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SALIVARY GLAND   NEOPLASMS Presenter:  Dr Gulzar Ahmad Bhat Moderator:  Dr M. Inam Zaroo Associate Profesor  Plastic Surgery Y M O T A AN PAROTID  Major salivary gland  Ectodermal origon  Irregular in shape extend from zygoma superiorly to oblique line of sternomastoid inferiorly and to mid point of massetor muscle  Superficial & deep lobes  Processes( glenoid , pterygoid ,facial)  parotid duct (Stensen’s duct) & accessory gland  Covered by investing fascia of the neck & contain lymph node mainly in superficial lobe  Structures within the gland:  Facial nerve  Retromandibular vein  External carotid artery  Parotid L.N STRUCTURES WITHIN GLAND  Deep lobe lie in parapharyngeal space  Anterior: Infratemporal fossa  Posterior: Carotid sheath & styloid process  Medial: Superior constrictor muscle of pharynx which is separating the gland from oropharynx & tonsils RELATIONS BLOOD SUPPLY  Superficial temporal & maxillary arteries  Retromandibular vein LYMPH DRAINAGE  Parotid & deep cervical L.N NERVE SUPPLY PARASYMPATHETIC Inf Salivary nucleus CN IX Lesser petrosal Nerve Otic ganglion Auriculoteporal N (CN V3) Parotid gland POSTOPERATIVE DETAILS  Evaluate postoperative facial, hypoglossal, and lingual nerve function Occasionally, transient facial nerve paresis occurs It usually resolves within 3-12 weeks after surgery P G O R S I S O N I Stage: • The most important factor • The incidence of local recurrence & regional metastasis are lowest in patient with stage I II HISTOLOGY & GRADE:  The biologic behavior depend largely on the histologic type of malignancy  Squamous cell carcinoma, malignant mixed tumors, undifferentiated carcinoma & salivary duct carcinoma are considered high-grade tumors while acinic cell carcinoma & polymorphous low grade adenocarcinoma are considered low-grade tumor  Adenoid cystic carcinoma considered a high grade malignancy although histologic pattern have different biologic behavior  Mucoepidermoid carcinoma highly correlated with tumor grade III SITE:  The prognosis & also the local recurrence after treatment have a definite correlations with primary site of origin which is better in major salivary glands than minor salivary glands  mainly due to:  Present at more advance stage  High incidence of extension & fixation  Bone involvement  IV Nodal metastasis: Considered as predictor of poor prognosis  Adenoid cyst carcinoma 10 & 20 years survival rate drop from 62 & 50% to 38 & 8% with nodal metastasis  V Surgical margins:  Some consider it as the most important factor  Microscopic positive margin need radiotherapy to achieve good prognosis VI Perineural spread In squamous cell carcinoma the perineural spread show poor prognosis The effect of perineural spread in the prognosis of adenoid cystic carcinoma still controversial But any how the perineural spread in major nerve indicate adverse prognostic factor VII Facial Nerve paralysis:  Although facial nerve paralysis may not be associated with 100% mortality rate, it is an indicator of poor prognosis VIII Pain:  Patients with pain appear to have a less favorable outcome  Its presence increase likelihood of local invasion of bone or sensory nerves • IX Distant metastasis: 20% of parotid malignancy Most frequently in adenoid cystic carcinoma & undifferentiated carcinoma Lung, bone & brain • X Gender: Men have poorer outcome REFRENCES Bailey & Loves Short Practice of surgery Schwartz’s Principles of Surgery Sabiston: Text book of surgery Mathews Internet THANK U