Salivary Gland Tumors

- Adenocarcinoma - Aggressive tumors with a tendency for local recurrence (38%); regional lymph node metastasis (33%); and dissemination to lungs, bone, and liver - 5-year survival, 78%; 20-year survival, 41%

para>During parotidectomy, facial nerve monitoring can be performed to prevent postoperative facial weakness. However, it has not shown to improve long-term facial nerve function (6)[A]. ‚

INPATIENT CONSIDERATIONS

Admission Criteria/Initial Stabilization

Airway impingement ‚

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

For malignancy: every 6 to 8 weeks, 1st year; every 8 to 12 weeks, 2nd year; every 4 months, 3rd year; every 6 months, 4th year; and then yearly
For benign tumors: once a year for 5 years

DIET

Nonstimulating liquid diet ‚

PATIENT EDUCATION

Xerostomia treatment and mouth care
Tobacco cessation and alcohol abstinence
Sensorineural hearing loss

PROGNOSIS

By tumor typeParotid pleomorphic adenoma: Untreated will demonstrate malignant degeneration in 2 " “10% over 20 years. Treated adequately, parotid pleomorphic adenoma has 1.5% recurrence rate. Extension of pseudopods of tumor beyond the tumor mass increases the risk of recurrent disease.Adenoid cysticParotid: 5-year survival, 73%; 15-year survival, 21%Submandibular: 5-year survival, 50%; 15-year survival, 0%Palate: 5-year survival, 80%; 15-year survival, 38%AdenocarcinomaAggressive tumors with a tendency for local recurrence (38%); regional lymph node metastasis (33%); and dissemination to lungs, bone, and liver5-year survival, 78%; 20-year survival, 41%MucoepidermoidLow grade: 5-year survival, 81%; 15-year survival, 48%High grade: 5-year survival, 46%; 15-year survival, 25%SCCRare tumor with 50% incidence of cervical lymph node metastasis and local recurrence5-year survival, 18%; 15-year survival, 0%LymphomaRare, accounting for 1.7% of salivary neoplasms5-year survival: Hodgkin-type, 90%; non " “Hodgkin-type, 43%
5-year survival rate for stages I " “IV and cause-specific survival (CSS)Stage I: 75% (CSS 86%)Stage II: 59% (CSS 66%)Stage III: 57% (CSS 53%)Stage IV: 28% (CSS 32%)

COMPLICATIONS

Frey syndrome (gustatory sweating) occurs symptomatically in 10 " “40% of patients undergoing parotidectomy.
Hematoma with possible posterior displacement of tongue and airway obstruction
Facial neurapraxia from surgery usually improve within 6 months. Permanent facial paralysis is rare.
Cosmetic deformity of moderate facial flattening on side of parotidectomy
Injury to hypoglossal or lingual nerve
If inadequately excised, pleomorphic adenoma may recur due to pseudopods in the lobe and possibly progress to carcinoma ex pleomorphic adenoma.
Wound infection of surgical site

REFERENCES

11 Lennon ‚ P, Silvera ‚ VM, Perez-Atayde ‚ A, et al. Disorders and tumors of the salivary glands in children. Otolaryngol Clin North Am. 2015;48(1):153 " “173.22 Guzzo ‚ M, Locati ‚ LD, Prott ‚ FJ, et al. Major and minor salivary gland tumors. Crit Rev Oncol Hematol. 2010;74(2):134 " “148.33 Witt ‚ BL, Schmidt ‚ RL. Ultrasound-guided core needle biopsy of salivary gland lesions: a systematic review and meta-analysis. Laryngoscope. 2014;124(3):695 " “700.44 Tryggvason ‚ G, Gailey ‚ MP, Hulstein ‚ SL, et al. Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically. Laryngoscope. 2013;123(1):158 " “163.55 Cerda ‚ T, Sun ‚ XS, Vignot ‚ S, et al. A rationale for chemoradiation (vs radiotherapy) in salivary gland cancers? On behalf of the REFCOR (French rare head and neck cancer network). Crit Rev Oncol Hematol. 2014;91(2):142 " “158.66 Sood ‚ AJ, Houlton ‚ JJ, Nguyen ‚ SA, et al. Facial nerve monitoring during parotidectomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;152(4):631 " “637.

ADDITIONAL READING

Afzelius ‚ P, Nielsen ‚ MY, Ewertsen ‚ C, et al. Imaging of the major salivary glands. Clin Physiol Funct Imaging. 2016;36(1):1 " “10.
Chen ‚ AM, Granchi ‚ PJ, Garcia ‚ J, et al. Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the major salivary glands: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 2007;67(4):982 " “987.
de Bree ‚ R, van der Waal ‚ I, Leemans ‚ CR. Management of Frey syndrome. Head Neck. 2007;29(8):773 " “778.
Surakanti ‚ SG, Agulnik ‚ M. Salivary gland malignancies: the role for chemotherapy and molecular targeted agents. Semin Oncol. 2008;35(3):309 " “319.

CODES

ICD10

D11.9 Benign neoplasm of major salivary gland, unspecified
C08.9 Malignant neoplasm of major salivary gland, unspecified
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
D11.0 Benign neoplasm of parotid gland
D11.7 Benign neoplasm of other major salivary glands
C08.1 Malignant neoplasm of sublingual gland

ICD9

210.2 Benign neoplasm of major salivary glands
142.8 Malignant neoplasm of other major salivary glands
142.0 Malignant neoplasm of parotid gland
142.1 Malignant neoplasm of submandibular gland
142.2 Malignant neoplasm of sublingual gland
142.9 Malignant neoplasm of salivary gland, unspecified
210.4 Benign neoplasm of other and unspecified parts of mouth

SNOMED

Tumor of salivary gland
Benign neoplasm of major salivary gland
Primary malignant neoplasm of major salivary gland
Primary malignant neoplasm of parotid gland
Malignant tumor of submandibular gland
Primary malignant neoplasm of sublingual gland

CLINICAL PEARLS

To evaluate a patient with a suspected salivary gland malignancy, complete history and physical exam and consider either CT scan or MRI; fine-needle aspiration likely will yield a working diagnosis.
The most common benign and malignant neoplasms are pleomorphic adenoma and mucoepidermoid carcinoma, respectively.
Treatment of choice is parotidectomy.
A neck lymphadenectomy is required with tumors ≥4 cm in size, SCC, adenocarcinoma, undifferentiated carcinoma, and high-grade mucoepidermoid carcinoma.