Parotid Gland And Tumour
Salivary Glands
Parotid Gland
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Parotid Space
Parotid gland
Facial Nerve- "Pes Anserinus"
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Facio-venous plane of PAT EYIdentify the sketch.......
Identify the sketch.....
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Identify the sketch......Parotid tumors
BENIGN
MALIGNANT
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Pleomorphic adenoma
Mucoepidermoid carcinoma
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Warthin's tumorAdenoid cystic carcinoma
Acinic cell carcinoma
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Adenocarcinoma
Squamous cell carcinoma
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Pleomorphic adenoma.Also k/a "Mixed Tumor"
.Most common benign tumor of salivary glands- 80%
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.Neoplastic proliferation of glandular tissue with myoepithelial component
.Distribution:
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Parotid(84%) > submandibular(8%) > lingual(0.5%).F:M= 3:1
Clinical presentation
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.Smooth firm lobulated mobile swelling.Commonly arise near the tail of parotid
.In superficial part
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Clinical presentation.....
.If tumor present in Deep Lobe
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Extend through stylomandibular tunnelPushes tonsils, pharynx and uvula
Pressure effect may cause dysphagia
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Long term sequel- Malignant change.Recent increase in size
.Pain- cause
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Capsular distention
Salivery duct obstruction
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Infiltration of nerveTumor necrosis
.Nodularity
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.Involvement of skin, lymph nodes, facial nerve and masseter muscle
.Restriction of jaw movement
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Clinical examination.Smooth firm lobulated mobile swelling
.Positive curtain sign
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.Lifted ear lobule
.Involvement of facial nerve- palsy
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.Bimanual palpation- for deep lobe.Opening of the stensons duct
Parotid duct palpation
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Diagnosis.Fine needle aspiration cytology
.Core needle biopsy
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.Ultrasonography
.CT scan
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.MRI scanUSG- hypoechoic lobulated lesion
CT scan
MRI scan
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Management
.Surgical excision of tumor
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Superficial parotidectomy - PATEY'S operationTotal parotidectomy
.Complication:
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Facial nerve injury
Recurrence 5-50%
Warthin's tumor
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.Also k/a Adenolymphoma or Papil ary Cystadenolymphomatosum
.Benign tumor occur in only parotid gland.
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.2nd MC benign tumor.Bilateral 10-15%
.M:F= 4:1
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.Association:
Cigarrete smoking
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IrradiationWarthin's tumor.......
.Often multicentric
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.Typical y heterogenous on imaging ie having cystic component frequently
.On T-99 pertechnetate scan- "Hot spot" due to high mitochondrial content, a characteristic
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feature..Management:
Excision of tumour
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Risk of recurrence ?nil
No malignant change
Mucoepidermoid tumor
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.Commonest malignant tumor
.Most common in parotid gland
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.Etiology: radiation.Early stage- painless gradually progressive mass
.Later on- may involve facial nerve
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.On the basis of cellular characteristic: 3 grade
Low grade
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Intermediate gradeHigh grade
Mucoepidermoid tumor.......
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.Management:
.Low grade ?
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WLE or superficial parotidectomy.High grade-
Radical parotidectomy with neck node dissection and adjuvant therapy
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Adenoid cystic carcinoma.Slow growing high malignant tumor
.High affinity to perinural extension
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.Management:
Radical parotidectomy with adjuvant cth
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Fast neutron therapyParotid surgery
.Superficial Parotidectomy
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.Total Conservative Parotidectomy
.Radical Parotidectomy
Intraop- identification of facial nerve
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Tragal Pointer of CONLEY'S- tip of inferior portion
of cartilaginous canal
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Tracing the tendinous insertion of posterior bellyof digastric muscle
Nerve just lateral to styloid process
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Hamilton bailey technique- tracing from distal to
proximal
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By use of nerve stimulatorIndication of facial nerve sacrifice
.Preoperative weakness or paralysis of nerve
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.Evidence of gross invasion
.Tumor transgressing from superficial to deep part
Complication of parotidectomy
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.Facial nerve injury
.Haemorrhage
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.Salivary fistula.Flap necrosis
.Frey 's syndrome
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.Injury to great auricular nerve
Frey 's syndrome
Nerve supply
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.Parasympathetic:
Secreto-motor- from otic ganglion ? postganglionic fibre via auriculo-temporal nerve
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.Sympathetic:.Sensory:
Great auricular nerve ? to parotid fascia
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Frey 's syndrome......After injury
.secretomotor fibres from auriculotemporal nerve grow out
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.joins with distal end of great auricular nerve..Also k/a "Gustatory Sweating"