Salivary glands tumors


Introduction

 

Salivary glands are located around the mouth. They produce saliva, which moistens food to make them easier to swallow. Saliva also contains enzymes that begin the process of digestion and helps cleanse the mouth washing away bacteria and food particles.

 

There are large and small salivary glands. The major salivary glands include three pairs of salivary glands: parotid, submandibular and sublingual. The biggest are parotid, which are located on both sides of the mandible anteriorly to the ears. Submandibular salivary glands are located on the back of the mouth, medially to the angle of the jaw. Sublingual salivary glands located in the front part of the floor of the mouth. In addition to large salivary glands responsible for the production of saliva are also thousands of small salivary glands scattered throughout the mouth, throat and nasal cavities.

 

Tumors of the salivary glands are rare. Most occur in the parotid glands (80%) and are benign, although some may be malignant (cancer). There is a relationship between the size and the nature of salivary gland tumors: the greater salivary gland, the more likely it is a benign tumor.

 

Symptoms

 

  • Firm, usually painless lump inside one of the salivary glands (in front of the ear, under the chin, or on the floor of the mouth), the tumor usually grows slowly.
  • Impaired mobility of the half of the face (Bell's palsy)

 

Diagnostics

 

  • It is essential in diagnostic process to carefully take medical history and conduct palpation.
  • Fine needle aspiration biopsy (FNAB) under ultrasound (USG) is performed to determine the nature of the tumor ( benign or malignant)
  • In certain cases (such as indistinct location of the tumor, suspected malignant nature of the tumor) basic medical examination is extended by imaging: computed tomography (CT) or magnetic resonance imaging (MRI).

 

Treatment

 

Salivary gland tumors are treated surgically by removing part or total of the salivary glands. Malignant tumors in most cases require concomitant treatment: operating (removal of the salivary glands and lymph nodes of the neck) and postoperative radiotherapy.

 

Parotid surgery (parotidectomy) is performed under general anesthesia. Cut of the skin starts anteriorly to the outer ear, then behind angle of the mandible is carried out over a short distance down the neck. Usually we remove the tumor along with a fragment of the salivary gland, salivary glands total removal is carried out only in specific cases. Potential complications of parotidectomy include:

  1. motion abnormalities of the half of face (facial nerve damage);
  2. numbness around earlobe (great aural nerve damage);
  3. postoperative bleeding in postoperative cavity;
  4. retention or leakage of saliva from postoperative cavity after surgery;
  5. excessive sweating and redness of the skin around the cheek area adjacent to the ear while eating (Frey’s syndrome)

 

These complications are rare and in most cases are transient.

 

Submandibular gland surgery is performed under general anesthesia. Skin incision is carried out in a natural neck skin furrow about 3 inches below the edge of the jaw. Salivary gland is always removed entirely with a part of its excretory duct. Potential complications of submandibular gland surgery include:

  1. motion abnormalities of the lower lip (damage to the marginal mandibular branch of the facial nerve);
  2. numbness of the floor of the mouth and the lateral side of the tongue (lingual nerve damage);
  3. motion abnormalities of the tongue (hypoglossal nerve damage);
  4. numbness around the skin of operated area (sensory nerve damage);
  5. postoperative bleeding in the postoperative cavity;
  6. oral postoperative infection.

 

Sublingual salivary gland surgery is usually performed through mouth, although in certain cases it may be necessary to make an additional cut on the neck.

 

Actions of small salivary glands (under the mucous membrane of the lips, mouth, throat and nasal cavities) often rely on local resection of the tumor along with a margin of tissue unchanged.

 

The postoperative period

 

 In the postoperative period antibiotics are used for 5-7 days, it is recommended to protect the wound from getting wet for one week and saving lifestyle for about two weeks. The skin sutures are removed after 7 days.

 

Paweł Szwedowicz MD