Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 +++ Epidemiology + • 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 +++ Symptoms and Signs + • Nodule in the parapharyngeal space• Enlarged cervical lymph nodes• Pain• Weakness in the muscles of facial expression• Trismus• Cranial nerve palsies +++ Imaging Findings + • CT or MRI: Can identify extent of salivary gland mass, extension in surrounding nerves, and local nodal spread + • 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 +++ Rule Out + • 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 + • 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) +++ Surgery + • Benign tumors are removed with margin of normal tissue• For low-grade salivary gland cancers, ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth