THROAT - Parotid Tumours

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

2. Carcinomas

  • 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

3. Non epithelial

  • Hemangioma
  • Lymphangioma
  • Neurofibroma
  • Neurilemma
  • Mostly infants affected. Frequent spontaneous regression of any gland affected in this group.

4. Malignant lymphoma

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

What are the criteria indicating malignant change in mixed parotid tumour?

  • 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

What is the treatment of parotid tumours?

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.

What is the differential diagnosis of parotid swelling?

Differential diagnosis of parotid swellings:

  • Winged mandible
  • Masseteric hypertrophy
  • Lipoma
  • External carotid aneurysm
  • Pre- Auricular lymph node

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