Salivary Glands: Managing lacerations of the parotid gland, duct and facial nerve

Intraductal carcinomas are rare, malignant tumors that arise from the salivary glands. They commonly grow from the parotid gland and no cases growing from the parapharyngeal space have been reported to date. We report a 76-year-old man who was inadvertently found to have a parapharyngeal lesion by CT scans and MR imaging. The tumor was resected through an upper neck approach and diagnosed histopathologically as intraductal carcinoma. As far as we are aware, this is the first case of intraductal carcinoma arising from the parapharyngeal space. Here, we describe the management of this disease together with a review of the relevant literature.

The aim: Is to assess the functional state of parotid glands and general secretion in patients with compression, dislocation dysfunction of TMJ, to correct the revealed disorders. Materials and methods: We examined 46 patients with dysfunction of TMJ. Examination included TMJ zonography and salivary glands sonography. We studied the general and parotid secretion, transparency, viscosity, pH of the oral fluid and the secretions of the parotid glands before and after treatment. The treatment of dysfunction and hyposialosis included the repositioning of the articular heads of the lower jaw in the correct anatomical position, the use of a repositioning plate on the posterior teeth at the compression side of the articular head, bougienage of the duct of the parotid gland, administration of 10% magnesium-mineral solution of bischofite into the gland. Results: In patients with TMJ dysfunction, a significant decrease in the oral fluid content was noted before treatment. The saliva transparency was reduced, the viscosity was increased, the pH was slightly acidic. A study, which was carried out a month after completion of the course of treatment showed that all the studied parameters corresponded to those in healthy individuals. Conclusions: The study confirmed that in compression and dislocation dysfunction of TMJ, there are disorders of the functional state of the salivary glands.

AbstractThe major salivary glands are considered to rarely be the sites of primary terminal duct adenocarcinomas, a neoplasm with a considerable predilection for origin from intraoral minor salivary glands. We present a clinicopathological study of 22 terminal duct adenocarcinomas of the parotid gland, the largest single series to date. A comparison between the parotid neoplasms and over 200 minor salivary gland terminal duct adenocarcinomas indicates there is little difference in biological behaviour and confirms the low-grade quality of the carcinomas, regardless of site of origin.

AbstractCavernous lymphangioma is a benign congenital lesion that usually appears in childhood. It rarely presents in the adult but may be diagnosed at this late stage due to the slow growing nature of the tumour. It is rarely found i n the salivary glands and when it does occur, the gland is usually incorporated by lymphangioma of surrounding tissue.We present and discuss the case of a cavernous lymphangioma in the parotid gland of an adult male.

Myoepithelial carcinoma is a rare malignancy of the parotid gland that is usually seen in adults. We report the first case in children of myoepithelial carcinoma of the parotid gland with massive invasion of the facial nerve and metastasis to cervical lymph nodes. Due to its rarity, the treatment and the clinical course of this tumor are not well defined yet. We performed a total parotidectomy, a modified neck dissection, and a postoperative radiotherapy in 7-year-old boy. Sparing of the facial nerve was impossible; it was sacrificed and grafted with a sural nerve. Histopathology confirmed the diagnosis of a parotid gland carcinoma and immunohistochemical markers showed that the tumor cells express cytokeratin, epithelial membrane antigen, cytokeratin 7, smooth muscle actin, P63, CEA, and S100. This pattern of immunostaining is consistent with the diagnosis of myoepithelial carcinoma. On the postoperative tenth month he presented with a pulmonary and lumbar vertebra metastasis.

Salivary gland tumours make an important part of oral & maxillofacial pathology. Only few studies have been done in Pakistani population. The aim of this study was to describe morphological types of salivary gland tumours diagnosed at King Edward Medical College/ Mayo Hospital, Lahore during the years 1999-2001 and to compare their demographic data with those previously published. Material & Methods: This descriptive cross-sectional study was carried out at King Edward Medical College/ Mayo Hospital, Lahore. It reports 117 cases of salivary gland tumours diagnosed at Pathology Department during 1999-2001. Results: Of the 128 specimens of salivary glands, 117(91.4%) were confirmed as salivary neoplasms. Out of them, 62.7% were benign and 37.6% malignant and a slight female predominance (58.1%) was found. The most common location was the parotid gland (65.8%) followed by minor salivary glands (19.6%). Majority oft he t tumours was diagnosed during 3rd to 5 decades of life. Median age for benign tumours was 33 years (range 1-78) and a female predominance (58.9%) was seen again. Median age for malignant neoplasms was 45 years (range 9-70) with a female predilection ( 56.8%). However, 4 out o f 5 patients with Warthin`s tumour were men. Pleomorphic adenoma was the most frequent tumour (51.3%), followed by mucoepidermoid carcinoma (25.6%), adenoid cystic carcinoma (7.7)), Warthin`s tumour (4.3%) and monomorphic adenoma (2.6%). Two cases each of oncytoma & adenocarcinoma were recorded. Rare categories (single case each) of salivary tumours included lipoma, acinic cell carcinoma, basal cell adenoma, capillary haemangioma, metastatic carcinoma and non Hodgkin`s lymphoma. Conclusion: The principal site of salivary tumours was the parotid gland and females were most affected. Pleomorphic adenoma was the most frequent finding. The results of this study are comparable with other studies.

SummaryCYSTS of the major salivary glands are most frequent in the parotid where they form a small percentage of its benign tumours. They can be congenital or acquired and of parotid or extraparotid origin. Two unusual cysts are reported: a cholesteatoma arising from the ipsilateral mastoid, twenty years after successful radical mastoidectomy, and a deeply located cyst of probable congenital origin. The literature is reviewed and the management discussed. Parotidectomy, often with extensive dissection, remains in general the treatment of choice.Cysts in the parotid gland represent a small percentage of benign parotid masses. They usually arise within the gland from salivary or non-salivary parotid tissue, and may be congenital or acquired. Some, however, may arise from surrounding structures.Unless the cyst is superficial and therefore readily amenable to proper examination, it usually escapes a definite diagnosis even with the help of sialography or more sophisticated procedures. Exploration is eventually resorted to for diagnosis and treatment. That is why the surgeon should be ready to perform extensive surgery if the findings at exploration necessitate it.The purpose of this article is to present two cystic lesions of the parotid. The first is a rarity, a cholesteatoma originating from the ipsilateral mastoid; and the second an unusually deeply located cyst. These cases illustrate well the problems met with in the management of preauricular masses.