The parotid glands would be the largest from the salivary glands. They are located in the infra-auricular region. The parotid has a deep and a superficial lobe. The facial nerve traverses the deep lobe.
The parotid includes a fascial covering that is continuous with the SMAS. The parotid duct (Stenson's duct) passes superficial to the masseter muscle and pierces the buccinator muscle. It enters the mouth area at the level of the upper second molar. All parotid masses should undergo fine needle aspiration for diagnosis. Imaging is generally not necessary, although an MRI may be useful when the tumor is large (over 3 cm).
The most typical tumor from the parotid is the benign pleomorphic adenoma (benign mixed tumor). They are treated by superficial parotidectomy (unless the tumor is in the deep lobe which is rare). If incompletely resected, they are able to recur and become locally invasive. If left untreated, they can degenerate into a malignant mixed tumor that is vulnerable to early metastasis.
Warthin's tumor is a benign cystic tumor. Ten percent are bilateral, which makes it the most typical bilateral parotid tumor. It happens primarily in male smokers. Superficial parotidectomy is sufficient treatment.
The most typical malignancy in the parotid may be the mucoepidermoid carcinoma. Such malignant tumors require excision of both superficial and deep lobes from the parotid. The facial nerve is spared unless the tumor directly invades the nerve. Nerve contaminated with tumor that is left behind should receive adjuvant radiation postoperatively. High-grade (anaplastic) mucoepidermoid carcinoma warrants a simultaneous neck dissection.
Complications from parotidectomy are uncommon. Facial nerve injury is easily the most devastating; any recognized facial nerve injury should be repaired during the time of injury. Hematoma can be avoided by meticulous hemostatic technique.
Frey's syndrome (auricular temporal syndrome) is gustatory sweating because of reinnervation of sweat fibers by severed salivomotor fibers. Botox treatments have shown some promise in treating this condition. Development of a sialocele is treated by aspiration and compression.
The paired submandibular and sublingual glands can be found below the mandible and in the floor from the mouth, respectively. Wharton's duct may be the submandibular duct that enters the floor of the mouth. The most common malignancy in these glands may be the mucoepidermoid carcinoma. Complete excision from the affected gland is required.
Minor salivary glands are mucus-secreting glands located below the oral submucosa. Most minor salivary gland tumors are malignant. The most typical number of these glands may be the adenoid cystic carcinoma. Treatment includes wide local excision.
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Note: This article was sent to us by: Keith Hayes at 02142011
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