Download MBBS General Surgery PPT 8 Parotid Gland And Tumour Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) General Surgery PPT 8 Parotid Gland And Tumour Lecture Notes

Parotid Gland And Tumour

Salivary Glands
Parotid Gland

Parotid Space
Parotid gland

Facial Nerve- "Pes Anserinus"
Facio-venous plane of PAT EY

Identify the sketch.......
Identify the sketch.....

Identify the sketch......
Parotid tumors
BENIGN

MALIGNANT

Pleomorphic adenoma

Mucoepidermoid carcinoma

Warthin's tumor

Adenoid cystic carcinoma

Acinic cell carcinoma

Adenocarcinoma

Squamous cell carcinoma

Pleomorphic adenoma

.Also k/a "Mixed Tumor"

.Most common benign tumor of salivary glands- 80%

.Neoplastic proliferation of glandular tissue with myoepithelial component

.Distribution:

Parotid(84%) > submandibular(8%) > lingual(0.5%)

.F:M= 3:1
Clinical presentation

.Smooth firm lobulated mobile swelling

.Commonly arise near the tail of parotid

.In superficial part

Clinical presentation.....

.If tumor present in Deep Lobe

Extend through stylomandibular tunnel

Pushes tonsils, pharynx and uvula

Pressure effect may cause dysphagia
Long term sequel- Malignant change

.Recent increase in size

.Pain- cause

Capsular distention

Salivery duct obstruction

Infiltration of nerve

Tumor necrosis

.Nodularity

.Involvement of skin, lymph nodes, facial nerve and masseter muscle

.Restriction of jaw movement

Clinical examination

.Smooth firm lobulated mobile swelling

.Positive curtain sign

.Lifted ear lobule

.Involvement of facial nerve- palsy

.Bimanual palpation- for deep lobe

.Opening of the stensons duct
Parotid duct palpation

Diagnosis

.Fine needle aspiration cytology

.Core needle biopsy

.Ultrasonography

.CT scan

.MRI scan
USG- hypoechoic lobulated lesion

CT scan
MRI scan

Management

.Surgical excision of tumor

Superficial parotidectomy - PATEY'S operation

Total parotidectomy

.Complication:

Facial nerve injury

Recurrence 5-50%
Warthin's tumor

.Also k/a Adenolymphoma or Papil ary Cystadenolymphomatosum

.Benign tumor occur in only parotid gland.

.2nd MC benign tumor

.Bilateral 10-15%

.M:F= 4:1

.Association:

Cigarrete smoking

Irradiation

Warthin's tumor.......

.Often multicentric

.Typical y heterogenous on imaging ie having cystic component frequently

.On T-99 pertechnetate scan- "Hot spot" due to high mitochondrial content, a characteristic

feature.

.Management:

Excision of tumour

Risk of recurrence ?nil

No malignant change
Mucoepidermoid tumor

.Commonest malignant tumor

.Most common in parotid gland

.Etiology: radiation

.Early stage- painless gradually progressive mass

.Later on- may involve facial nerve

.On the basis of cellular characteristic: 3 grade

Low grade

Intermediate grade

High grade

Mucoepidermoid tumor.......

.Management:

.Low grade ?

WLE or superficial parotidectomy

.High grade-

Radical parotidectomy with neck node dissection and adjuvant therapy
Adenoid cystic carcinoma

.Slow growing high malignant tumor

.High affinity to perinural extension

.Management:

Radical parotidectomy with adjuvant cth

Fast neutron therapy

Parotid surgery

.Superficial Parotidectomy

.Total Conservative Parotidectomy

.Radical Parotidectomy
Intraop- identification of facial nerve

Tragal Pointer of CONLEY'S- tip of inferior portion

of cartilaginous canal

Tracing the tendinous insertion of posterior belly

of digastric muscle

Nerve just lateral to styloid process

Hamilton bailey technique- tracing from distal to

proximal

By use of nerve stimulator

Indication of facial nerve sacrifice

.Preoperative weakness or paralysis of nerve

.Evidence of gross invasion

.Tumor transgressing from superficial to deep part
Complication of parotidectomy

.Facial nerve injury

.Haemorrhage

.Salivary fistula

.Flap necrosis

.Frey 's syndrome

.Injury to great auricular nerve

Frey 's syndrome
Nerve supply

.Parasympathetic:

Secreto-motor- from otic ganglion ? postganglionic fibre via auriculo-temporal nerve

.Sympathetic:

.Sensory:

Great auricular nerve ? to parotid fascia
Frey 's syndrome......
After injury

.secretomotor fibres from auriculotemporal nerve grow out

.joins with distal end of great auricular nerve.

.Also k/a "Gustatory Sweating"