Parotid Tumour ASICON 2017 Jaipur Rajasthan PG master class

1. PAROTID TUMOUR
DR. FAKIR MOHAN SAHU
Junior resident
Dept. of General and
laparoscopic surgery
VIMSAR
ASI PG master class-2017 Jaipur

2. PATIENT DETAILS
 MR. C.B 60 Yr, HM, ODISHA
 PRESENTED WITH C/O-
 A Swelling in front, below & behind
the left ear lobule for 6 yrs.

3. PRESENT ILLNESS
 Apparently asymptomatic 6 yrs back.
 Noticed a peanut size swelling, below the
left ear lobule.
 Insidious in onset, gradually increased in
size to attain the present size.
 Not associated with pain.
 No H/o rapid increase in size.

4. PRESENT ILLNESS (cont..)
 No H/o- any facial asymmetry
- difficulty in closing eyes
opening mouth
chewing food
swallowing
- dryness or discharge in mouth.
 No H/o fever and weight loss.

5. PAST ILLNESS
 No H/o similar illness
trauma
irradiation
Sx intervention.
 Not a k/c/o DM,HTN,TB and any other
endocrine diseases.

6. PERSONAL HISTORY
 Married
 Farmer, Low SES
 Mixed Indian diet
 Addicted to chewing tobacco for last 20 yrs.
 Non alcoholic, Non smoker
FAMILY HISTORY
None of his family members suffered
from similar illness.

7. GENERAL SURVEY
 Conscious, oriented
 Average built and nutrition
 No pallor, no icterus, no clubbing,
no cyanosis, no generalized
lymphadenopathy, no b/l pedal
edema.
 Temperature - 37 Degree C.
 Pulse- 76 bpm , BP-130/80mmHg
 RR- 16 breaths/min

8. O/E-INSPECTION
 A solitary swelling in the left
parotid region .
 Size 5×4 cm, ovoid, bosselated
surface, well defined margin.
 Horizontally; mastoid process to 3
cm behind the angle of mouth.
 Vertically;1 cm below the zygomatic
arch to 1 cm below the angle of
mandible.
 Obliterated left retromandibular
groove.
 Raised ear lobule. Posterior view
Lateral view

9. INSPECTION (cont..)
 No visible pulsations, venous
prominence, ulceration.
 Skin over the swelling- normal.
 On clenching- swelling becomes
more prominent.
 No other facial or neck swelling.
 Contralateral parotid and other
salivary glands-normal.

10. Intraoral examination
 No bulge in lateral wall of pharynx/
behind the 3rd molar tooth.
 Parotid ductal openings- normal in
position, no discharge.
 Lips, Buccal mucosa,Tongue-healthy
 B/l Tonsilar pillars-normal position.
 Uvula centrally placed.

11. PALPATION
 No local rise of temperature
 Non-tender
 Size 5x4 cm, bosselated, well
defined margin, firm, mobile,
non pulsatile, non compressible.
 Doesn’t move above the
zygomatic arch.
 Not fixed to overlying skin,
underlying muscle, bone.

12. PALPATION (Cont..)
 Ductal openings- normal in
position, no discharge.
 Deep lobe-not enlarged.
 No cervical Lymphadenopathy.
- TM joint movements-normal.

13. Facial Nerve Examination
ORBICULARIS OCULIFRONTAL BELLY
OF O.F
BUCCINATOR
ORBICULARIS ORIS LEVATOR ANGULI ORIS PLATYSMA

14. PERCUSSION
Percussion over the swelling -
dull.
ASCULTATION
No bruit.

15. SYSTEMIC EXAMINATION
 RESPIRATORY- B/L VBS, no added sound
 CVS- S1, S2, no murmur
 CNS- No focal neurological deficit
 MUSCULOSKELETAL- no bony tenderness

16. SUMMARY
 A 60 Yr HM, presented with slow growing, painless,
solitary swelling in the left parotid region for last
6yrs, without any h/o rapid increase in size and
systemic symptoms.
 With vitals stable, left parotid swelling, non tender,
bosselated, firm, mobile, not fixed to overlying skin
or underlying muscle, bone.
 Deep lobe couldn’t be felt.
 Without any involvement of facial nerve, TM joint.
 No cervical lymphadenopathy.
 Contralateral parotid, other salivary glands and
systemic examination being normal.

17. PROVISIONAL DIAGNOSIS
MIXED PAROTID TUMOUR
OF LEFT PAROTID GLAND.

18. Thank you