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

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Parotid Space
Parotid gland

Facial Nerve- "Pes Anserinus"

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Facio-venous plane of PAT EY

Identify 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 tumor

Adenoid 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 tunnel

Pushes 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 nerve

Tumor 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 scan
USG- hypoechoic lobulated lesion

CT scan
MRI scan

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Management

.Surgical excision of tumor

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Superficial parotidectomy - PATEY'S operation

Total 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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Irradiation

Warthin'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 grade

High 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 therapy

Parotid 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 belly

of 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 stimulator

Indication 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"