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Benign Nonepithelial Tumors

  1. Hemangiomas Q
    1. Two forms, capillary and cavernous, develop in the major salivary glands. The capillary type is the most prevalent tumor in the first year of life.
    2. Capillary hemangiomas are rapidly growing, lack a capsule and are formed by purple, spongy, lobular masses that infiltrate salivary gland tissue. Observation is recommended in children.
    3. Cavernous hemangiomas, which present in an older age group, rarely show spontaneous regression. Recurrent ulceration or bleeding may require conservative surgical resection.  
  2. Lymphangioma (cystic hygroma)
    1. They manifest as painless masses that may involve parotid, submandibular, or both. Diagnosis is made based on clinical findings.
    2. Surgical excision with preservation of the vital structures is the treatment of choice.  
  3. Lipoma
    These tumors manifest as soft, mobile, painful masses and peak in the fifth and sixth decades, with a male-to-female ratio of 10:1. They are slow-growing tumors with an average diameter of 3 cm. Treatment is surgical excision.  
  4. Metastatic disease of the parotid gland
    Melanoma (46%), squamous cell carcinoma (37%), and a variety of tumors (17%) are included in this category.  
  5. Malignant Tumours:
    Mucoepidermoid carcinoma, Adenoid cystic carcinoma, Adenocarcinoma, Malignant mixed tumour, Acinic cell carcinoma, epidermoid carcinoma. 
  6. Acinic cell carcinoma:
    It is a rare, low grade malignancy commonly seen in parotid. Infrequently invade the facial nerve and are late to metastasize (to lung). 
  7. Mucoepidermoid carcinoma:
    1. Most common Major salivary gland tumour
    2. It can be of low grade or high grade type. High grade version is locally aggressive and prone for invasion of nerves and vessels and to early metastasis (to regional nodes).
    3. Treatment of high grade type is generous primary excision with regional node dissection followed by radiotherapy.  
  8. Adenocarcinoma:
    It is more common in minor salivary glands than parotid. It again has a low grade and high grade type and high grade has a very poor prognosis.  
  9. Adenoid cystic carcinoma:
    1. It makes up one fourth of malignant salivary gland tumours. Lung is most common metastatic site but it is known for its prolonged natural history (eg. Pt. may live for 10-15 years even after lung metastasis).
    2. When visceral or bone metastasis occurs prognosis is poor. Adenoid cystic carcinoma invades nerve tissue. Treatment is wide surgical excision with radiation therapy. 
  10. Clinical:
    1. SGTs manifest as a painless mass on the face (parotid), the angle of the jaw (parotid tail, submandibular), neck (submandibular), or a swelling at the floor of mouth (sublingual). Q
    2. New onset of pain, rapid growth of the mass, facial nerve weakness, paresthesias, and hoarseness of the voice are indicators of possible underlying malignancy.
    3. Trismus usually represents invasion to the masseter or pterygoid muscles. Skin involvement and fixation to the mastoid tip are also signs of malignancy. 
  11. Etiology: An associated long-standing history of smoking and a strong family history may be risk factors.   SGTs are indolent, painless, and well-circumscribed tumors.  
  12. Treatment
    1. Medical therapy: Inflammatory, infectious masses (eg, reactive, fungal), and lymphoma should be treated medically.
    2. Salivary gland excision is also sometimes done for symptomatic, recurrent chronic gland infection, refractory to conservative treatments. Q 
  13. Surgical therapy:
    Standard in the management of SGTs is surgical therapy.
    1. Treatment of the benign neoplasm is complete surgical excision of the affected gland -Superficial parotidectomy with nerve preservation. Tumor spillage of a pleomorphic adenoma is undesirable because it can lead to tumor recurrence and should be avoided. Q
    2. Excision of the tumor with clear margins is the aim for malignant tumours. No adjuvant chemotherapy is required.

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