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 of the body.
- Sites of Occurrence: While it can arise in any salivary gland, the parotid gland is a common site of occurrence for Mucoepidermoid Carcinoma. However, it’s not uncommon to find it in minor salivary glands, like those located in the palate or lips.
- Symptoms: The manifestation of this carcinoma usually involves a gradually enlarging mass, which might be associated with pain. High-grade tumours might be associated with facial nerve weakness or other symptoms indicative of aggressive growth.
- Treatment: Surgical removal is the primary treatment modality for Mucoepidermoid Carcinoma. Depending on the tumour’s grade and stage, additional treatments like radiation therapy or chemotherapy might be recommended. Early detection and intervention are crucial for a favourable outcome.
- Prognosis: The prognosis for Mucoepidermoid Carcinoma varies based on its grade. Low-grade tumours generally have an excellent prognosis with appropriate treatment, while high-grade tumours require more aggressive management and carry a relatively less favourable prognosis.
- Follow-up: Regular post-treatment surveillance is essential to monitor for any signs of recurrence or metastasis. Periodic imaging and clinical evaluations play a vital role in the post-treatment care of patients.
Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma is a unique and relatively rare type of malignant salivary gland tumour. Here are the salient features and aspects of Adenoid Cystic Carcinoma:
- Histological Features: The tumour is characterised by a cribriform (Swiss-cheese-like) appearance microscopically. It comprises small, dark-staining cells arranged around cyst-like spaces.
- Growth Characteristics: Adenoid Cystic Carcinoma is notorious for its paradoxical behaviour. Although it grows slowly, it is locally invasive and has a penchant for invading the nerves (a phenomenon termed perineural invasion).
- Sites of Occurrence: While any salivary gland can be affected, this carcinoma has a higher propensity for the minor salivary glands, often those situated in the palate, tongue, or lips.
- Symptoms: Due to its nerve-invading nature, patients may experience pain or a sensation of numbness. The presentation typically involves a slowly enlarging mass that might be firm to touch.
- Metastatic Potential: One of the concerning traits of Adenoid Cystic Carcinoma is its capacity for distant metastasis. Even after years of initial diagnosis, metastatic lesions can appear, particularly in the lungs.
- Treatment: Surgical excision remains the cornerstone for treating Adenoid Cystic Carcinoma. Given its aggressive nature and propensity for recurrence, adjunctive treatments like radiation therapy are often employed. In cases with advanced disease or metastasis, chemotherapy or targeted therapies might be considered.
- Prognosis: While the long-term survival rates can be favourable due to its slow growth, the tumour’s relentless nature and potential for distant metastasis pose challenges in management. Regular follow-up and monitoring are crucial.
- Follow-up: Periodic imaging studies and clinical evaluations are essential in the post-treatment phase to monitor for recurrence, metastasis, or any new developments.
Adenocarcinoma
Adenocarcinoma is a broad categorisation of cancers that begin in glandular cells. In the context of the salivary glands, various subtypes of adenocarcinomas can manifest. Dr Sandeep Uppal and his team at The ENT Clinic, due to their proficiency in ENT disorders, would be adept at diagnosing and managing these malignancies.
Here are the primary aspects and subtypes of Adenocarcinoma as it pertains to the salivary glands:
- Glandular Origin: Adenocarcinomas are derived from the glandular tissue. Glandular cells are specialised cells that produce and secrete substances.
- Sites of Occurrence: Within the domain of ENT, adenocarcinomas can arise in any of the salivary glands, including the parotid, submandibular, and minor salivary glands.
- Microscopic Variants: There are several subtypes of adenocarcinomas in the salivary glands, each with its unique microscopic appearance. Some of the subtypes include:
- Polymorphous Low-Grade Adenocarcinoma (PLGA): Often found in minor salivary glands, PLGA grows slowly and has a good prognosis.
- Salivary Duct Carcinoma: Resembling ductal carcinoma of the breast, this is an aggressive subtype often located in the parotid gland.
- Acinic Cell Adenocarcinoma: Arising primarily from the acinar cells of the salivary gland, this subtype is usually found in the parotid gland.
- Symptoms: The presentation typically includes a progressively enlarging mass. Depending on the tumour’s location and aggressiveness, symptoms like pain, facial nerve dysfunction, or lymphadenopathy might also manifest.
- Treatment: Management strategies for adenocarcinoma of the salivary glands depend on the tumour’s specific subtype, size, location, and stage. Surgical excision is usually the primary treatment approach. Adjuvant therapies like radiation or chemotherapy might be employed based on the tumour’s aggressiveness and stage.
- Prognosis: The prognosis varies significantly based on the subtype of adenocarcinoma and the stage at diagnosis. Early detection and intervention are pivotal for a favourable outcome.
- Follow-up: Regular post-treatment check-ups are vital to monitor for potential recurrence, assess treatment outcomes, and ensure the patient’s overall well-being.
Given the complexity and variability of adenocarcinomas in the salivary glands, seeking specialist expertise is crucial.
Acinic Cell Carcinoma
Acinic Cell Carcinoma is a relatively rare type of malignant salivary gland tumour. Here are the defining features and considerations for Acinic Cell Carcinoma:
- Cellular Origin: Acinic Cell Carcinoma arises from the acinar cells of salivary glands. These cells are primarily responsible for producing the serous component of saliva.
- Site of Occurrence: The majority of Acinic Cell Carcinomas arise in the parotid gland, which is the largest salivary gland situated in front of the ear. However, it can occasionally develop in other salivary glands as well.
- Growth Pattern: Generally, Acinic Cell Carcinomas are slow-growing tumours. They can, however, exhibit varied growth patterns, and some might be more aggressive than others.
- Microscopic Appearance: Under the microscope, the tumour is characterised by cells resembling normal acinar cells. They often have a granular cytoplasm because of the presence of zymogen granules.
- Symptoms: Patients typically present with a painless lump or swelling in the region of the affected salivary gland. In some cases, there might be associated pain, facial weakness, or other related symptoms depending on the tumour’s size and location.
- Metastatic Potential: While it’s primarily a slow-growing tumour, there’s a potential for Acinic Cell Carcinoma to spread to regional lymph nodes. Rarely, distant metastasis can occur, especially in cases of high-grade tumours.
- Treatment: Surgical excision of the tumour is the primary mode of treatment. Depending on the tumour’s stage, size, and histologic grade, additional treatments like radiation therapy might be recommended.
- Prognosis: Generally, the prognosis for Acinic Cell Carcinoma is favourable, especially when diagnosed early. However, regular monitoring is crucial due to its potential for recurrence.
- Follow-up: Periodic clinical evaluations post-treatment is essential to check for any signs of recurrence, complications, or metastasis.
Malignant Mixed Tumours
Malignant Mixed Tumours are a complex category of neoplasms related to the salivary glands. Here’s a detailed overview of Malignant Mixed Tumours:
- Nature and Origin: Malignant Mixed Tumours can either arise from previously benign mixed tumours, such as pleomorphic adenomas, or manifest de novo as malignant entities without a benign precursor.
- Carcinoma ex Pleomorphic Adenoma: This is the most common type of malignant mixed tumour. It refers to a carcinoma that arises from a pre-existing pleomorphic adenoma. The malignant transformation of a longstanding benign pleomorphic adenoma can result in this entity. Histologically, it exhibits features of both benign pleomorphic adenoma and carcinoma.
- Carcinosarcomas: These are aggressive neoplasms that contain both malignant epithelial (carcinomatous) and malignant mesenchymal (sarcomatous) components. They are relatively rare but are often associated with a poor prognosis due to their aggressive nature.
- Metastasising Pleomorphic Adenoma: Although pleomorphic adenomas are benign, in extremely rare cases, they can metastasise to distant sites without undergoing malignant transformation at the primary site. This phenomenon is unique and is referred to as ‘benign metastasis’.
- Sites of Occurrence: Malignant mixed tumours can arise in any of the salivary glands, with the parotid gland being a frequent site. However, they can also develop in minor salivary glands scattered throughout the oral cavity and other parts of the upper aerodigestive tract.
- Symptoms: Patients might present with a rapidly growing mass, which might be associated with pain, skin ulceration, or facial nerve dysfunction. The tumour’s aggressive nature can lead to symptoms related to local invasion or metastasis.
- Diagnosis: Histopathological examination is crucial for accurate diagnosis. Imaging studies like CT, MRI, and occasionally PET scans can aid in staging the disease and planning treatment.
- Treatment: The mainstay of treatment for malignant mixed tumours is surgical excision, ensuring clear margins to reduce the risk of recurrence. Depending on the tumour’s stage and grade, adjunctive treatments like radiation therapy or chemotherapy might be necessary.
- Prognosis: The prognosis depends on the specific type of malignant mixed tumour, its stage, grade, and the adequacy of surgical excision. Regular follow-up is critical due to the potential for local recurrence and distant metastasis.
Salivary gland tumours can manifest in any of the salivary glands, whether major or minor. If someone experiences symptoms like persistent swelling, pain, or other abnormalities in the area of the salivary glands, they should promptly consult specialists like Dr Sandeep Uppal and his dedicated team at The ENT Clinic for a comprehensive evaluation and appropriate care.
MANAGEMENT OF PAROTID GLAND TUMOURS
CONSULTATION PROCESS
Patients are warmly welcomed to The ENT Clinic, where they will receive the utmost care and attention.
The consultation process begins with the patient’s initial appointment, during which a thorough evaluation of their medical history, symptoms, and concerns is conducted.
Clinical History
Dr Sandeep Uppal and his team take the time to listen attentively to the patient’s description of their condition, including any pain, swelling, changes in hearing, or facial weakness.
During the history-taking phase at The ENT Clinic, Dr Sandeep Uppal and his team pay close attention to gathering a comprehensive understanding of the patient’s medical background and specific details related to parotid gland tumours. Here’s an elaboration of the history-taking process:
PAROTID GLAND TUMOUR-SPECIFIC QUESTIONS
To assess the presence and characteristics of parotid gland tumours, specific questions related to the patient’s symptoms are asked:
- Duration of Symptoms: Patients are asked when they first noticed symptoms related to their parotid gland, such as swelling, pain, difficulty in breathing or swallowing, or changes in facial appearance. The duration of these symptoms and rate of progression of swelling and associated symptoms can provide important diagnostic insights.
- Family History: Inquiry is made into the patient’s family history to determine if there are any genetic predispositions or a family history of parotid gland tumours or other related conditions. This information can help in assessing potential hereditary factors.
- Changes in Facial Appearance or Function: Patients are encouraged to describe any changes they have noticed in their facial appearance or function. This includes issues such as facial weakness or difficulty in moving certain facial muscles, which can be indicative of parotid gland tumour involvement of the facial nerve.
MEDICAL HISTORY
Patients are asked to provide a detailed account of their medical history. This includes any significant illnesses or conditions they have experienced in the past, as well as any surgeries they may have undergone. Information about chronic medical conditions, such as diabetes or hypertension, is also important.
MEDICATIONS AND ALLERGIES
A thorough list of the patient’s current medications is obtained, along with the dosages and frequencies. This is crucial to assess potential drug interactions and their impact on the treatment plan.
Patients are asked about any known allergies to medications, food, or environmental factors, as this information is essential for safe treatment and medication choices.
LIFESTYLE AND HABITS
Patients are also asked about their lifestyle and habits, including smoking and alcohol consumption, as these factors can sometimes be associated with an increased risk of certain types of parotid gland tumours.
PATIENT CONCERNS AND QUESTIONS
Dr Sandeep Uppal and his team prioritize open communication with patients. They encourage patients to share any concerns or questions they may have about their condition or potential treatments. This helps in addressing individual patient needs and ensuring they are well-informed throughout the assessment process.
By collecting this comprehensive medical history and addressing specific questions related to parotid gland tumours, Dr Sandeep Uppal and The ENT Clinic ensure that each patient’s assessment is tailored to their unique situation. This detailed history-taking process is fundamental to accurate diagnosis and the development of personalized treatment plans.
PHYSICAL EXAMINATION
The physical examination conducted by Dr Sandeep Uppal and his team at The ENT Clinic is a critical step in assessing patients with suspected parotid gland tumours. It involves a comprehensive evaluation of the head and neck region, with a particular focus on the parotid gland. Here’s an elaboration of the examination process:
INSPECTION OF HEAD AND NECK
The examination begins with a visual inspection of the patient’s head and neck. This includes looking for any noticeable asymmetry, swelling, or changes in the facial appearance that may be associated with parotid gland tumours.
The presence of visible masses or deformities in the parotid gland area is noted. Any enlargement of the lymph nodes in the neck is documented.
Dr Sandeep will also examine the mouth and throat to assess whether the parotid gland tumour is involving the deeper tissues of the neck and pushing them into the throat.
PALPATION OF THE PAROTID GLAND
Palpation involves gently feeling the parotid gland and surrounding areas with the fingers. It is a crucial part of the examination.
Dr Sandeep assesses for:
- Tenderness: Any tenderness or discomfort in the parotid gland area is noted, as it can be indicative of inflammation or infection.
- Masses: The presence of any palpable masses or irregularities within the parotid gland is carefully evaluated. The size, location, and consistency of these masses are documented.
- Mobility: The mobility of the parotid gland during palpation is assessed to determine if it is freely movable or fixed to surrounding deeper structures or overlying skin.
INSPECTION OF HEAD AND NECK
Palpation involves gently feeling the parotid gland and surrounding areas with the fingers. It is a crucial part of the examination.
Dr Sandeep assesses for:
- Tenderness: Any tenderness or discomfort in the parotid gland area is noted, as it can be indicative of inflammation or infection.
- Masses: The presence of any palpable masses or irregularities within the parotid gland is carefully evaluated. The size, location, and consistency of these masses are documented.
- Mobility: The mobility of the parotid gland during palpation is assessed to determine if it is freely movable or fixed to surrounding deeper structures or overlying skin.
EVALUATION OF FACIAL NERVE FUNCTION
Facial nerve function is a critical aspect of the examination, as the facial nerve passes through the parotid gland. Any impairment of this nerve can be associated with parotid gland tumours and may indicate a malignancy.
Dr Sandeep Uppal and his team assess facial nerve function by asking the patient to perform various facial movements, such as smiling, raising eyebrows, and closing the eyes tightly.
Signs of facial weakness, asymmetry, or difficulty in performing these movements are carefully observed and documented.
EAR EXAMINATION
In some cases, otoscopy may be performed to assess the ear canal and eardrum. The proximity of the parotid gland to the ear means that parotid gland tumours can occasionally lead to ear-related symptoms.
Throughout the examination process, Dr Sandeep Uppal and his team maintain a patient-centric approach, ensuring that the patient is comfortable and informed. They explain each step of the examination and encourage patients to communicate any discomfort or concerns.
The findings from this comprehensive physical examination, along with the patient’s medical history, aid in the diagnostic process and guide the development of an appropriate treatment plan tailored to the patient’s specific condition and needs.
DIAGNOSTIC TESTS
Diagnostic tests are a crucial part of the evaluation process for parotid gland tumours at The ENT Clinic under the care of Dr Sandeep Uppal and his team. These tests are employed to confirm the diagnosis, determine the nature of the tumour, and guide the most appropriate treatment plan. Here’s an elaboration of the diagnostic tests involved:
IMAGING STUDIES
Imaging studies play a fundamental role in visualizing and characterizing parotid gland tumours. Dr Sandeep Uppal and his team may recommend one or more of the following imaging techniques:
- Ultrasound: This non-invasive test uses high-frequency sound waves to create real-time images of the parotid gland. It helps evaluate the size, location, and characteristics of the tumour.
- CT Scan (Computed Tomography): CT scans provide detailed cross-sectional images of the parotid gland and surrounding structures. They can help determine the extent of the tumour and its relationship to nearby tissues.
- MRI Scan (Magnetic Resonance Imaging): MRI scans offer high-resolution images that are particularly useful for assessing soft tissue structures. They provide valuable information about the tumour’s composition and potential involvement of nearby nerves or blood vessels.
BIOPSY
When imaging studies suggest the presence of a parotid gland tumour, further evaluation through tissue sampling may be necessary to establish a definitive diagnosis and determine if the tumour is benign or malignant.
- Fine-Needle Aspiration (FNA): FNA involves using a thin, fine needle to extract a small sample of tissue from the tumour. The collected cells are then examined under a microscope to assess their characteristics. FNA is particularly valuable for diagnosing benign tumours and some malignant ones.
- Core Needle Biopsy: In cases where FNA results are inconclusive or when a more extensive tissue sample is required, a core needle biopsy may be performed. This procedure involves obtaining a larger tissue sample for a more comprehensive analysis.
The choice between FNA and core needle biopsy depends on the specific characteristics of the tumour and the clinical judgment of Dr Sandeep Uppal and his team.
- Histopathological Analysis: The tissue samples obtained through FNA or core needle biopsy undergo histopathological analysis by experienced pathologists. This analysis provides essential information about the tumour’s histology, grade, and whether it is benign or malignant.
Histopathology is crucial in guiding treatment decisions and determining the best approach for managing the parotid gland tumour.
The choice between FNA and core needle biopsy depends on the specific characteristics of the tumour and the clinical judgment of Dr Sandeep Uppal and his team.
- Histopathological Analysis:
The tissue samples obtained through FNA or core needle biopsy undergo histopathological analysis by experienced pathologists. This analysis provides essential information about the tumour’s histology, grade, and whether it is benign or malignant.
Histopathology is crucial in guiding treatment decisions and determining the best approach for managing the parotid gland tumour.
Throughout the diagnostic process, Dr Sandeep Uppal and his team maintain open communication with the patient, explaining the purpose of each test and ensuring that the patient is informed and comfortable with the procedures. The results of these diagnostic tests are instrumental in developing a personalized treatment plan tailored to the patient’s specific condition and needs, whether it involves surgical intervention, radiation therapy, chemotherapy, or ongoing monitoring.
MANAGEMENT OF BENIGN PAROTID TUMOURS
Benign parotid tumours, while non-cancerous, can pose a challenge due to their proximity to the facial nerve. Their management depends on the tumour’s histology, size, and location within the parotid gland.
PLEOMORPHIC ADENOMA (MOST COMMON BENIGN PAROTID TUMOUR):
Superficial Lobe
- Surgical Approach: Primary treatment involves superficial parotidectomy, ensuring the facial nerve’s preservation. Complete excision is the goal to prevent recurrence.
- Wait and Watch: For smaller, asymptomatic tumours, a “wait and watch” strategy with regular imaging may be an option. However, surgery remains the standard recommendation for many due to the risk of growth and low potential for malignant transformation.
Deep Lobe
- Surgical Approach: Total parotidectomy is often necessary. This involves a more intricate procedure, dissecting around the facial nerve.
- Wait and Watch: A “wait and watch” approach may be considered for select, asymptomatic tumours. Regular imaging checks are vital to monitor for growth or symptom development.
Reference: Zhan KY, Khaja SF, Flack AB, et al. Observing the growth of benign parotid tumours. Otolaryngol Head Neck Surg. 2018;158(6):1049-1052.
WARTHIN TUMOUR
Superficial Lobe
- Surgical Approach: Superficial parotidectomy is the primary treatment choice. The tumour’s encapsulated nature facilitates a relatively straightforward dissection.
- Wait and Watch: Given the benign nature and slow growth, a “wait and watch” approach can be considered, especially in elderly patients. Regular imaging checks are essential due to its multifocal nature.
Deep Lobe
- Surgical Approach: Total parotidectomy may be required, ensuring facial nerve preservation.
- Wait and Watch: Similar to its superficial counterpart, regular surveillance through imaging is crucial if opting for a “wait and watch” strategy.
Reference: Nouraei SAR, Ismail Y, Ferguson MS, McLean NR, Milford CA. Analysis of complications following surgical treatment of benign parotid disease. Ann R Coll Surg Engl. 2008;90(8):643-647.
CONCLUSION
Benign parotid tumours require meticulous management due to their location near the facial nerve. The treatment approach, whether surgical or “wait and watch”, hinges on the tumour’s type, size, and lobe origin. Regular follow-up is critical, especially if opting for observation. Expertise, such as that offered by Dr Sandeep Uppal and his team at The ENT Clinic, is essential for optimal patient outcomes.
MANAGEMENT OF MALIGNANT TUMOURS
MUCOEPIDERMOID CARCINOMA OF THE PAROTID
Mucoepidermoid carcinoma is the most common malignant tumour of the salivary glands, including the parotid. The treatment approach for mucoepidermoid carcinoma is determined primarily by its grade (low, intermediate, high) and its stage.
SURGICAL MANAGEMENT
Early-stage or low-grade tumours
These tumours can often be managed with parotidectomy, ensuring complete removal with clear margins. Preservation of the facial nerve is essential unless it’s directly involved by the tumour.
Advanced or high-grade tumours
More extensive surgery, such as a total parotidectomy, may be required, especially if the tumour has infiltrated deep structures or the facial nerve. In cases of lymph node involvement, a neck dissection might also be indicated.
RADIOTHERAPY
Intermediate or high-grade tumours
Post-operative radiotherapy is often recommended for these tumours, especially if there are factors like close or positive margins, perineural invasion, lympho-vascular invasion, or nodal involvement.
Low-grade tumours
Generally, radiotherapy is not required unless there are adverse features.
CHEMOTHERAPY
Traditionally, chemotherapy has a limited role in the primary treatment of mucoepidermoid carcinoma. However, it might be considered in advanced or metastatic cases, especially when other treatment options are limited.
FOLLOW-UP
Regular follow-up is crucial. It typically includes clinical examination and imaging studies to detect local recurrence or distant metastasis early.
References
- NCCN Clinical Practice Guidelines in Oncology. Available at: https://www.nccn.org
- Goode RK, Auclair PL, Ellis GL. Mucoepidermoid carcinoma of the major salivary glands: clinical and histopathologic analysis of 234 cases with evaluation of grading criteria. Cancer. 1998;82(7):1217-1224.
- Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg. 1986;8(3):177-184.
- Lopes MA, Kowalski LP, da Cunha Santos G, Paes de Almeida O. A clinicopathologic study of 196 intraoral minor salivary gland tumours. J Oral Pathol Med. 1999;28(6):264-267.
- Rapidis AD, Givalos N, Gakiopoulou H, et al. Mucoepidermoid carcinoma of the salivary glands. Review of the literature and clinicopathological analysis of 18 patients. Oral Oncol. 2007;43(2):130-136.
- Chen MM, Roman SA, Sosa JA, Judson BL. Histologic grade as prognostic indicator for mucoepidermoid carcinoma: A population-level analysis of 2400 patients. Head Neck. 2014;36(2):158-163.
- Aro K, Leivo I, Mäkitie AA. Management and outcome of patients with mucoepidermoid carcinoma of major salivary gland origin: a single institution’s 30-year experience. Laryngoscope. 2008;118(2):258-262.
- Liu S, Ow A, Ruan M, Yang W, Zhang C, Wang L, Zhang C. Prognostic factors in primary salivary gland mucoepidermoid carcinoma: an analysis of 376 cases in an Eastern Chinese population. Int J Oral Maxillofac Surg. 2014;43(6):667-673.
- Baddour HM Jr, Magliocca KR, Chen AY. Salivary gland mucoepidermoid carcinoma: A population-based study of 2,332 cases. Oral Oncol. 2014;50(9):879-884.
While the above guidelines provide a general approach, individual treatment decisions are made in a multidisciplinary setting, considering the specifics of each case. If one suspects or is diagnosed with this condition, it’s imperative to consult with a specialist, such as an otolaryngologist or head and neck surgeon, for a tailored approach.
ACHIEVE OPTIMAL OUTCOMES FOR SALIVARY GLAND LUMPS IN SINGAPORE WITH DR SANDEEP UPPAL'S FACELIFT EXPERTISE
Salivary gland lumps require careful attention not only for health reasons but also for maintaining facial aesthetics. Dr Sandeep Uppal brings experience in facelift surgery to the table. This expertise is invaluable when addressing salivary gland lumps, as it allows for the strategic placement of incisions in a manner that results in minimally perceptible scars.
Patients who choose The ENT Clinic can expect a treatment approach that blends rigorous medical care with the finesse of facial plastic surgery. Dr Sandeep’s proficiency in facelift techniques ensures that any necessary incisions are discreetly positioned, enhancing post-surgical recovery, and leaving your facial aesthetics uncompromised.
For those who prioritize both health and appearance, Dr Sandeep Uppal offers an unparalleled service. Reach out to The ENT Clinic to explore your options for salivary gland lump treatment with the added benefit of minimal scarring. Schedule your consultation today and experience the fusion of top-tier medical expertise and aesthetic precision.
