MEET THE DOCTORS IN NYC, ORLANDO, HOUSTON: JULY 2017

Dr. Hamilton and Dr. Osborne will be in New York City, NY on July 26th, Orlando, Florida on July 27th, and Houston, Texas on July 28th. They will be holding discussion sessions with individual patients to discuss the details of surgery. We are scheduling plenty of time between appointments to ensure that you can obtain answers to all of your questions.

Parotid Tumors

When learning about parotid tumors, it is important to know that the salivary gland system is comprised of the following structures:

  • Parotid Glands
  • Submandibular Glands
  • Sublingual Glands
  • Minor Salivary Glands
  • Secondary Accessory Glands
  • Duct Network – It is important to note that each of the structures above is associated with a network of ducts that carry saliva into the oral cavity.

While neoplasm or tumor growth is possible in each of these structures, the parotid gland is the most frequent site of salivary gland tumor occurrence. Over 80% of all salivary gland tumors occur within the parotid gland.

Tumors of the parotid gland can be separated into two main categories based on behavior, benign and malignant. Benign tumors are typically non-aggressive cell growths that result from a variety of aberrant intracellular events. These tumors typically grow slowly over time, are not painless, and do not invade or destroy adjacent tissues. Benign parotid tumors can however compress adjoining structures and cause dysfunction of surrounding structures based purely on their space occupying effects.

While the word “benign” carries better connotations than more aggressive tumors, it is important to note that benign parotid tumors can undergo malignant transformation over time if not treated in a timely manner. Malignant transformation alters prognosis and affects treatment protocols considerably.

parotid tumors
Figure: Neoplasia and tumor are terms that are commonly used interchangeably to refer to the abnormal growth of a new cell mass. The behaviour of the cell mass can be further described by using terms such as benign or malignant. Benign tumors typically demonstrate slow growth patterns and do not invade adjacent tissues. Malignant tumors can exhibit more aggressive growth patterns as well as invade adjacent tissues. Malignant tumors can metastasize and spread to distant body sites. While benign tumors do not typically exhibit the aggressive characteristics of their malignant counterparts, they can on occasion undergo malignant transformation.

 

Symptoms of Parotid Tumors

  • Unexplained painless or painful growth of the parotid gland
  • Lump in the cheek, neck, or mouth
  • Sensation of fullness of the parotid gland
  • Numbness or changes of sensation over parts of the face
  • Sudden onset of facial or neck pain
  • Twitching or weakness of the facial muscles
  • Paralysis of the face
  • Difficulty with speech
  • Unexplained weight loss, fever, or night sweats

Note: Every patient’s case is unique and is accompanied by its own constellation of symptoms. While this list should not be considered all-inclusive, some or none of these symptoms may be present in your particular case. Evaluation by a qualified head and neck surgeon is crucial to distinguish between a parotid tumor and other head and neck pathology.

Evaluation

Parotid tumors can vary in presentation and associated symptoms. Due to a variety of factors including tumor type, location, extent of disease, comorbidities, and general patient health, each case of parotid tumor must be meticulously evaluated to obtain an accurate diagnosis and customize an appropriate treatment plan. A salivary gland specialist is cognizant of these sensitive factors and is most qualified to evaluate and treat suspected cases of parotid tumors. Comprehensive evaluation of your case should include the following areas of focus:

Patient History

Preliminary evaluation involves extensive review of the patient’s medical background and associated symptoms. An in-depth history is important in establishing the timeline of symptom onset, frequency, intensity, aggravating/ameliorating factors, and associated activities. This crucial first step in the evaluation process assists in developing a list of possible explanations for the patient’s symptoms.

Focused Physical Exam

A focused physical examination is crucial in further pinpointing the cause of a patient’s symptoms. While growth of the parotid gland may frequently conjure images of tumor growth in the patient’s mind, there are several diseases processes that are non-neoplastic in origin such as cystic disease, gland hypertrophy, parotitis, etc. that can explain parotid enlargement. A comprehensive focused physical exam assists the physician in differentiating between these disease processes.

During physical examination the physician can evaluate the integrity and function of the salivary gland system. The gland itself can be examined manually by gentle palpation to further verify the consistency of the underlying tissue and any notable growths.

Imaging

Imaging is frequently requested in order to further investigate the integrity of the salivary gland system and to assist in determining spread or extent of disease. Magnetic resonance imaging (MRI) is of particular importance to evaluating parotid gland tumors. Infiltrative cancers can compromise glandular function and ductal architecture. Imaging is helpful in determining the presence and extent of these masses.

parotid tumor MRI scan
Figure: Axial MRI of the skull depicting a parotid tumor (red arrow). MRI is crucial to the diagnostic and treatment protocol.

Diagnostic Procedures

Salivary Gland Biopsy – Fine Needle Aspiration (FNA)

  • Biopsy can provide relevant diagnostic information during the evaluation phase of salivary gland tumors. During FNA, small glandular tissue samples are obtained and examined by microscopy to determine cellular integrity of the salivary gland. This information can provide a definitive diagnosis or rule out suspicion of other conditions.

Sialendoscopy

  • Ductal evaluation via sialendoscopy is an innovative minimally invasive diagnostic procedure helpful in the assessment of salivary gland dysfunction, including obstructive disease of the salivary gland duct system. Invasive cancer or other benign growths can obstruct or compress the ductal system.

Treatment

 

parotid tumor
Figure: Schematic of the face depicting the parotid gland and its close association to the facial nerve.

First line treatment for all parotid tumors, both benign and malignant, is generally surgical removal of the gland. The main risk to the surgery which is called parotidectomy is facial nerve paralysis. Due to the variety of sensitive structures overlying, surrounding, and coursing through the parotid gland, exquisite care and dexterity must be implemented by the treating surgeon to preserve function and avoid unwanted complications. For example, the facial nerve is intimately integrated into the parotid gland. The facial nerve is responsible for motor control of the face and partially responsible for taste sensation. The treating surgeon must be experienced and familiar enough to successfully identify, separate, and preserve this crucial structure and all its branches. In some cases of parotid tumor, the facial nerve can be involved or compressed within the tumor, adding further complexity to the case. A qualified salivary gland specialist has performed hundreds of these cases and is prepared for the meticulous nature of such a procedure. These physicians employ specialized protocols to identify this crucial nerve and its branches while minimizing any intraoperative trauma or subsequent risk of facial paralysis.

Parotidectomy
Mini - Incision™

miniprocedure

Smaller incision
Faster recovery

Parotidectomy
Trans-Oral Removal

No facial scars or weakness
Tumor removed through mouth

Recurrent Parotid
Tumors Treatment

Variety of innovative
treatment options

Evaluation & Treatment Checklist

A comprehensive evaluation of parotid tumor should include the traditional components of a comprehensive medical exam but should include consideration of the following critical components:

  • Salivary gland specific history
  • Ductal system evaluation
  • Salivary gland biopsy
  • MRI imaging
  • Customized treatment options

Discussion with patient regarding treatment options, prognosis, and followup

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