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 type
- Parotid 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 cystic
- Parotid: 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%
- 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%
- Mucoepidermoid
- Low grade: 5-year survival, 81%; 15-year survival, 48%
- High grade: 5-year survival, 46%; 15-year survival, 25%
- SCC
- Rare tumor with 50% incidence of cervical lymph node metastasis and local recurrence
- 5-year survival, 18%; 15-year survival, 0%
- Lymphoma
- Rare, accounting for 1.7% of salivary neoplasms
- 5-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.
SEE ALSO
Sj ƒ ¶gren Syndrome ‚
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.