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Parotid Tumors and Other Salivary Gland Tumors

Parotid Tumors and Other Salivary Gland Tumors


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Published by drhiwaomer
surgical lecture
surgical lecture

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Published by: drhiwaomer on Apr 04, 2008
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Dr. Hiwa Omer Ahmed Assistant professor in General Surgery

There are three main paired glands in the head and neck producing saliva. They are the: parotid glands submandibular glands sublingual glands The parotid glands are the largest and overlie the angle of the jaw in front of the ear. A tube, known as Stensens duct, drains saliva from the glands into the mouth. The openings are inside the cheek opposite the upper molar teeth.


Areas of parotid




Facial palsy


The submandibular glands lie deep to the horizontal part of the lower jaw. Their ducts are the longest and narrowest of all the salivary glands, and enter the mouth under the front of the tongue. The sublingual glands lie deep in the lining of the mouth on each side of the tongue. These glands have many short ducts entering the mouth directly through the mouth lining. In addition to these major glands there are hundreds of minor salivary glands throughout the lining of the mouth and throat, with most on the lips and soft palate

 Salivary

glands produce saliva in response to food being placed in the mouth. Even the thought or smell of food can stimulate salivary flow and most people make about one litre of saliva per day. As well being 99.5% water, saliva has minerals and proteins that aid digestion and keep the mouth and teeth healthy.

Mumps & parotitis
is a viral infection that primarily affects the parotid glands — one of three pairs of salivary glands, located below and in front of your ears. It can cause swelling in one or both parotid glands



 About

one-third of people infected with the mumps virus have no signs or symptoms. When signs and symptoms do develop, they usually appear about two to three weeks after exposure to the virus and may include:  Swollen, painful salivary glands on one or both sides of the face  Pain with chewing or swallowing  Fever  Weakness and fatigue  Tenderness and swelling of a testicle (orchitis)

Signs and symptoms

 

Complications of mumps are potentially serious, but rare. These include: Orchitis. This inflammatory condition causes swelling of one or both testicles. Orchitis is painful, but it rarely leads to sterility — the inability to conceive a child. Pancreatitis. This disease causes swelling of the pancreas. Signs and symptoms of pancreatitis include pain in the upper abdomen, nausea and vomiting. Encephalitis. Encephalitis is inflammation of the brain caused by a viral infection, such as mumps. Encephalitis can lead to neurologic problems and become life-threatening. Although it's serious, encephalitis is a rare complication of mumps.


Meningitis. Meningitis is infection and inflammation of the membranes and fluid surrounding your brain and spinal cord. It can occur if the mumps virus spreads through your bloodstream to infect your central nervous system. Like encephalitis, meningitis is a rare complication of mumps. Inflammation of the ovaries. Pain in the lower abdomen in women may be a symptom of this problem. Fertility doesn't seem to be affected. Hearing loss. In rare cases, mumps can cause temporary or permanent hearing loss in one or both ears.

 In

general, you're considered immune to mumps if you've previously had the infection or if you've been immunized against mumps.  The mumps vaccine is usually given as a combined measles-mumps-rubella (MMR) inoculation, which contains the safest and most effective form of each vaccine. Doctors recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 3 and 6 years of age — before entering school.

 Because

mumps is caused by a virus, antibiotics are not an effective treatment.  Like most viral illnesses, mumps infection must simply run its course. Fortunately, most children and adults recover from an uncomplicated case of mumps within two weeks' time

 If

you or your child has mumps, time and rest are the best treatments. There's little your doctor can do to speed recovery. But you can take some steps to ease pain and discomfort and keep others from becoming infected:  Rest in bed until the fever goes away.  Isolate yourself or your child to prevent spreading the disease to others.  Take acetaminophen (Tylenol, others) or a nonsteroidal anti-inflammatory drug such as ibuprofen (Advil, Motrin, others) to ease symptoms. Adults may also use aspirin. Don't give aspirin to children because of the risk of Reye's syndrome, a rare but


 Use

a cold compress to ease the pain of swollen glands.  Wear an athletic supporter to ease the pain of tender testicles.  Avoid foods that require lots of chewing. Instead, try broth-based soups or soft foods, such as mashed potatoes or cooked oatmeal, for nourishment.  Avoid sour foods such as citrus fruits or juices that stimulate saliva production.  Drink plenty of fluids.  Plan low-key activities.

 There

are three main salivary glands in the head and neck and hundreds of tiny ones. Stones usually occur in the submandibular glands, less frequently in the parotid gland and very rarely in the sublingual and minor salivary glands.  Stones form from mineral deposits in the gland ducts, causing swelling and pain and sometimes becoming infected.

symptoms of a salivary stone
 Stones

in the affected gland or duct cause obstruction to the flow of saliva, resulting in swelling of the gland. The swelling can be painful and usually occurs during eating or when thinking about food. It usually settles slowly after finishing a meal and can be aided by massaging the gland, which will feel firm and be tender.  Sometimes the swelling remains and occasionally the gland can become infected and abscessed resulting in fever, severe pain and inflammation in the overlying skin


Intermittent of incomplete obstruction

 The

majority (80%) of these stones are visible on plain x-ray, however some are not seen on x-ray so are investigated using ultrasound or a sialogram:  An ultrasound scan is a painless procedure using high frequency echoes where the gland and duct can be identified by probe. Stones may be seen as shadows within the gland or duct.

salivary stone

Salivary gland tumors are rare: as few as 3 out of 100,000 people develop salivary gland tumors per year. Men are more likely to develop salivary gland tumors than women, and the peak incidence occurs between thirty and fifty years of age. Eighty percent of all salivary growth tumors are benign

Parotid Tumors and Other Salivary Gland Tumors

parotid tumor

Benign Tumors of the Parotid Gland
The majority of salivary gland tumors occur in the parotid glands, the pair of major salivary glands located in front of the ears. Parotid gland tumors are usually benign pleomorphic adenomas. Although often benign, a parotid gland tumor can block the salivary gland and cause a dry mouth

Mixed adenoma

 Salivary

gland tumors that develop in the submandibular, sublingual, and minor salivary glands are more likely to be malignant than parotid gland tumors. Mucoepidermoid carcinoma is the most common type of malignant salivary gland tumor. Other salivary gland tumors include adenoid cystic carcinoma, acinic cell carcinoma, adenocarcinoma, and squamous cell carcinoma.

Malignant Salivary Gland Tumors

Malignant tumor

Risk Factors
Salivary gland tumors have been linked to sunlight exposure, alcohol consumption, and hair dye chemicals. Herpes and HIV may also increase the risk of salivary gland cancer. Links have been discovered between breast cancer and salivary gland tumors. While the exact connection is unclear, the presence of breast cancer does increase the risk of salivary gland tumors.

Symptoms of Salivary Gland  Tumors
difficulty swallowing or chewing difficulty speaking pain (as the tumor grows) swelling lumps or growths in the mouth dry mouth facial paralysis (due to pressure on facial nerves by the tumor).

Diagnosis of Salivary Gland Tumors

biopsy  Diagnostic imaging tools, such as an MRI or CAT scan, provide information on the location, size, and shape of the tumor.

adenoid cystic carcinoma

 depends

on tumor size. Tumors larger than four centimeters tend to have a worse prognosis than smaller growths. Survival rates vary depending on the type of cancer. The five-year survival rate for parotid gland cancer is 85 percent, even if the cancer has affected local lymph nodes.

Treatment Options

Surgical removal of the tumor is the standard treatment option whether the growth is a benign parotid gland tumor or a malignant cancer.  Radiation therapy is used if the tumor is large or if the cancer returns after initial treatment. Radiation therapy carries the risk of permanently damaging salivary glands.
 Chemotherapy

is occasionally used in salivary gland tumor treatment, but its use is usually limited to palliative pain

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