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  • • Paired major salivary glands include parotid, submandibular, and sublingual glands

    • Minor salivary glands are distributed in the mucosa of the lips, cheeks, hard and soft palate, uvula, floor of mouth, tongue, and peritonsillar region

    • Few salivary glands in the nasopharynx, paranasal sinuses, larynx, trachea, bronchi, and lacrimal glands

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Epidemiology

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  • • About 5% of head and neck tumors are in the salivary glands

    • 5 times more prevalent in major than minor salivary glands (70% in parotids)

    • Malignancy rates by gland:

    • -15% of parotid tumors

      -50% of submandibular tumors

      -90% of minor salivary gland tumors

    • 70% of parotid tumors are pleomorphic adenomas (50% of all salivary gland tumors)

    • Mixed tumors are more common in women, with peak incidence in fifth decade

    • Warthin tumor accounts for 5% of parotid tumors

    • -Typically occur in men in sixth and seventh decade of life

      -10% bilateral

    • Monomorphic tumors are rare and seen most commonly in the minor salivary glands of the lip

    • Mucoepidermoid carcinoma is the most common parotid cancer

    • Acinic cell carcinomas are found almost exclusively in the parotid

    • Descending frequency of minor salivary gland carcinomas: Adenoid cystic, adenocarcinoma, mucoepidermoid

    • 70% of minor salivary gland carcinomas occur in the oral cavity, principally hard palate

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Symptoms and Signs

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  • • Nodule in the parapharyngeal space

    • Enlarged cervical lymph nodes

    • Pain

    • Weakness in the muscles of facial expression

    • Trismus

    • Cranial nerve palsies

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Imaging Findings

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  • CT or MRI: Can identify extent of salivary gland mass, extension in surrounding nerves, and local nodal spread

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  • • Majority of tumors derived from intercalated and excretory duct cells; rarely, myoepithelial cells

    • Benign neoplasms of the salivary gland:

    • -Pleomorphic adenoma

      -Mixed tumor

      -Monomorphic adenomas

      -Oncocytoma

      -Warthin tumor (papillary cystadenoma lymphomatosum)

    • Malignant neoplasm of the salivary gland:

    • -Acinic cell carcinoma

      -Adenocarcinoma

      -Adenoidcystic carcinoma

      -Malignant mixed tumor

      -Mucoepidermoid carcinoma

      -Squamous cell carcinoma

      -Undifferentiated carcinoma

    • In parotid region, presence of pain, rapid enlargement of preexisting nodule, skin involvement or facial nerve paralysis suggests cancer

    • Enlarged cervical lymph nodes in association with salivary gland tumors are considered manifestations of cancer until proven otherwise

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Rule Out

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  • • For swelling in the parotid gland:

    • -Parotitis

      -Primary parotid tumor

      -Upper jugular chain lymph node enlargement

      -Tumor of the tail of the submandibular gland

      -An enlarged preauricular or parotid lymph node

      -A branchial cleft cyst

      -An epithelial inclusion cyst

      -Mesenchymal tumor

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  • • Complete history and physical exam

    • Biopsy

    • -Either fine-needle aspiration or local excisional biopsy with margin of normal tissue

    • For minor salivary gland, often perform incisional biopsy to plan for definitive treatment (as these are more often malignant)

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Surgery

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  • • Benign tumors are removed with margin of normal tissue

    • For low-grade salivary gland cancers, complete excision is sufficient

    • ...

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