Salivary Glands

Anatomy and Tumors

Dr. Mahmoud W. Qandeel

 Anatomy
• Major Glands
– Parotid, submandibular and sublingual glands

• Minor Glands
– Hundreds residing in the oral
cavity, pharynx and
paranasal sinuses.

Dr. Mahmoud W. Qandeel

 Parotid Gland
• Facial nerve divides the gland into the superficial (80 %) and deep lobe (20%)
• Parotid duct (Stensons) is 5 cm long and opens opposite the 2nd molar.
• Lymphatic drainage – periparotid/intraparotid – lvl I – lvl II- lvl III.
• Accessory parotid lobe – Present in 20% of patients.

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
 Submandibular Gland
• Borders
– Lateral – proximal half of the mandible.
– Posterior – anterior to but near the low anterior margin of the parotid gland.
– Inferior – approaches the level of the hyoid bone.
– Majority of gland lies over the external surface of the mylohyoid muscle.
– Lateral to and abuts the lingual and hypoglossal nerve and is medial to the
marginal mandibular and cervical branch of the facial nerve.
• Drains through Wharton’s duct in anterior floor of the mouth
• Lymphatic Drainage Lvl I – Lvl II- Lvl III

Dr. Mahmoud W. Qandeel

 Sublingual Gland
• 10% size of parotid gland
• Located anterior floor of the mouth
• Borders
– Lateral –medial aspect of mandible
– Inferior –mylohyoid muscle
• Lingual nerve courses adjacent to sublingual gland
• Drain into the floor of the mouth through Rivinus ducts
• Lymphatic drainage – Lvl I- Lvl II- Lvl III

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
 Epidemiology
• Salivary tumors 7% of head and neck tumors
• Parotid tumors 10x more common then submandibular and 100x more
common then lingual
– Parotid 80% benign (pleomorphic adenoma)
– Submandibular 50% malignant
– Sublingual majority (65-88%) are malignant
• Equal incidence between sexes
• Risk Factors: nutritional deficiency, exposure to ionizing radiation, UV
exposure, genetic predisposition, EBV

Dr. Mahmoud W. Qandeel

 Surgical pathology
• Some tumors occur only in salivary glands with variable biological behavior
• 70-80% of those tumors found in parotid, 10% to 15% in the submandibular
gland
• Of the parotid tumors 70-80% benign and 70-80% of them is pleomorphic
adenoma.
• The next benign tumor is monomorphic adenoma(papillary cystadenoma
lymphomatosum; Warthin’s tumor.

Dr. Mahmoud W. Qandeel

• Malignancies are often asymptomatic,
• Signs and symptoms indicative of a malignancy include
– Rapid tumor enlargement,
– Pain,
– Trismus, and
– Facial or other cranial nerve paralyses

• A key diagnostic test, which has 95% sensitivity in salivary

gland neoplasms, is fine needle aspiration

Dr. Mahmoud W. Qandeel

General features of salivary gland tumors in adults and children

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
 Pleomorphic adenoma
• The commonest tumor mainly in parotid.
• Slight female predominance, 5th decade.
• Usually unilateral solitary painless mass, no nerve injury, grow slowly
with rapid shots capsulated by the compressed normal tissue, but
tumor extends through the capsule.
• Epith. and mesoderm. elements
• Malignant degeneration 2-10% in long period.
• 75% in parotid, 5-10% in submandibular, 10% in sublingual.

Dr. Mahmoud W. Qandeel

 Monomorphic adenoma
Warthin's tumor (papillary cystadenoma lymphomatosum)
• Only seen in parotid gland.
• Male : female ratio being 7:1
• Peak age is 7th decade
• 10% bilateral but rarely synchronously.
• Soft ,cystic and often fluctuant.
• Probably arise from lymph tissue in the parotid gland.

Dr. Mahmoud W. Qandeel

 Mucoepidermoid carcinoma
• The most common malignant tumor of the parotid gland.
• Usually has facial nerve palsy.
• Can be divided into low-grade and high-grade tumors.
• High-grade lesions have a propensity for regional and distant metastases.

Dr. Mahmoud W. Qandeel

 Adenoid cystic carcinoma
• The commonest malignant tumor in minor salivary glands.
• Age incidence is 6th decade ,equal M:F
• Pain is the commonest presenting feature
• Vascular dissemination more than lymph.
• Spread along nerve sheaths
• Distant Mets mainly to lungs
• Survival rates 70% at 5 years and 40% at 10 years, but inevitably fatal.

Dr. Mahmoud W. Qandeel

 Adenocarcinoma
• 3% of parotid and 10% of submandibular and minor glands tumors
• Six incidence is equal, common in children
• The undifferentiated type is aggressive.
• 23% pre operative facial nerve paralysis

Dr. Mahmoud W. Qandeel

 Squamous cell carcinoma
• Rare and never occurs in the minor glands
• 2/3 of pt. are men ,age incidence is 7th decade
• Grows rapidly, causing pain ,facial paralysis, skin fixation and ulceration.
• ½ of pt. has lymph node mets when first seen
• Arise from the duct system.

Dr. Mahmoud W. Qandeel

 Treatment policy in benign tumors

Parotid :
• superficial parotidectomy , and hemi superficial parotidectomy.

Submandibular :
• Simple removal of the gland

Minor glands :
• Mostly local removal with primary closure.

Dr. Mahmoud W. Qandeel

 Treatment policy in malignant tumors

Parotid :
• Total parotidectomy ,nerve removal and grafted, possible neck
dissection for lymph nodes, adjuvant radiotherapy, removal of adjacent
structures.

Submandibular :
• Wide removal of the gland and adjacent tissues

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel