Salivary Glands

1
Salivary Glands

• Three paired glandsParotid largest of the major
  salivary glands
• Two Lobes divided by facial nerve
• Submandibular gland Deep to mylohyoid,
  superficial to hyoglossus
• Sublingual Smallest of the salivary glands
• Common surgical disease infection/calculi

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Salivary GlandsBenign conditions

• Mumps
• Acute painful parotitis
• Viral in aetiology
• Self limiting
• Mikuliczs Syndrome
• Bilateral enlargement of salivary lacrimal
  glands
• Sjogrens Syndrome
• Triad of dry eyes, dry mouth, dry joints
• Autoimmune
• Lymphocytic infiltration
• Pyogenic parotitis
• Surgical, debilitated patients
• Staphylococcus
• Swollen, painful parotid glands
• Pus from stensens duct

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Salivary glandsBenign Tumours

• Comprise 3 - 6 of all head neck tumours
• Pleomorphic Adenoma
• Commonest tumour (53 - 71)
• Slowly growing, painless, solitary, firm, smooth,
  moveable without nerve involvement
• Both mesenchymal/epithelial elements
• FNA, CT, MRI
• Superficial parotidectomy

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Salivary GlandsTumours

• Warthins tumour(adenolymphoma, papillary
  cystadenoma lymphomatosum)
• 6 - 10
• Benign, bilateral, parotid gland only,
• Older age group
• Superficial location
• Malignant potential non existent

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Salivary GlandsMalignantTumours

• Locally aggressive
• Grow along neural pathways, may access skull base
  and brain eventually
• Also lymphatic and haematogenous spread

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Salivary GalndsMalignant Tumours

• Mucoepidermoid Carcinoma
• Commonest malignant tumour
• 50 of all salivary gland malignancies
• Parotid involved in 40 - 50
• 75 are low grade have good prognosis
• 1 5 year survival 85
• High grade mucoepidermoid carcinomas invade
  locally, spread regionally distant mets
• 5 year survival drops 30

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Salivary Glands

• Adenocystic carcinoma(Cylindroma)
• Commonly involves submandibular (35 - 40), only
  7 of parotid malignancies
• Slowly growing
• Perineural invasion
• 30 lymph node mets, 50 distant mets
• 5 year survival 75
• 10 year survival 30
• 20 year survival 13

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Salivary Glands

• Mixed malignant tumour
• Long standing pleomorphic adenoma
• Older age group
• Worse prognosis
• Lymph node mets 15
• Distant mets 30
• 5 year survival 40 - 50
• 15 year survival 20

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Salivary Glands

• Acinic cell carcinoma
• Low grade
• Slow growing
• 10 of malignant parotid tumour
• Lymph node mets 10
• Aggressive tumours
• Radical parotidectomy

10
Salivary Glands

• Squamous cell carcinomas
• Infrequent occurrence 1 - 5
• May have skin infiltration
• Total radical parotidectomy_

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Salivary GlandsEvaluation Diagnosis

• History clinical examination
• Sialography of no value
• CT scans
• CT sialography for retromandibular/parapharayngeal
  
• MRI
• Incisional biopsy containdicated
• FNAC

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Salivary GlandsStaging System

• T0 no clinical evidence of primary tumour
• T1 0.1 2.0 cms diameter without significant
  local extension
• T2 2.1 4 cms without local extension
• T3 4.1 6.0 cms without local extension
• T4a gt6 cms without local extension
• T4b tumour of any size with significant extension

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Salivary GlandsStaging system

• N0 no evidence of regional nodal involvement
• N1 evidence of regional nodal involvement
• Nx regional nodes not assessed
• M0 no distant mets
• M1 distant mets eg., bone, lung, etc.

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Salivary GlandsSurgical complications

• Flap necrosis
• Seromas haematomas
• Oropharangeal cutaneous fistulas
• Carotid rupture
• Thoracic duct fistula
• Pneumothorax
• Airway obstruction, dysphagia, oedema, loss of
  tongue mobility, superoir laryngeal nerve damage

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Neck swellingsDifferential diagnosis

• Neck divided into ant. And posterior triangle by
  sternocleidomastoid
• Cervical lymphadenopathy commonest cause of neck
  swelling

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Neck SwellingsD/D (benign)

• Congenital swellings branchial cleft swellings,
  thyroglossal duct cyst, laryngocoele,
  haemangiomas, cystic hygromas, dermoid.
• Inflammatory acute chronic lymphadenitis(
  infectious mononucleosis, toxoplasmosis, cat
  scratch fever, actinomycosis, histoplasmosis,
  tuberculosis
• traumatic aneurysms, av malformation,
  torticollis, etc
• Pharyngeal pouch, cervical ribs, thyroid, etc

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Neck swellings

• Branchial cleft cyst
• Remnants of incompletely obliterated branchial
  clefts/pouches
• Located anterior deep to sternomastoid
• Painless swelling
• Young adults
• M F ratio
• Unilateral, 75 on left side

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Neck swellings

• Thyroglossal duct cyst
• 70 of all congenital cysts
• Arrested migration of thyroid
• Painless midline swelling
• Sistrunk operation

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Neck swellings

• Csytic hygroma
• Collection of lymph sacs
• Present at the root of neck(post. Triangle), arm,
  groin.
• Pharyngeal pouch
• Pulsion divertuculum
• Uncoordinated swallowing
• Sternomastoid tumour
• Birth trauma, infarcted segment , fibrosis,
  torticollis

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Neck swellings

• Cervical rib
• Extra cervical rib
• lt 1 population
• Neurological and vascular problems
• Ranula
• Mucous containing cyst in floor of mouth
• Painless midline, spherical, smooth, fluctuant,
  transillumanant
• Dermoid cyst
• Midline, asymtomatic, painful when infected
• Laryngocoele
• Diverticulum of laryngeal ventricle
• Lined by epithelium
• Common in glass blowers/wind instruments
  musicians, etc

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Neck swellingsTumours

• Benign Carotid body tumour, lipoma, soft tissue
  tumour
• Malignant skin tumours( SCC, BCC, melanomas),
  thyroid tumours, salivary gland tumours
• Carotid body tumour
• Sporadic occurrence 90
• Familial 10
• Unilateral, but bilateral/multicentric 10
  sporadic, 50 bilateral familial
• Grows 0.5 cms/year

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Schedule of Lectures V Med

• Salivary glands Neck Swellings
• Skin soft tissue tumours
• Benign Malignant breast diseases
• Thyroid, parathyroid disorders, carcinoid,
  phaechromocytoma, MEN syndrome
• Oesophageal gastric disorders
• Small bowel obstruction, Crohns disease,
  meckels, etc
• Colon rectal diseases
• Hepatobiliary disorders

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Lectures

• Pancreatic disorders
• Hernias
• Arterial venous disorders
• Osteoarthritis Rheumatoid arthritis
• Fluid electrolyte balance, nutrition
• Preoperative preparation, haemostasis blood
  transfusion
• Trauma burn Management
• Common urological problems
• Common orthopaedic problems
• Common cardiothoracic problems
• Common neurosurgical problems