Salivary Glands

• Three paired glands

Parotid; largest of the major salivary
glands
• Two Lobes divided by facial nerve
• Submandibular gland Deep to mylohyoid,
superficial to hyoglossus
• Sublingual; Smallest of the salivary
glands
• Common surgical disease; infection/calculi
 Salivary Glands
{Benign conditions}
• Mumps:
• Acute painful parotitis
• Viral in aetiology
• Self limiting

• Mikulicz’s Syndrome
• Bilateral enlargement of salivary & lacrimal glands

• Sjogren’s Syndrome
• Triad of dry eyes, dry mouth, dry joints
• Autoimmune
• Lymphocytic infiltration

• Pyogenic parotitis
• Surgical, debilitated patients
• Staphylococcus
• Swollen, painful parotid glands
• Pus from stensen’s duct
 Salivary glands
{Benign Tumours}
• Comprise 3% - 6% of all head & neck tumours
• Pleomorphic Adenoma
• Commonest tumour (53% - 71%)
• Slowly growing, painless, solitary, firm, smooth,
moveable without nerve involvement
• Both mesenchymal/epithelial elements
• FNA, CT, MRI
• Superficial parotidectomy
 Salivary Glands
Tumours
• Warthin’s tumour(adenolymphoma,
papillary cystadenoma lymphomatosum)
• 6% - 10%
• Benign, bilateral, parotid gland only,
• Older age group
• Superficial location
• Malignant potential non existent
 Salivary Glands
MalignantTumours
• Locally aggressive
• Grow along neural pathways, may access
skull base and brain eventually
• Also lymphatic and haematogenous
spread
•
 Salivary Galnds
Malignant Tumours
• Mucoepidermoid Carcinoma
• Commonest malignant tumour
• 50% of all salivary gland malignancies
• Parotid involved in 40% - 50%
• 75% are low grade & have good prognosis
• 1 – 5 year survival 85%
• High grade mucoepidermoid carcinomas invade
locally, spread regionally & distant mets
• 5 year survival drops 30%
 Salivary Glands
• Adenocystic carcinoma(Cylindroma)
• Commonly involves submandibular (35% - 40%),
only 7% of parotid malignancies
• Slowly growing
• Perineural invasion
• 30% lymph node mets, 50% distant mets
• 5 year survival 75%
• 10 year survival 30%
• 20 year survival 13%
 Salivary Glands
• Mixed malignant tumour
• Long standing pleomorphic adenoma
• Older age group
• Worse prognosis
• Lymph node mets 15%
• Distant mets 30%
• 5 year survival 40% - 50%
• 15% year survival 20%
 Salivary Glands
• Acinic cell carcinoma
• Low grade
• Slow growing
• 10% of malignant parotid tumour
• Lymph node mets 10%
• Aggressive tumours
• Radical parotidectomy
 Salivary Glands
• Squamous cell carcinomas
• Infrequent occurrence 1% - 5%
• May have skin infiltration
• Total radical parotidectomy_
 Salivary Glands
Evaluation & Diagnosis
• History & clinical examination
• Sialography – of no value
• CT scans
• CT sialography for
retromandibular/parapharayngeal
• MRI
• Incisional biopsy containdicated
• FNAC
 Salivary Glands
Staging System
• T0 no clinical evidence of primary tumour
• T1 0.1 – 2.0 cms diameter without
significant local extension
• T2 2.1 – 4 cms without local extension
• T3 4.1 – 6.0 cms without local extension
• T4a >6 cms without local extension
• T4b tumour of any size with significant
extension
 Salivary Glands
Staging system
• N0 no evidence of regional nodal
involvement
• N1 evidence of regional nodal involvement
• Nx regional nodes not assessed
• M0 no distant mets
• M1 distant mets eg., bone, lung, etc.
 Salivary Glands
Surgical complications
• Flap necrosis
• Seromas & haematomas
• Oropharangeal cutaneous fistulas
• Carotid rupture
• Thoracic duct fistula
• Pneumothorax
• Airway obstruction, dysphagia, oedema, loss of
tongue mobility, superoir laryngeal nerve
damage
 Neck swellings
Differential diagnosis
• Neck divided into ant. And posterior
triangle by sternocleidomastoid
• Cervical lymphadenopathy commonest
cause of neck swelling
 Neck Swellings
D/D (benign)
• Congenital swellings; branchial cleft swellings,
thyroglossal duct cyst, laryngocoele,
haemangiomas, cystic hygromas, dermoid.
• Inflammatory: acute & chronic
lymphadenitis( infectious mononucleosis,
toxoplasmosis, cat scratch fever, actinomycosis,
histoplasmosis, tuberculosis
• traumatic: aneurysms, av malformation,
torticollis, etc
• Pharyngeal pouch, cervical ribs, thyroid, etc
 Neck swellings
• Branchial cleft cyst
• Remnants of incompletely obliterated
branchial clefts/pouches
• Located anterior & deep to sternomastoid
• Painless swelling
• Young adults
• M= F ratio
• Unilateral, 75% on left side
 Neck swellings
• Thyroglossal duct cyst
• 70% of all congenital cysts
• Arrested migration of thyroid
• Painless midline swelling
• Sistrunk operation
 Neck swellings
• Csytic hygroma
• Collection of lymph sacs
• Present at the root of neck(post. Triangle), arm, groin.

• Pharyngeal pouch
• Pulsion divertuculum
• Uncoordinated swallowing

• Sternomastoid tumour
• Birth trauma, infarcted segment , fibrosis, torticollis
 Neck swellings
• Cervical rib
• Extra cervical rib
• < 1% population
• Neurological and vascular problems

• Ranula
• Mucous containing cyst in floor of mouth
• Painless midline, spherical, smooth, fluctuant, transillumanant

• Dermoid cyst
• Midline, asymtomatic, painful when infected

• Laryngocoele
• Diverticulum of laryngeal ventricle
• Lined by epithelium
• Common in glass blowers/wind instruments musicians, etc
 Neck swellings
Tumours
• Benign; Carotid body tumour, lipoma, soft tissue tumour
• Malignant: skin tumours( SCC, BCC, melanomas),
thyroid tumours, salivary gland tumours

• Carotid body tumour

• Sporadic occurrence 90%
• Familial 10%
• Unilateral, but bilateral/multicentric 10% sporadic, 50%
bilateral familial
• Grows 0.5 cms/year
 Schedule of Lectures V Med
• Salivary glands & Neck Swellings
• Skin & soft tissue tumours
• Benign & Malignant breast diseases
• Thyroid, parathyroid disorders, carcinoid,
phaechromocytoma, MEN syndrome
• Oesophageal & gastric disorders
• Small bowel obstruction, Crohn’s disease,
meckel’s, etc
• Colon & rectal diseases
• Hepatobiliary disorders
•
 Lectures
• Pancreatic disorders
• Hernias
• Arterial & venous disorders
• Osteoarthritis Rheumatoid arthritis
• Fluid & electrolyte balance, nutrition
• Preoperative preparation, haemostasis & blood
transfusion
• Trauma & burn Management
• Common urological problems
• Common orthopaedic problems
• Common cardiothoracic problems
• Common neurosurgical problems