal Growth: A distinctive trait of this tumour is that it can emerge on both sides of the face or have multiple focal points within the same gland. This bilateral or multifocal appearance is not common in other types of salivary gland tumours. Histology: Under the microscope, Warthin’s Tumour displays a unique combination of epithelial and lymphoid tissue. The cystic spaces filled with fluid are lined with a double layer of epithelial cells, while the surrounding regions are dense with lymphoid tissue. Symptoms: Often, individuals with Warthin’s Tumour may not exhibit any overt symptoms. The tumour is usually discovered as a painless, slow-growing mass. However, any persistent swelling or growth in the salivary gland region warrants medical attention. Treatment: The primary treatment for Warthin’s Tumour is surgical removal, especially if it causes discomfort or aesthetic concerns. The prognosis after surgery is generally excellent, with a low recurrence rate. Postoperative Care: Regular follow-up after surgery is crucial to monitor for any signs of recurrence and ensure the patient’s well-being. Monomorphic Adenoma Here are the primary characteristics of Monomorphic Adenoma: Uniform Structure: As the name ‘monomorphic’ suggests, this tumour has a more consistent cellular structure. Unlike the pleomorphic adenoma, which showcases a variety of tissue types, the monomorphic adenoma maintains a homogenous appearance microscopically. Histological Features: The term “monomorphic adenoma” groups together several benign salivary gland tumours, each having its unique microscopic appearance. However, they all share the commonality of presenting a consistent, uniform pattern of cells. Site of Occurrence: Monomorphic Adenomas can arise in any salivary gland. However, similar to many salivary gland tumours, the parotid gland is a frequent site of occurrence. Symptoms: Patients typically present with a painless, slowly enlarging mass. The lump is usually firm and can be moved easily upon palpation. Treatment: Surgical excision remains the treatment of choice for Monomorphic Adenomas. Given their benign nature, complete removal often results in a cure. However, it’s essential to ensure the entire tumour is excised to prevent any potential recurrence. Postoperative Care: Regular follow-up after surgery is crucial to monitor for any signs of recurrence and ensure the patient’s well-being. Oncocytoma Here’s a closer look at the characteristics of Oncocytoma: Cellular Composition: The primary cellular component of an oncocytoma is the oncocytic cell. These cells are large, eosinophilic (pink-staining under the microscope), and granular, containing numerous mitochondria, which is responsible for their distinctive appearance. Site of Occurrence: While Oncocytomas can appear in any of the salivary glands, the parotid gland is the most common site for these tumours. The parotid gland, situated in front of the ear, is the largest of the salivary glands. Demographics: Oncocytomas are more frequently diagnosed in older adults. While they can affect any age group, their prevalence increases with advancing age. Symptoms: Most individuals with an oncocytoma present with a slow-growing, painless mass. Because of its benign nature, the tumour doesn’t typically cause pain or functional issues unless it reaches a significant size, at which point it might exert pressure on adjacent structures. Histological Features: Under the microscope, an oncocytoma showcases sheets or nests of the characteristic oncocytic cells. The abundant granular cytoplasm of these cells, owing to the high mitochondrial content, is a defining histological feature. Treatment: The gold standard treatment for Oncocytoma is surgical excision. Complete removal is typically curative, and recurrence rates are low when the tumour is entirely excised. Follow-up: After surgery, patients should maintain regular follow-up appointments to monitor for any potential recurrence or complications and to ensure optimal recovery. MALIGNANT SALIVARY GLAND TUMOURS Mucoepidermoid Carcinoma Here are the primary characteristics and aspects of Mucoepidermoid Carcinoma: Histological Features: Mucoepidermoid Carcinoma derives its name from its histological makeup, which includes a mix of mucous-producing cells (mucocytes) and squamous cells (epidermoid cells). The proportion and arrangement of these cells play a vital role in determining the tumour’s grade. Grading: The tumours are typically categorised into low-grade, intermediate-grade, and high-grade based on their microscopic features. Low-grade tumours tend to grow slower and have a better prognosis, while high-grade tumours are more aggressive and may spread to other parts

PAROTID SURGERY TAKE A CONFIDENT STEP TOWARDS PAROTIDECTOMY: SKILLED INTERVENTION FOR HEALTH AND AESTHETICS BY DR SANDEEP Parotid gland issues, such as tumours or infections, require careful intervention. Dr Sandeep brings his extensive experience in facial surgery to each parotidectomy, ensuring a focus on excellent health outcomes and superior cosmetic results. DETAILED EVALUATION AND TAILORED PLANNING Your journey to recovery starts with a comprehensive consultation where Dr Sandeep assesses your specific condition through imaging studies and tests. He then crafts a personalized surgical plan to address your parotid gland issue effectively. INFORMED CONSENT PROCESS Dr Sandeep will ensure you have a thorough understanding of the parotidectomy process, discussing the potential benefits and risks so you can make a well-informed decision about your care. RIGOROUS PRE-SURGICAL PREPARATION Preparation is key to the success of your surgery. Dr Sandeep’s team will guide you through the necessary pre-operative preparations, including dietary restrictions, medication adjustments, and any lifestyle modifications needed to ensure optimal surgical outcomes. Our seasoned anaesthesia team will conduct a thorough pre-anaesthetic evaluation to ensure you are in the best possible condition for your surgery. THOROUGH PRE-SURGICAL PREPARATION The team, led by Dr Sandeep, will prepare you for surgery with detailed instructions on any necessary adjustments to medications or diet, aiming for the best possible surgical outcome. PRECISE SURGICAL PROCEDURE WELCOMING ENVIRONMENT Upon arrival at our state-of-the-art facility, you’ll be made comfortable as we prepare for your procedure. EXPERT ANAESTHESIA An experienced Senior anaesthesiologist administers anaesthesia, ensuring your comfort throughout the surgery. INCISIONS WITH AESTHETIC PRECISION Dr Sandeep’s facelift experience informs his approach to incisions, aiming for barely visible scars by strategically placing and meticulously closing incisions. GLAND REMOVAL WITH CARE The surgery, whether superficial or total parotidectomy, is executed with the utmost precision, considering both functional and aesthetic outcomes. NERVE INTEGRITY PRESERVATION Dr Sandeep’s parotidectomy procedure integrates state of the art equipment for facial nerve monitoring, a practice that significantly enhances the safety to maintain facial function and expression. This advanced technique, coupled with Dr Sandeep’s extensive experience in facial aesthetic surgery, ensures both optimal health outcomes and minimal scarring. POSTOPERATIVE ATTENTION FOR RECOVERY AND APPEARANCE Post-surgery, individualized care is paramount to ensure a smooth recovery. DRAIN AND SUTURE MANAGEMENT Drains are inserted to prevent fluid build-up and are typically removed within the first few days. Sutures, if not dissolvable, are removed after a week or as healing dictates. SCAR CARE PROTOCOL Utilizing his facelift experience, Dr Sandeep applies techniques such as silicone gel application and recommends products like TriLuma for Post Inflammatory Hyperpigmentation (PIH) management. Sun avoidance and sunscreen use are crucial to protect the healing skin and aid in scar maturation for the best cosmetic results. UNDERSTANDING THE RISKS AND POTENTIAL COMPLICATIONS When considering a parotidectomy, it’s important to be aware of the potential risks and complications, despite the high level of care and precision in the surgical process. Here’s a more detailed look at what these could entail: BLEEDING AND HEMATOMA Any surgical intervention carries the risk of bleeding. In the context of parotidectomy, postoperative bleeding can lead to the formation of a hematoma—a localized collection of blood outside the blood vessels. This may require additional interventions, such as drainage or, in rare cases, another surgical procedure to manage. INFECTION As with any surgery, there is a potential for infection at the site of the incision. If an infection occurs, it is most commonly treated with antibiotics. In some instances, further treatment may be needed to address deeper or more persistent infections. FACIAL NERVE IMPACT Given the proximity of the facial nerve to the parotid gland, there is a risk of nerve injury during surgery. This could result in temporary or, albeit rarely, permanent changes in facial movements, including weakness or paralysis. FREY’S SYNDROME Some patients may develop Frey’s Syndrome, where sweating occurs in the area near the surgical site while eating or thinking about food. This happens due to rerouted nerve fibres that were affected during the surgery. SALIVARY LEAK Although uncommon, there is a possibility of a salivary leak where saliva can escape through the incision site. This is typically a temporary issue that resolves as the surgical site heals. AESTHETIC IMPACT Dr Sandeep leverages his experience in facial plastic surgery to minimize visible scarring. Techniques are employed to ensure that incisions are made along natural creases of the skin when possible and closed meticulously to promote the best cosmetic outcome. Postoperative care may include the use of silicone gel and other treatments to assist in scar healing, further reducing visibility. It’s crucial that these risks are discussed in detail with your surgeon prior to the operation to understand their likelihood and the measures taken to mitigate them. Dr Sandeep and his team are committed to providing comprehensive care that includes thorough pre-surgical counselling, expert surgical technique, and diligent postoperative follow-up to address any complications should they arise. CHOOSE EXPERT CARE WITH DR SANDEEP Opt for Dr Sandeep’s skilled approach to parotidectomy for a procedure that offers health benefits and aesthetic care. Contact us to arrange a consultation and begin addressing your parotid gland condition with confidence.

PAROTID GAND AND DUCT STONES WHAT YOU MIGHT FEEL PAIN AND DISCOMFORT Where It Hurts The pain usually starts in front of your ears and can extend towards your cheeks. When It Hurts You’ll likely feel a sharp pain when you’re eating, as this is when the glands are most active in producing saliva. SWELLING Where You’ll See It The swelling is often visible in front of your ears or on your cheeks. When It Happens It’s usually more noticeable when you eat and will likely reduce after you’ve finished your meal. DRY MOUTH How It Feels You might experience some dryness in your mouth, although this is generally less severe than with Submandibular Gland stones. DIFFICULTY IN SWALLOWING OR SPEAKING How Often To remove any debris or discharge. Ear toilet under a microscope is a pivotal procedure in treating ear infections. It enables targeted removal of infected material and debris, reducing the bacterial/fungal load while minimizing risk of trauma to sensitive ear structures, including the eardrum. It also facilitates accurate sample collection for microbiological analysis, aiding in targeted antibiotic therapy. HOW IT’S DIAGNOSED? DETAILED CLINICAL HISTORY Onset of Symptoms Dr Sandeep aims to establish when the symptoms began, whether they were gradual or sudden, and any specific triggering events. Character of Pain and Discomfort Detailed questions about the nature of the pain (e.g., dull, sharp, constant, intermittent) are asked to understand its severity and implications. Aggravating and Relieving Factors Understanding what exacerbates or alleviates symptoms can provide critical clues. For instance, increased pain during meals suggests salivary stasis due to a stone. Swelling and Physical Changes Dr Sandeep enquires about any noticeable swelling, its location, and whether it comes and goes or has been persistent. Oral and Dental History Information about oral hygiene, recent dental work, or history of dental infections may be relevant, especially to rule out differential diagnoses. Previous Episodes A history of similar episodes could suggest recurrent stones or chronic issues with the parotid glands. Associated Symptoms Symptoms like dry mouth, fever, or difficulty in swallowing and speaking are explored to assess the extent of the condition. Medical History Existing medical conditions, medications, and any history of autoimmune diseases can be relevant in diagnosis and treatment planning. Lifestyle Factors Dietary habits, hydration levels, and lifestyle choices like smoking and alcohol consumption are considered, as they can influence salivary gland function. Family History Although rare, a family history of salivary gland issues or stones can be pertinent. PHYSICAL EXAMINATION When faced with a patient presenting symptoms indicative of Parotid Duct stones, Dr Sandeep would conduct a thorough and methodical physical examination. His vast experience and specialisation in ENT conditions guarantee a precise evaluation, allowing for targeted treatment plans. Here is what Dr Sandeep Uppal’s physical examination process would entail: Visual Inspection Dr Sandeep starts by visually inspecting the patient’s face and neck, particularly looking for any asymmetry, swelling, or changes in skin colour. Palpation of the Parotid Region Employing a careful and systematic palpation technique, Dr Sandeep assesses the size, shape, and consistency of the parotid gland, as well as any associated tenderness. Examination of Salivary Duct Dr Sandeep inspects the opening of the Stenson’s duct which drains the saliva from th Parotid gland. This is located inside the mouth opposite the upper second molar, checking for any redness, swelling, or signs of discharge. Salivary Flow Assessment To assess salivary flow, he might use sialagogues like lemon juice to stimulate salivation. During this, he observes whether this induces or exacerbates any pain. Bimanual Examination Dr Sandeep uses one hand inside the mouth and another on the skin surface to feel for any hard, immobile masses that could indicate the presence of a stone. Facial Nerve Function The integrity of the facial nerve is verified by asking the patient to perform facial expressions such as smiling, frowning, and closing the eyes. The function of the nerve may be compromised if the parotid gland swelling turns into an abscess. Lymph Node Assessment Any lymph nodes in the neck and submandibular regions are also palpated to rule out secondary infection or other underlying conditions. Assessment of Associated Symptoms If the patient has reported additional symptoms like dry mouth, difficulty swallowing, or speaking, these aspects are evaluated during the examination. Synthesizing Findings All findings from the physical examination are cross-referenced with the patient’s medical history to form a comprehensive understanding of the condition. IMMEDIATE MANAGEMENT In cases where a stone is palpable and proximal to the duct opening, Dr Sandeep might proceed with an immediate extraction attempt under aseptic conditions, offering instant relief to the patient. Through his meticulous physical examination process, Dr Sandeep Uppal ensures that the diagnosis of Parotid Duct stones is as accurate as possible. This sets the foundation for the most effective treatment plan tailored to each patient’s specific needs. IMAGING An ultrasound is usually the first step, and in more complex cases, a CT scan might be necessary to identify the position and number of stones in the parotid duct. TREATMENT OF PAROTID DUCT STONES For patients experiencing this condition, understanding the range of available treatment options can be empowering. Here’s a detailed guide: CONSERVATIVE MANAGEMENT Sialagogues Substances like lemon juice or sour candies stimulate saliva production and flow, they can sometimes help to naturally flush out smaller stones. Warm Compresses and Massage Applying a warm cloth to the affected area and gentle massage can facilitate the movement of the stone towards the ductal opening. Hydration Adequate hydration can help maintain optimal saliva consistency, aiding in stone expulsion. Antibiotics They’re used primarily when there’s evidence of a secondary bacterial infection. They help in resolving the infection to reduce inflammation and pain. Minimally Invasive Procedures SIALOENDOSCOPY It is a minimally invasive procedure that uses a tiny camera (endoscope) to enter the duct, directly visualize the stones and remove them without the need for more invasive surgical approaches. The patient can go home the same day with complete relief of symptoms. LITHOTRIPSY A procedure that uses ultrasonic