Salivary gland tumours

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Neoplastic lesions of the salivary glands are divided into benign or malignant. Malignant lesions are further divided into primary and secondary.

Contents

Classification

About 80% of salivary gland tumours arise in the parotid gland. 80% of these are benign, 80% are pleomorphic adenoma. One in three tumours in the submandibular gland and one in two in the minor salivary glands are malignant.

Benign

Malignant

Variable

  • Mucoepidermoid carcinoma
  • Acinic cell carcinoma

Non-epithelial

  • Haemangioma
  • Lymphangioma
  • Neurofibroma
  • Lymphoma

Clinical assessment

  • Inspect the mass
  • Inspect the rest of the ears, nose, throat, head and neck
  • Check the cranial nerves (if facial nerve palsy, probably malignant tumour)
  • Fine needle aspiration is 95% sensitive, and is safe
  • Imaging with CT or MRI

Malignant tumours

Malignant tumours of the salivary glands are described using the UICC system.

Tumour
T0 No evidence of primary tumour
T1 Tumour <2 cm, without parenchymal extension
T2 Tumour >2 cm but <4 cm, without parenchymal extension
T3 Tumour 4-6cm or with parenchymal extension, but without facial nerve invovlement
T4 Tumour >6 cm, or invades skull base, or invades facial nerve
T4a No local extension
T4b Local extension involving skin, soft tissue, bone or nerve
Nodes
N0 No regional lymph node metastasis
N1 Metastasis in single ipsilateral node, <3 cm in greatest diameter
N2a Single ispilateral node involvement, 3-6 cm
N2b Multiple ipsilateral node involvement, all <6 cm
N2c Contrlateral or bilateral node involvement, <6 cm
N3 Node involvement >6 cm
Metastasis
M0 No distant metastasis
M1 Distant metastasis


Complications of parotid surgery

  • Haematoma
  • Nerve damage: temporary nerve paralysis of the facial nerve occurs in 10% of patients; permenent dysfunction is rare (less than 2%).
  • Frey's syndrome - gustatory sweating.
  • Salivary fistula

Salivary tumours in children

Salivary tumours are rare in children, and occur mainly in the parotid. Only 3% of parotid neoplasms occur in patients under 16 years old.

Benign tumours

Mixed tumours are the most common tumours by far. The peak incidence occurs at 10 years old. The behaviour of the tumours is similar to those in adults. Haemangiomas are the next most common tumour.

Malignant tumours

These are very rare. Well differentiated / high grade mucoepidermoid carcinoma is the most common malignant parotid tumour in children.

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