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Surgery M4 part 1 > Salivary neoplasms > Flashcards

Salivary neoplasms Flashcards

1
Q

Which salivary gland is more prone to development of benign neoplasms?

A

Parotid gland 80% are benign
Submandibular 50% are benign
Minor glands 10% are benign

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2
Q

Which salivary glands have the highest malignancy rate?

A

minor salivary glands

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3
Q

What is the classification of salivary neoplasms?

A

PRIMARY

  • > epithelial
  • > non-epithelial
  • > lymphoepithelial
  • > lymphoma

SECONDARY

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4
Q

What is the sub-classification of epithelial salivary neoplasms?

A

BENIGN (adenoma)

  • pleomorphic (most common)
  • Wathin’s (monomorphic): papillary cystadenolymphomatosum
  • Oxyphil: oncocytoma

MALIGNANT (adenocarcinoma)

  • mucoepidermoid
  • acinic cell
  • adenoid cystic
  • squamous cell carcinoma
  • carcinoma ex pleomorphic adenoma
  • undifferentiated
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5
Q

What are the types of non-epithelial salivary neoplasms?

A
  • hemangioma: most common benign tumor in pediatrics
  • lymphangioma
  • neurofibroma
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6
Q

Which benign salivary neoplasm occurs mainly in the parotids, & in common with HIV & Sjogren?

A

Lymphoma (NON-HODGKIN)

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7
Q

Which benign salivary neoplasm occurs mainly in the parotids, & in common with HIV & Sjogren?

A

Lymphoma (NON-HODGKIN)

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8
Q

What are the types of lymphoepithelial salivary neoplasms?

A
  • Godwin’s tumor: benign & bilateral

- Eskimoma: malignant & rare (affects submandibular)

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9
Q

What are the types of lymphoepithelial salivary neoplasms?

A
  • Godwin’s tumor: benign & bilateral

- Eskimoma: malignant & rare (affects submandibular)

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10
Q

How is a pleomorphic adenoma described grossly & histologically?

A

GROSS

  • lobulated encapsulated
  • contains cartilages, cystic spaces, & solid tissues

HISTOLOGICALLY

  • epithelial cell, myoepithelial cells, stromal cells
  • mucoid material with myxomatous changes
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11
Q

What are the clinical features of a pleomorphic adenoma?

A
  • unilateral single painless smooth firm lobulated
  • mobile swelling in front of the parotid with positive CURTAIN SIGN (can never move above zygomatic arch)
  • ear lobule is lifted
  • facial nerve in not involved
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12
Q

What are the features of malignant transformation?

A
  • recent increase in size
  • pain & nodularity
  • involvement of skin & ulceration
  • involvement of masseter
  • involvement of facial nerve
  • hard fixed immobile neck lymph nodes
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13
Q

What are the important investigations that should be done to diagnose a pleomorphic neoplasm?

A
  • sonography: initially
  • FNAC: diagnostic
  • CT & MRI: status of deep lobe, local extension & spread
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14
Q

How should a salivary pleomorphic neoplasm be treated?

A
  • if only superficial lobe: conservative superficial parotidectomy
  • if both lobes: total conservative parotidectomy

enucleation is avoided due to high recurrence because of psuedopods (incomplete capsule)

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15
Q

Which tumor is composed of a double layer of columnar epithelium with papillary projections into cystic spaces with lymphoid tissues in the stroma, that only occurs in the parotid gland’s lower pole?

A

Warthin’s tumor = Adenolymphoma = Papillary cystadenolymphomatosum

DOES NOT TURN INTO MALIGNANCY

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16
Q

What are the clinical features of Warthin’s tumor?

A
  • bilateral non tender
  • common in males
  • common in old people
  • only in lower part of superficial lobe of parotid gland
  • slow growing, smooth, soft, cystic, fluctuant swelling
17
Q

What is the diagnostic method of investigation in case of papillary cystadenolymphomatosum (Warthin’s tumor)?

A

99TECHNETIUM SCAN -> hot nodule

fnac could be used as well

18
Q

What is the treatment of papillary cystadenolymphomatosum?

A

conservative superficial parotidectomy

19
Q

What tumor is characterized by presences of oncocytes & its red color? How should it be treated?

A

Oxyphil adenoma (oncocytoma)

Surgical removal

20
Q

What is the commonest malignant salivary gland tumor?

A

Mucoepidermoid tumor

21
Q

What are the types of mucoepidermoid tumor?

A

low grade: mucus cells mainly
high grade: epidermoid cells mainly

facial nerve involvement is late

22
Q

What are the clinical features of a mucoepidermoid tumor?

A
  • swelling in parotid or submandibular region
  • slowly increasing in size
  • attains large size, hard, nodular, with involvement of skin & lymph nodes
23
Q

Which malignant salivary neoplasm is characteristically soft & cystic but can involve the facial nerve or neck lymph nodes?

A

Acinic cell tumor

24
Q

What is the most severe malignant salivary neoplasms & where does it commonly occur?

A

adenoid cystic carcinoma

- in submandibular & minor salivary glands

25
Q

What is invaded in adenoid cystic carcinoma?

A
  • facial nerve (very early) & shows perineural spread
  • periosteum & bone medulla early & spreads extensively

poor prognosis

26
Q

How should adenoid cystic carcinoma be treated?

A

RADICAL parotidectomy & radical radiotherapy

27
Q

What are the general features of malignant salivary tumors?

A
  • pain & anesthesia in the skin & mucosa
  • rapid rate of growth
  • fixation, irregular, nodular, ill-defined edge, hard
  • resorption of adjacent bone
  • infiltration of skin, muscles, vessels, & nerves (facial nerve in parotid/hypoglossal nerve in submandibular)
  • involvement of jaw & mastication muscles
  • spread to LUNGS
28
Q

What is the most important method of investigation in case of malignancy?

A

MRI -> shows better soft tissue definition

29
Q

What investigations are used in malignant salivary gland tumors?

A
  • CT: to see deep lobe of parotid, involvement of bone, extension into base of skull, relation of tumor to vessels
  • MRI: better soft tissue definition
  • FNAC: from tumor or lymph node
  • incisional biopsy: only from minor salivary glands
30
Q

How should a malignancy in the parotid gland be treated surgically?

A

RADICAL PAROTIDECtOMY

  • removal of both lobes of parotid, soft tissues, part of the mandible with the facial nerve
  • facial nerve is reconstructed using GREATER AURICULAR NERVE or SURAL NERVE
  • radical neck dissection if lymph nodes are involved
31
Q

How should a malignant tumor in the submandibular gland be treated surgically?

A

WIDE EXCISION with removal of adjacent muscle, soft tissues & mandible
- block dissection of neck in case of lymph node involvement

32
Q

Why is radiotherapy used in case of malignant salivary tumors?

A
  • reduce chances of relapse
  • more useful in ADENOID CYSTIC & squamous cell carcinoma
  • adjuvant or neo-adjuvant therapy (pre-op to try to shrink the tumor)
33
Q

What are the post-parotidectomy complications?

A

GENERAL

  • hemorrhage
  • SSI
  • flap necrosis

SPECIFIC

  • Frey’s syndrome
  • Facial nerve injury
34
Q

What are the clinical features of Frey’s syndrome?

A

AKA auriculo-temporal syndrome & gustatory sweating

  • flushing, sweating, pain, hyperaesthesia in the skin over the face innervated by the auriculotemporal nerve whenever salivation is stimulated (mastication)
35
Q

How is Frey’s syndrome prevented OR treated?

A

PREVENT

  • avoid overdissection
  • insert flap like sternomastoid muscle of temporal fascia as a barrier over the parotid bed

TREAT

  • Jacobsen nerve neurectomy
  • injection of botulinum toxin to the affected skin
36
Q

What are the causes of facial nerve injury?

A
  • trauma
  • surgical complications
  • Bell’s palsy (viral infection)
37
Q

What are the clinical features of facial nerve injury?

A
  • inability to wrinkle brow (frontalis)
  • drooping eyelid, inability to close eye (orbicularis oculi)
  • inability to puff cheek, asymmetric smile (buccinator)
  • drooping corner of mouth, dry mouth (facial expression muscles)
38
Q

How should facial nerve injury be treated?

A
  • conservative & reassurance (30% are temporary)

- if persistent: surgical intervention

39
Q

What surgeries could be done incase of facial nerve injuries?

A

STATIC

  • suspension surgery using temporal fascia
  • lateral tarsoraphy
  • upper eyelid weights

DYNAMIC

  • muscle transfer (temporal to masseter)
  • free muscle graft (Gracilis)
  • nerve grafts (Sural nerve)

Surgery M4 part 1 (47 decks)

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