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Salivary Gland Tumour

OtolaryngologyPlastic Surgery

Salivary Gland Tumour refers to a growth occurring within the salivary glands, which can be benign or malignant and includes various types of tumour lesions. The salivary glands are responsible for secreting saliva, aiding digestion, and maintaining oral lubrication. These glands are primarily located in the parotid gland, submandibular gland, sublingual gland, and numerous minor salivary glands distributed throughout the oral cavity, nasal cavity, and throat.

Types of Salivary Gland Tumours

Salivary gland tumours are primarily categorized into benign and malignant types and often occur in the following three major salivary glands:

Parotid Gland: The most frequently affected gland, accounting for 70-80% of all cases.
Submandibular Gland: Represents 10-15% of cases.
Sublingual and Minor Salivary Glands: Though less common, these glands have more malignant tumours.

Benign Tumours	Pleomorphic Adenoma The most common benign salivary gland tumour is predominantly found in the parotid gland. It grows slowly but carries a risk of malignant transformation. Warthin's Tumour The second most common benign tumour is usually found in the parotid gland. Strongly associated with smoking. It may contain cystic fluid and often presents bilaterally.
Malignant Tumours	Adenoid Cystic Carcinoma Progresses slowly but is highly invasive, often involving nerve tissues. Mucoepidermoid Carcinoma The most common malignant salivary gland tumour is in the parotid and minor salivary glands. Adenocarcinoma: Highly aggressive with rapid growth and poorer prognosis. Other Malignancies Includes squamous cell carcinoma and malignant pleomorphic adenoma.

Symptoms

The symptoms of salivary gland tumours vary depending on the size, location, and nature (benign or malignant) of the tumour. Common symptoms include:

Lump or Gland Swelling: A painless, slow-growing lump is typically benign. A painful and rapidly enlarging mass may indicate malignancy.
Pain: Caused by the tumour pressing on nerves or surrounding tissues.
Facial Nerve Paralysis: Tumours in the parotid gland that invade the facial nerve may cause facial numbness or paralysis, more commonly seen in malignant cases.
Difficulty Swallowing or Chewing: Large tumours may compress the throat or nearby structures.
Abnormal Oral or Glandular Secretions: Symptoms include reduced saliva production, dry mouth, or blood in the saliva.
Ulcers or Tenderness: Often associated with malignant tumours and may involve surface ulceration.

Causes and Factors

The exact causes of salivary gland tumours remain unclear, but they may be associated with the following factors:

Smoking: Smoking is a major risk factor for Warthin's tumour.
Radiation Exposure: Individuals who have undergone head and neck radiation therapy are at increased risk.
Viral Infections: Epstein-Barr Virus (EBV) may be linked to certain salivary gland tumours.
Genetic Predisposition: Hereditary gene mutations may raise the risk of some malignant tumours.
Occupational Exposure: Long-term exposure to chemicals, nickel, dust, or radiation may heighten the risk.

Diagnosis

Clinical Examination	Palpation: Assess the size, texture, and mobility of the mass. Neurological Function Assessment: Evaluate facial nerve function for potential impairment.
Imaging Studies	Ultrasound: Initial examination to determine the size and nature of the tumour (solid or cystic). MRI: Provides detailed evaluation of the tumour's location, surrounding tissues, and nerve involvement. CT: Assesses the tumour's extent, calcification, or participation of bones. PET-CT: Used for staging and detecting metastasis of malignant tumours.
Pathological Examination	Fine Needle Aspiration (FNA): Commonly used for preliminary diagnosis to determine the tumour's nature (benign or malignant). Incisional Biopsy: Performed when FNA cannot provide a definitive diagnosis; involves sampling a larger tissue area.。

Treatments

The treatment options for salivary gland tumours depend on the tumour's nature, size, and stage.

Surgical Treatment	Parotidectomy (Parotid Gland Removal): For Benign Tumours: Partial parotidectomy (superficial lobe removal). For Malignant Tumours: Total parotidectomy with removal of affected lymph nodes. Submandibular Gland or Minor Salivary Gland Resection: Complete removal of the affected salivary gland and surrounding involved tissues.
Radiation Therapy	It is commonly used as adjuvant therapy after surgery for malignant tumours, particularly adenoid cystic carcinoma or locally advanced cases. It helps alleviate symptoms in inoperable advanced cases.
Chemotherapy	While its effectiveness for malignant salivary gland tumours is limited, platinum-based combination therapy may be used for advanced or metastatic tumours.
Targeted Therapy	Ongoing research in the medical field; some cases may benefit from targeted therapy drugs for specific genetic mutations.

FAQ

Some benign tumours, such as pleomorphic adenomas, may undergo a malignant transformation if left untreated for a prolonged period.

Most salivary gland tumours require surgical removal to confirm the pathology and prevent malignant transformation.

Parotid gland surgery carries a risk of affecting the facial nerve. However, specialists typically take measures to avoid or minimize nerve damage.

The prognosis depends on the type and stage of the tumour. Early detection and treatment generally result in a better prognosis.

Removal of a single salivary gland usually does not significantly affect saliva production. However, bilateral gland removal may result in a dry mouth.