The Parotid gland is the salivary gland which is situated laterally near the mandible.
Approximately 75% of neoplasm of salivary glands occur in the parotid glands. 80% of parotid tumours are benign and of these 80% are called pleomorphic adenomas.
Classification of parotid tumours:
1. Adenoma
A) Pleomorphic
- Any age, no gender predilection
- 75% of all parotid tumours
- Over 60 years of age
B) Warthin's tumour
- Over 60 years
- Male to female ratio is 4:1
- Acinic cell Carcinoma: Low grade malignancy
- Adenoid Cystic carcinoma: Commonly seen in USA. Invariably fatal due to perineural spread and pulmonary metastasis
- Adenocarcinoma and Squamous Cell Carcinoma: Both have poor prognosis. Very rare. 25% have 5 year survival
- Hemangioma
- Lymphangioma
- Neurofibroma
- Neurilemma
- Mostly infants affected. Frequent spontaneous regression of any gland affected in this group.
5. Unclassified tumour
What are the characteristic features of parotid tumours?
- All parotid neoplasms are radioresistant
- No formal biopsy should be performed in parotid tumours except in tumours of ectopic salivary gland e.g. palatal salivary gland
- Sudden and rapid increase in size
- Painless tumour becomes painful and tender
- Feels stony hard
- Growth becomes fixed to the deeper structures e.g. masseter, mandible
- Overlying skin may become fixed to the swelling and looks and feels reddish blue and hot
- Evidence of facial nerve involvement causing asymmetry of face and difficulty in closing the eye
- Areas of anaesthesia over the skin
- Jaw movements become restrained
- Veins over the swelling become prominent
- Enlargement of cervical lymph node
- There may be evidence of disseminated blood borne metastasis
Outlined here is the treatment of parotid tumours:
- Benign: Superficial parotidectomy.
- Malignant: Radical parotidectomy or total conservative parotidectomy.
- Malignant metastatic lymph nodes may be treated by radical neck dissection or by radiotherapy.
Differential diagnosis of parotid swellings:
- Winged mandible
- Masseteric hypertrophy
- Lipoma
- External carotid aneurysm
- Pre- Auricular lymph node
References:
1) http://specialist-ent.com/throat/parotid-tumours.aspx
2) google pictures
Example shortcase ENT posting : (what should student do)
1) General
- Look at the patient and greet him / her
•Explain
to the patient that you are going to examine him / her
•Ask
if there is any tender parts so that you will not hurt the patient
2 )Inspection
–Surgical
scars
–Punctum
–Skin
changes / inflammation
3) Palpation
–Increased
warmth
–Tenderness
–Surface
–Edge
–Mobility
–Solid
/ cystic
–Fixed
to underlying muscle or overlying skin
4) Do a Transilluminate test
5) Ascultate for
carotid bruit
6) Test
facial nerve
Questions that always doctor ask after finish do examination!
Questions that always doctor ask after finish do examination!
•Give
Differential Diagnoses
–Pleomorphic
adenoma
–Warthin’s tumour
–Adenoid
cystic carcinoma
–Lymph
node enlargement within Parotid
–TB
Lympadenitis
•Parotid
tumour: Investigation and treatment
•Name
one diagnostic investigation?
–Fine
needle aspiration
•How
will you treat this condition?
–Parotidectomy
•Superficial
parotidectomy if benign
•Total
parotidectomy if malignant
Source : Prof Sani Slide presentation.
p/s: just sharing. not a pirates of carribean~ehhe. ^^,
