Download - Parotid Gland And Tumour - AIIMS, Rishikesh
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Parotid Gland And TumourDR SUDHIR KUMAR SINGH
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Salivary Glands
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Parotid Gland
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Parotid Space
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Parotid gland
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Facial Nerve- “Pes Anserinus”
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Facio-venous plane of PATEY
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Identify the sketch…….
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Identify the sketch…..
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Identify the sketch……
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Parotid tumorsBENIGN
Pleomorphic adenoma
Warthin’s tumor
MALIGNANT
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Acinic cell carcinoma
Adenocarcinoma
Squamous cell carcinoma
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Pleomorphic adenomaAlso 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
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Clinical presentationSmooth 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
Extend through stylomandibular tunnel
Pushes tonsils, pharynx and uvula
Pressure effect may cause dysphagia
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Long term sequel- Malignant changeRecent 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
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Clinical examinationSmooth 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
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Parotid duct palpation
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DiagnosisFine needle aspiration cytology
Core needle biopsy
Ultrasonography
CT scan
MRI scan
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USG- hypoechoic lobulated lesion
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CT scan
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MRI scan
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Management Surgical excision of tumor
Superficial parotidectomy - PATEY’S operation
Total parotidectomy
Complication:
Facial nerve injury
Recurrence 5-50%
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Warthin’s tumorAlso k/a Adenolymphoma or Papillary Cystadenolymphomatosum
Benign tumor occur in only parotid gland.
2nd MC benign tumor
Bilateral 10-15%
M:F= 4:1
Association:
Cigarrete smoking
Irradiation
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Warthin’s tumor……..Often multicentric
Typically 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
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Mucoepidermoid tumorCommonest 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
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Mucoepidermoid tumor……..Management:
Low grade –
WLE or superficial parotidectomy
High grade-
Radical parotidectomy with neck node dissection and adjuvant therapy
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Adenoid cystic carcinomaSlow growing high malignant tumor
High affinity to perinural extension
Management:
Radical parotidectomy with adjuvant cth
Fast neutron therapy
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Parotid surgerySuperficial Parotidectomy
Total Conservative Parotidectomy
Radical Parotidectomy
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Intraop- identification of facial nerveTragal 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
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Indication of facial nerve sacrificePreoperative weakness or paralysis of nerve
Evidence of gross invasion
Tumor transgressing from superficial to deep part
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Complication of parotidectomyFacial nerve injury
Haemorrhage
Salivary fistula
Flap necrosis
Frey’s syndrome
Injury to great auricular nerve
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Frey’s syndromeNerve supply
Parasympathetic:
Secreto-motor- from otic ganglion – postganglionic fibre via auriculo-temporal nerve
Sympathetic:
Sensory:
Great auricular nerve – to parotid fascia
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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”
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