1) Parotid gland tumors are relatively uncommon, accounting for less than 1% of reported malignancies. Pleomorphic adenoma is the most common parotid gland tumor, comprising 60% of cases.
2) The document outlines the classification, presentation, diagnostic evaluation, surgical and treatment options for parotid gland tumors. It also presents representative cases from the author's experience.
3) Superficial parotidectomy with preservation of the facial nerve is the most common surgical intervention undertaken and was performed in 95% of cases. Post-operative complications included transient or permanent facial nerve weakness.
1) Parotidectomy is performed to remove tumors or treat infections of the parotid gland. It involves dissecting around the facial nerve to preserve function.
2) The facial nerve is the key anatomical structure and must be carefully identified and protected throughout the surgery. Landmarks like the tympanomastoid suture line help locate the nerve.
3) The surgery can range from partial removal of the superficial lobe for benign tumors to total removal of the entire gland for high grade malignancies. Meticulous hemostasis and drainage are important for wound healing.
Branchial anomalies result from improper development of the branchial apparatus during embryogenesis. They present as cysts, sinuses, or fistulas in the neck region due to failure of branchial clefts or pouches to regress normally. The definitive treatment is complete surgical excision to prevent recurrent infections while protecting important nerves like the spinal accessory and recurrent laryngeal. Second branchial cleft cysts are the most common type and manifest as neck masses anterior to the sternocleidomastoid muscle.
thyroidectomy-surgical seminare, prepared by Dr. Siddharth JINDAL, third year resident in dept. of general surgery at P.D.U. Government Medical College and Civil Hospital, Rajkot, Gujarat.
This document discusses various branchial remnants and their characteristics. It describes:
- First branchial cleft cysts which can be parallel to the external auditory canal or connect to the malleus or incus.
- Second branchial cleft cysts, the most common type, which present as painless neck masses behind the sternocleidomastoid muscle.
- Preauricular pits and sinuses which can lead to interconnected cysts in front of the tragus.
- Skin tags which are usually benign but may be associated with other conditions.
- Branchial fistulas which have openings in the tonsillar fossa.
- Surgical excision is usually required to treat infected or
1) The document discusses treatment guidelines and radiation therapy for malignant parotid gland tumors. It outlines the workup, treatment algorithm, indications for postoperative radiation, and clinical target volume definition.
2) Recommendations include radiation therapy for T3/T4 tumors, incomplete resection, high grade histology, recurrent disease, and node-positive disease. The clinical target volume covers the parotid bed and neck lymph nodes.
3) Guidelines provide organ at risk contours and trial management group recommendations on radiation doses and volumes based on tumor and node characteristics. Elective neck irradiation is advised for high grade tumors, T3/T4 disease, and certain histologies.
Anatomy of parapharyngeal space and its tumoursjassicajassica
1. The parapharyngeal space is an inverted pyramidal space bounded by the skull base superiorly, the greater cornu of the hyoid bone inferiorly, and the carotid sheath posteriorly. (2) Salivary gland tumors, schwannomas, and paragangliomas are common tumor types found in the parapharyngeal space. (3) Evaluation involves imaging such as CT and MRI to determine tumor location, size, and relationship to surrounding structures, while biopsy is used for diagnosis.
This document discusses different types of neck dissection procedures used to remove cervical lymph nodes. It describes the standard radical neck dissection, which removes lymph nodes from levels I through V, as well as the internal jugular vein and sternocleidomastoid muscle. Modified radical neck dissection spares one or more of these structures. Selective neck dissection removes lymph nodes from certain levels based on the primary cancer site, preserving other lymph node groups. Extended radical neck dissection removes additional lymph node groups or tissues beyond a standard radical neck dissection.
- Salivary gland tumors can arise in the parotid, submandibular, and sublingual glands.
- The parotid gland has both superficial and deep lobes separated by the facial nerve plane. Lymphatic drainage is to the parotid nodes and upper cervical nodes.
- Biopsy and imaging such as CT, MRI, and FNAC are used for diagnosis. Surgery is the main treatment for benign and low-grade tumors while surgery with adjuvant radiation is used for high-grade or residual tumors.
1) Parotidectomy is performed to remove tumors or treat infections of the parotid gland. It involves dissecting around the facial nerve to preserve function.
2) The facial nerve is the key anatomical structure and must be carefully identified and protected throughout the surgery. Landmarks like the tympanomastoid suture line help locate the nerve.
3) The surgery can range from partial removal of the superficial lobe for benign tumors to total removal of the entire gland for high grade malignancies. Meticulous hemostasis and drainage are important for wound healing.
Branchial anomalies result from improper development of the branchial apparatus during embryogenesis. They present as cysts, sinuses, or fistulas in the neck region due to failure of branchial clefts or pouches to regress normally. The definitive treatment is complete surgical excision to prevent recurrent infections while protecting important nerves like the spinal accessory and recurrent laryngeal. Second branchial cleft cysts are the most common type and manifest as neck masses anterior to the sternocleidomastoid muscle.
thyroidectomy-surgical seminare, prepared by Dr. Siddharth JINDAL, third year resident in dept. of general surgery at P.D.U. Government Medical College and Civil Hospital, Rajkot, Gujarat.
This document discusses various branchial remnants and their characteristics. It describes:
- First branchial cleft cysts which can be parallel to the external auditory canal or connect to the malleus or incus.
- Second branchial cleft cysts, the most common type, which present as painless neck masses behind the sternocleidomastoid muscle.
- Preauricular pits and sinuses which can lead to interconnected cysts in front of the tragus.
- Skin tags which are usually benign but may be associated with other conditions.
- Branchial fistulas which have openings in the tonsillar fossa.
- Surgical excision is usually required to treat infected or
1) The document discusses treatment guidelines and radiation therapy for malignant parotid gland tumors. It outlines the workup, treatment algorithm, indications for postoperative radiation, and clinical target volume definition.
2) Recommendations include radiation therapy for T3/T4 tumors, incomplete resection, high grade histology, recurrent disease, and node-positive disease. The clinical target volume covers the parotid bed and neck lymph nodes.
3) Guidelines provide organ at risk contours and trial management group recommendations on radiation doses and volumes based on tumor and node characteristics. Elective neck irradiation is advised for high grade tumors, T3/T4 disease, and certain histologies.
Anatomy of parapharyngeal space and its tumoursjassicajassica
1. The parapharyngeal space is an inverted pyramidal space bounded by the skull base superiorly, the greater cornu of the hyoid bone inferiorly, and the carotid sheath posteriorly. (2) Salivary gland tumors, schwannomas, and paragangliomas are common tumor types found in the parapharyngeal space. (3) Evaluation involves imaging such as CT and MRI to determine tumor location, size, and relationship to surrounding structures, while biopsy is used for diagnosis.
This document discusses different types of neck dissection procedures used to remove cervical lymph nodes. It describes the standard radical neck dissection, which removes lymph nodes from levels I through V, as well as the internal jugular vein and sternocleidomastoid muscle. Modified radical neck dissection spares one or more of these structures. Selective neck dissection removes lymph nodes from certain levels based on the primary cancer site, preserving other lymph node groups. Extended radical neck dissection removes additional lymph node groups or tissues beyond a standard radical neck dissection.
- Salivary gland tumors can arise in the parotid, submandibular, and sublingual glands.
- The parotid gland has both superficial and deep lobes separated by the facial nerve plane. Lymphatic drainage is to the parotid nodes and upper cervical nodes.
- Biopsy and imaging such as CT, MRI, and FNAC are used for diagnosis. Surgery is the main treatment for benign and low-grade tumors while surgery with adjuvant radiation is used for high-grade or residual tumors.
The para-pharyngeal space is an inverted pyramid-shaped area located between the muscles of mastication and muscles of deglutition. It has important structures passing through like the internal carotid artery and cranial nerves. Lesions in this space can be benign like pleomorphic adenomas or malignant like metastases. Imaging with CT or MRI is important for evaluating these lesions. The transcervical approach is most commonly used for surgery but transoral, transparotid, and infratemporal fossa approaches may also be used depending on the location and extent of the lesion. Complications can include nerve injuries, bleeding, and infection. New advances like transoral robotic surgery may help access some lesions with fewer complications.
The parotid gland is located below and in front of the ear. It has two lobes and is drained by Stenson's duct which opens into the mouth. The gland has a capsule and structures like arteries pass through it. It is supplied by parasympathetic and sympathetic nerves. Common tumors include pleomorphic adenoma and Warthin's tumor. Mucoepidermoid carcinoma and adenoid cystic carcinoma are malignant tumors that can occur. Surgical excision is the main treatment for tumors but radiotherapy may also be used for malignant ones. Complications after parotidectomy include facial nerve injury and salivary fistula.
The key points are:
1. Tumors of the parapharyngeal space can be divided into those originating from salivary glands (most common), nerves, and other miscellaneous sources.
2. Imaging such as CT and MRI are important for diagnosis and determining the relationship to surrounding structures like blood vessels.
3. Surgical excision is usually the primary treatment, with the approach depending on factors like location and size of the tumor.
4. Observation or radiation therapy may be considered for patients who are not surgical candidates or if the tumor is not resectable.
This document discusses maxillectomy, which is the surgical removal of part or all of the maxilla bone. It provides a history of maxillectomy and describes the anatomy of the maxilla bone. It also discusses different classifications of maxillectomy procedures based on the extent of bone removed. The common indications for maxillectomy are malignant tumors like squamous cell carcinoma. The approaches used include lateral rhinotomy, Weber-Ferguson, and transoral-transpalatal. Reconstruction options involve dental prosthetics, maxillofacial prosthetics, and titanium implants.
The facial nerve originates from the pons and has both motor and sensory components. It passes through the internal acoustic meatus, facial canal within the temporal bone, and exits at the stylomastoid foramen. Within the facial canal it has several segments separated by genu. Important surgical landmarks along the facial canal include the geniculate ganglion, cochleariform process, and digastric ridge. The main trunk divides into 5 terminal branches in the parotid gland which innervate muscles of facial expression. Careful knowledge of the anatomy is important for safe middle ear, mastoid, and parotid surgery.
Parotid neoplasms most commonly occur in the parotid gland, which is the largest of the three major salivary glands. The parotid gland has a pyramidal shape and is located below the ear. It can be divided into superficial and deep lobes. The most common benign tumor is pleomorphic adenoma, while mucoepidermoid carcinoma is the most common malignant tumor. Investigation, surgical treatment, and risk of complications from parotidectomy such as Frey's syndrome are discussed for parotid neoplasms.
The document provides information on the operative technique of parotidectomy. It discusses the embryology, surgical anatomy, types (partial, superficial, total, radical), procedure, and complications of parotidectomy. The procedure involves raising skin flaps and identifying landmarks like the facial nerve to fully expose and dissect the parotid gland from surrounding tissues. The main steps are identification and preservation of the facial nerve branches, ligation of duct and vessels, and removal of the gland. Complications can include hematoma, facial nerve injury, salivary fistula, cosmetic deformity, and Frey's syndrome.
Pharyngeal pouch, also known as Zenker's diverticulum, is a pulsion diverticulum that arises between the thyropharyngeus and cricopharyngeus muscles in an area of weakness. It is the most common type of posterior pharyngeal pouch. Zenker's diverticulum usually presents in older adults, affecting men more often than women. Symptoms include dysphagia, regurgitation of food, and halitosis. Treatment involves surgical excision of the diverticulum. While the exact cause is unknown, it is hypothesized to be related to the large size and oblique orientation of the pharyngeal muscles in humans, creating regions of weakness where the divert
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
The major salivary glands are the parotid, submandibular, and sublingual glands. The parotid gland is the largest and is located below and in front of the ear. The submandibular gland is beneath the jawbone and the sublingual gland is beneath the floor of the mouth. Each gland has specific blood supply, nerve innervation and ducts through which saliva passes. Imaging modalities like ultrasound and CT are useful for evaluating salivary gland disorders. Surgical procedures like gland excision require careful dissection to preserve structures like nerves and ducts.
This document provides an overview of the surgical anatomy of the major salivary glands. It discusses the embryology, anatomy, functions and clinical implications of the parotid, submandibular, and sublingual glands. Specifically, it describes the locations and relationships of the parotid and submandibular glands, the branches of the facial nerve in the parotid, and the ducts of the parotid and submandibular glands. Examination of the salivary glands and their ducts is important clinically for evaluating inflammation, stones, and tumors. The lymphatics associated with the parotid can also lead to the development of certain cysts and tumors
This document discusses the history and anatomy of neck dissections for head and neck cancer. It traces developments from the late 19th century of increasingly conservative neck dissections to preserve important structures. It describes the levels and boundaries of lymph node groups involved in the neck dissection staging system, including levels I-V. Key structures like the hypoglossal nerve and spinal accessory nerve are discussed in relation to the lymph node groups.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
Tumors of the Parotid Gland - How to ManageReynaldo Joson
This document discusses the management of tumors of the parotid gland. It outlines the clinical diagnostic process, which involves determining if a bulge is abnormal, the organ of origin, the disorder/disease, and extent. Pattern recognition and prevalence are used to diagnose disorders like inflammatory tumors, malignant tumors, or benign tumors. The paraclinical diagnostic process is also described, including determining the need for tests, selecting appropriate tests based on factors like benefit, risk and cost, and interpreting results. Common tests discussed are biopsy methods, imaging like ultrasound, CT and MRI. The document provides guidance on when each test may be indicated.
Esthesioneuroblastoma (ENB) is a rare malignant tumor that arises from the olfactory epithelium in the nasal cavity. Imaging such as CT and MRI are used to determine the extent of the tumor. Histopathological examination shows small round blue cells forming rosettes. Treatment involves surgery such as craniofacial resection along with radiation therapy. For advanced disease, chemotherapy may be given as part of multimodality treatment. With aggressive treatment, 5-year survival rates for ENB exceed 60%.
This document discusses the anatomy seen on CT scans of the temporal bone in different planes. It provides details on key structures visible in the axial, coronal, and sagittal planes, including the semicircular canals, cochlea, facial nerve canal, ossicles, and mastoid air cells. Different anatomical compartments of the middle ear are also described based on coronal imaging. The purpose is to identify relevant anatomy, assess disease extension and surgical planning for ear procedures.
All about uncinate process of nose and paranasal sinusesBikash Shrestha
Uncinate process is one of the important landmarks during the endoscopic sinus surgery. so it is important to know about the variation of unicinate process.
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
1. The document discusses the anatomy and infections of the neck spaces. It describes the layers of cervical fascia and the various neck spaces such as retropharyngeal, masticator, parotid, and submandibular spaces.
2. Common neck space infections discussed include retropharyngeal abscess, Ludwig's angina, parotid abscess, and submandibular space infections. Symptoms, causes, and treatment involving incision and drainage or needle aspiration are described for each infection.
3. Successful treatment of neck space infections requires identifying the involved space, administering antibiotics, and surgically draining any abscess while protecting the airway.
Childhood mumps, certain bacterial infections (for example, of the tonsils or teeth), and other diseases that are typically more common among adults (such as AIDS, Sjögren syndrome, diabetes mellitus, sarcoidosis, and bulimia) often cause swelling of the major salivary glands.
4.NON-ODONTOGENIC TUMOURS OF EPITHELIAL TISSUE ORIGIN.pptxSusovanGiri6
The document provides an overview of oral tumors, including the contrasting features of benign and malignant tumors, cellular adaptations, carcinoma in situ, metastasis, diagnosis, TNM staging, and classifications of non-odontogenic tumors. Specific benign and malignant tumors of epithelial tissue origin are discussed, including squamous papilloma, basal cell carcinoma, squamous cell carcinoma, and verrucous carcinoma. Diagnostic methods like biopsy and cytology are also summarized.
The para-pharyngeal space is an inverted pyramid-shaped area located between the muscles of mastication and muscles of deglutition. It has important structures passing through like the internal carotid artery and cranial nerves. Lesions in this space can be benign like pleomorphic adenomas or malignant like metastases. Imaging with CT or MRI is important for evaluating these lesions. The transcervical approach is most commonly used for surgery but transoral, transparotid, and infratemporal fossa approaches may also be used depending on the location and extent of the lesion. Complications can include nerve injuries, bleeding, and infection. New advances like transoral robotic surgery may help access some lesions with fewer complications.
The parotid gland is located below and in front of the ear. It has two lobes and is drained by Stenson's duct which opens into the mouth. The gland has a capsule and structures like arteries pass through it. It is supplied by parasympathetic and sympathetic nerves. Common tumors include pleomorphic adenoma and Warthin's tumor. Mucoepidermoid carcinoma and adenoid cystic carcinoma are malignant tumors that can occur. Surgical excision is the main treatment for tumors but radiotherapy may also be used for malignant ones. Complications after parotidectomy include facial nerve injury and salivary fistula.
The key points are:
1. Tumors of the parapharyngeal space can be divided into those originating from salivary glands (most common), nerves, and other miscellaneous sources.
2. Imaging such as CT and MRI are important for diagnosis and determining the relationship to surrounding structures like blood vessels.
3. Surgical excision is usually the primary treatment, with the approach depending on factors like location and size of the tumor.
4. Observation or radiation therapy may be considered for patients who are not surgical candidates or if the tumor is not resectable.
This document discusses maxillectomy, which is the surgical removal of part or all of the maxilla bone. It provides a history of maxillectomy and describes the anatomy of the maxilla bone. It also discusses different classifications of maxillectomy procedures based on the extent of bone removed. The common indications for maxillectomy are malignant tumors like squamous cell carcinoma. The approaches used include lateral rhinotomy, Weber-Ferguson, and transoral-transpalatal. Reconstruction options involve dental prosthetics, maxillofacial prosthetics, and titanium implants.
The facial nerve originates from the pons and has both motor and sensory components. It passes through the internal acoustic meatus, facial canal within the temporal bone, and exits at the stylomastoid foramen. Within the facial canal it has several segments separated by genu. Important surgical landmarks along the facial canal include the geniculate ganglion, cochleariform process, and digastric ridge. The main trunk divides into 5 terminal branches in the parotid gland which innervate muscles of facial expression. Careful knowledge of the anatomy is important for safe middle ear, mastoid, and parotid surgery.
Parotid neoplasms most commonly occur in the parotid gland, which is the largest of the three major salivary glands. The parotid gland has a pyramidal shape and is located below the ear. It can be divided into superficial and deep lobes. The most common benign tumor is pleomorphic adenoma, while mucoepidermoid carcinoma is the most common malignant tumor. Investigation, surgical treatment, and risk of complications from parotidectomy such as Frey's syndrome are discussed for parotid neoplasms.
The document provides information on the operative technique of parotidectomy. It discusses the embryology, surgical anatomy, types (partial, superficial, total, radical), procedure, and complications of parotidectomy. The procedure involves raising skin flaps and identifying landmarks like the facial nerve to fully expose and dissect the parotid gland from surrounding tissues. The main steps are identification and preservation of the facial nerve branches, ligation of duct and vessels, and removal of the gland. Complications can include hematoma, facial nerve injury, salivary fistula, cosmetic deformity, and Frey's syndrome.
Pharyngeal pouch, also known as Zenker's diverticulum, is a pulsion diverticulum that arises between the thyropharyngeus and cricopharyngeus muscles in an area of weakness. It is the most common type of posterior pharyngeal pouch. Zenker's diverticulum usually presents in older adults, affecting men more often than women. Symptoms include dysphagia, regurgitation of food, and halitosis. Treatment involves surgical excision of the diverticulum. While the exact cause is unknown, it is hypothesized to be related to the large size and oblique orientation of the pharyngeal muscles in humans, creating regions of weakness where the divert
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
The major salivary glands are the parotid, submandibular, and sublingual glands. The parotid gland is the largest and is located below and in front of the ear. The submandibular gland is beneath the jawbone and the sublingual gland is beneath the floor of the mouth. Each gland has specific blood supply, nerve innervation and ducts through which saliva passes. Imaging modalities like ultrasound and CT are useful for evaluating salivary gland disorders. Surgical procedures like gland excision require careful dissection to preserve structures like nerves and ducts.
This document provides an overview of the surgical anatomy of the major salivary glands. It discusses the embryology, anatomy, functions and clinical implications of the parotid, submandibular, and sublingual glands. Specifically, it describes the locations and relationships of the parotid and submandibular glands, the branches of the facial nerve in the parotid, and the ducts of the parotid and submandibular glands. Examination of the salivary glands and their ducts is important clinically for evaluating inflammation, stones, and tumors. The lymphatics associated with the parotid can also lead to the development of certain cysts and tumors
This document discusses the history and anatomy of neck dissections for head and neck cancer. It traces developments from the late 19th century of increasingly conservative neck dissections to preserve important structures. It describes the levels and boundaries of lymph node groups involved in the neck dissection staging system, including levels I-V. Key structures like the hypoglossal nerve and spinal accessory nerve are discussed in relation to the lymph node groups.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
Tumors of the Parotid Gland - How to ManageReynaldo Joson
This document discusses the management of tumors of the parotid gland. It outlines the clinical diagnostic process, which involves determining if a bulge is abnormal, the organ of origin, the disorder/disease, and extent. Pattern recognition and prevalence are used to diagnose disorders like inflammatory tumors, malignant tumors, or benign tumors. The paraclinical diagnostic process is also described, including determining the need for tests, selecting appropriate tests based on factors like benefit, risk and cost, and interpreting results. Common tests discussed are biopsy methods, imaging like ultrasound, CT and MRI. The document provides guidance on when each test may be indicated.
Esthesioneuroblastoma (ENB) is a rare malignant tumor that arises from the olfactory epithelium in the nasal cavity. Imaging such as CT and MRI are used to determine the extent of the tumor. Histopathological examination shows small round blue cells forming rosettes. Treatment involves surgery such as craniofacial resection along with radiation therapy. For advanced disease, chemotherapy may be given as part of multimodality treatment. With aggressive treatment, 5-year survival rates for ENB exceed 60%.
This document discusses the anatomy seen on CT scans of the temporal bone in different planes. It provides details on key structures visible in the axial, coronal, and sagittal planes, including the semicircular canals, cochlea, facial nerve canal, ossicles, and mastoid air cells. Different anatomical compartments of the middle ear are also described based on coronal imaging. The purpose is to identify relevant anatomy, assess disease extension and surgical planning for ear procedures.
All about uncinate process of nose and paranasal sinusesBikash Shrestha
Uncinate process is one of the important landmarks during the endoscopic sinus surgery. so it is important to know about the variation of unicinate process.
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
1. The document discusses the anatomy and infections of the neck spaces. It describes the layers of cervical fascia and the various neck spaces such as retropharyngeal, masticator, parotid, and submandibular spaces.
2. Common neck space infections discussed include retropharyngeal abscess, Ludwig's angina, parotid abscess, and submandibular space infections. Symptoms, causes, and treatment involving incision and drainage or needle aspiration are described for each infection.
3. Successful treatment of neck space infections requires identifying the involved space, administering antibiotics, and surgically draining any abscess while protecting the airway.
Childhood mumps, certain bacterial infections (for example, of the tonsils or teeth), and other diseases that are typically more common among adults (such as AIDS, Sjögren syndrome, diabetes mellitus, sarcoidosis, and bulimia) often cause swelling of the major salivary glands.
4.NON-ODONTOGENIC TUMOURS OF EPITHELIAL TISSUE ORIGIN.pptxSusovanGiri6
The document provides an overview of oral tumors, including the contrasting features of benign and malignant tumors, cellular adaptations, carcinoma in situ, metastasis, diagnosis, TNM staging, and classifications of non-odontogenic tumors. Specific benign and malignant tumors of epithelial tissue origin are discussed, including squamous papilloma, basal cell carcinoma, squamous cell carcinoma, and verrucous carcinoma. Diagnostic methods like biopsy and cytology are also summarized.
This document discusses salivary gland tumors. It begins with definitions of tumors and classifications of salivary glands and salivary gland tumors. It then covers the incidence, clinical features, histopathological features, and treatment plans for various benign and malignant salivary gland tumors. The document emphasizes that surgical resection is usually the primary treatment for salivary gland tumors, with adjuvant radiotherapy sometimes used as well.
Malignant Salivary Gland Pathologies, Tumors & Its Treatment Plan by Dr. Adit...Aditya Tiwari
This document discusses malignant pathologies of the salivary glands. It begins by describing the major and minor salivary glands and notes that malignant neoplasms can exhibit a wide range of behaviors from slow-growing to highly aggressive. It then covers surgical pathology aspects like incidence rates and common tumor types by gland. The document also discusses etiology, cellular origins, WHO classifications, and provides detailed descriptions of common malignant tumor types like mucoepidermoid carcinoma and adenoid cystic carcinoma. It concludes with treatment approaches for different malignant salivary gland tumors.
Metastasis of Neck Node with Unknown Primary Himanshu Soni
1) An unknown primary is defined as squamous cell carcinoma presenting in cervical lymph nodes with no identifiable primary tumor site after examination. This clinical entity is known as carcinoma of unknown primary (CUP).
2) Evaluation involves physical examination, imaging like PET-CT, and panendoscopy with biopsies of suspicious sites to identify the occult primary tumor. Bilateral tonsillectomy and tongue base biopsy can identify occult tumors in the tonsillar crypts in many cases.
3) Treatment depends on tumor stage but often involves combined modality treatment with surgery, radiation, and/or chemotherapy aimed at locoregional control while minimizing morbidity.
Salivary gland tumors can be benign or malignant. The majority are benign and arise most commonly in the parotid gland. Histologically, tumors are best classified based on their patterns. Treatment depends on the type and severity of the tumor, with more aggressive surgery and radiation used for malignant tumors. Prognosis varies significantly depending on the specific tumor type.
This document discusses oral squamous cell carcinoma (OSCC). It covers the epidemiology, risk factors, early detection methods, premalignant lesions, investigations, management including surgery and reconstruction, and treatment including radiation and chemotherapy. OSCC is the 6th most common cancer worldwide and the most common cancer in Indian men. Tobacco and alcohol are major risk factors. Detection methods include toluidine blue staining and tissue autofluorescence. Premalignant lesions include leukoplakia and erythroplakia. Management involves wide local excision and neck dissection, with reconstruction options like flaps and grafts. Radiation and chemotherapy may be used as adjuvant or palliative treatment.
1. Nasopharyngeal angiofibroma is a rare, benign tumor that occurs mostly in adolescent males and arises from the posterior nasal cavity.
2. It is locally invasive and can extend into surrounding areas like the nasal cavity, paranasal sinuses, and cranial cavity, causing symptoms like nasal obstruction, epistaxis, and cranial nerve palsies.
3. Diagnosis involves imaging like CT and MRI to determine the extent of the tumor. Surgical excision is the primary treatment but carries a risk of heavy bleeding, so preoperative embolization of feeding vessels is often used to reduce bleeding during surgery.
This document provides information about parotidectomy, which is the surgical removal of the parotid gland. It discusses the different types of parotidectomy including superficial and total parotidectomy. Superficial parotidectomy involves removing the superficial lobe of the parotid gland while preserving the facial nerve. The procedure is described in detail, including identifying landmarks to locate the facial nerve and carefully dissecting the gland superficial to the nerve. Complications involving the facial nerve are also addressed.
A malignant neoplasm that contains elements of carcinoma (cancer of epithelial tissue, which is skin and tissue that lines or covers the internal organs) and sarcoma (cancer of connective tissue, such as bone, cartilage, and fat) so extensively intermixed as to indicate neoplasia of epithelial and mesenchymal tissue.
This document provides an overview of salivary gland tumors including their anatomy, epidemiology, classification, and management. It discusses the most common benign tumors like pleomorphic adenoma and Warthin's tumor as well as malignant tumors such as mucoepidermoid carcinoma and adenoid cystic carcinoma. The document outlines the clinical presentation, investigations, treatment and prognosis of various salivary gland tumors. It emphasizes complete surgical excision of benign tumors and importance of postoperative radiation for malignant tumors.
1. Juvenile nasopharyngeal angiofibroma is a rare, benign tumour that occurs primarily in adolescent males and is highly vascular.
2. It originates from the posterior nasal cavity near the sphenopalatine foramen and can extend into local structures like the sinuses, orbit and cranium.
3. Treatment involves preoperative embolization followed by surgical excision via various approaches depending on tumour extent. Endoscopic removal is used for smaller tumours while more extensive approaches are needed for larger or invasive tumours.
This document provides an overview of nasopharyngeal carcinoma. It begins with an introduction defining nasopharyngeal carcinoma as a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx. It then covers the epidemiology, risk factors, clinical presentation, investigations including imaging and biopsy, histopathological classification, staging, and treatment options. The key points are that nasopharyngeal carcinoma most commonly presents with neck swelling, is strongly associated with Epstein-Barr virus, and is classified into three types by the WHO based on differentiation and presence of lymphoid stroma.
Pleomorphic adenoma is the most common salivary gland tumor, accounting for 60% of cases. It occurs most often in the parotid glands and presents as a painless, firm mass. Histologically, it contains both epithelial and mesenchymal elements arranged in a trabecular pattern within a fibrous stroma. Treatment involves complete surgical removal of the tumor with adequate margins to prevent recurrence due to microscopic projections outside the capsule. Imaging such as CT or MRI is used to identify the location and characteristics of the tumor prior to surgery.
The document discusses tumors of the pharynx, including anatomy, histology, risk factors, types, diagnosis, staging, and treatment. The pharynx is divided into nasopharynx, oropharynx, and hypopharynx. Common pharyngeal cancers include squamous cell carcinoma and nasopharyngeal carcinoma. Risk factors include smoking, alcohol, radiation exposure, and viruses. Diagnosis involves medical history, examination, and imaging tests. Treatment depends on cancer type and stage but may include surgery, radiation therapy, or chemoradiation.
The document discusses tumors of the pharynx, including anatomy, histology, risk factors, types, diagnosis, staging, and treatment. The pharynx is divided into nasopharynx, oropharynx, and hypopharynx. Common pharyngeal cancers include squamous cell carcinoma and nasopharyngeal carcinoma. Risk factors include smoking, alcohol, radiation exposure, and viruses. Diagnosis involves medical history, examination, and imaging tests. Treatment depends on cancer type and stage but may include surgery, radiation therapy, or chemoradiation.
This document discusses anal canal carcinoma, including:
1. The anatomy and histology of the anal canal, which can give rise to different tumor types based on location.
2. The staging and classification of anal canal carcinoma according to the TNM and American Joint Committee on Cancer systems.
3. Risk factors for anal canal carcinoma like HPV infection and HIV status, as well as pre-cancerous lesions.
4. Methods for diagnosing anal canal carcinoma through physical examination, imaging like MRI, and biopsy.
Management of sinonasal tract tumors 27082018Varshu Goel
This document discusses the management of sinonasal tract tumors. It begins with the anatomy and lymphatic drainage of the sinonasal tract. It then discusses the clinical presentation, diagnostic workup including imaging, and staging of sinonasal tumors. Finally, it briefly discusses the treatment modalities and follow up for sinonasal tumors.
This document discusses tumors of the nasal cavity and paranasal sinuses. It begins with an introduction stating that these cancers make up 3% of head and neck cancers, most commonly affecting older males. It then discusses the anatomy of the different paranasal sinuses and drainage pathways. The document classifies tumors as benign epithelial, benign non-epithelial, malignant epithelial, and malignant non-epithelial. Common tumor types like squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, melanoma, and esthesioneuroblastoma are described. Imaging modalities like CT, MRI, PET and angiography are discussed. The staging systems for maxillary sinus cancers and other paranasal
Nasopharyngeal carcinoma is a non lymphomatous squamous-cell carcinoma that occurs in the epithelial lining of the nasopharynx.
It frequently arises from the pharyngeal recess (fossa of Rosenmuller) posteromedial to the medial crura of the eustachian tube opening in the nasopharynx
Similar to Parotid gland tumours Conference Presentation (20)
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3. INCIDENCE
Salivary gland tumours are relatively uncommon,
accounting for less than 1% of all reported
malignancies.
In USA parotid tumours claim 650 lives annually.
In UK 40 new cases are reported annually.
Parotid gland is the most common site of neoplasms
among these (75% - 80%) and account for 3-4% of
all head and neck tumours. They display
considerable variation in their biological behaviour
and even histology is not a good prognostic
indicator.
8. PAROTID TUMOURS
INCREASING ORDER OF MALIGNANCY
Anaplastic, Adeno CA
Cylindroma
Mucoepidermoid tumour
Fast growing CAs
Add Your Text
Add Your Text
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Acinic cell tumour
Pleomorphic adenoma
9. SO THE INCREASING ORDER OFSO THE INCREASING ORDER OF
MALIGNANCY IS AS FOLLOWSMALIGNANCY IS AS FOLLOWS
10. 1) Pleomorphic adenoma
2) Acinic cell tumour
3) Mucoepidermoid
tumour
4) Cylindroma
5) Fast growing CA
Adeno CA
Anaplastic CA
12. Most common of all parotid tumours (60 % of all)
Patient is usually around 45 years .
It is important for three reason:
a.Close proximity to Facial Nerve that can be damaged
during surgery.
b.May recurr if tumour is damaged at operation
c.Can become CA ex-pleomorphic adenoma
14. Usually as a painless slow growing lump on the side of
the face in front of the ear.
Pleomorphic adenoma is usually firm to hard, mobile,
well circumscribed lump. Very rarely it arises from
deep lobe and then develop within parapharyngeal
space.
21. Is characterized by presence of multiple, round, well-
circumscribed nodules growing in salivary gland tissue, in
adipose tissue adjacent to gland or in the scar of previous
surgery.
History of same previous benign tumour.
Carcinoma may arise in these therefore each nodule should
be examined microscopically.
Nodules in recurrent mixed tumour do not exhibit the
features of cell anaplasia and invasiveness that characterize
malignant mixed tumour.
22. Adenoma Lymphoma
Warthin’s tumour, Papillary cystadenoma lymphatosum is
slow growing, soft sometimes fluctuant, bilateral 10%, hot
spot on Tc99 pertechnictate scan
Treatment excision.
24. Adenoid Cystic Carcinoma
Elderly, slow growing, hard, fixed painful, areas of
anaesthesia and paralysis of muscles due to
involvement of related nerves. Infilterates for long
distances in the perineural tissues of adjacent nerves
and may invade maxillary bone.
Metastasis to lymph nodes and hematogenous to long
bones may occur.
26. 1) Sudden rapid growth in previously slowly
growing tumour.
2) Mild intermittent pain, tenderness.
3) Nerve involvement/Facial weakness
4) Skin ulceration, tethered skin etc.
5) Symptoms due to surrounding structure
involvement e.g dysphagia
6) Unremarkable mass at the site of origin.
27. DIFFERENTIAL DIAGNOSES OF PAROTID
SWELLING:
1) Idiopathic hypertrophy of masseter muscle.
2) Pre-auricular lymphadenopathy.
3) TB
4) Reticulosis
5) Calculus(rare)
6) Miscellaneous
Ch. parotitis
Hemangioma
Cysts etc.
29. 1) LOCAL EXAM. INCLUDING BIMANUAL
EXAMINATION (Compare with the opposite side).
a) Inspect the gland from outside
b) Palpate the gland from outside:
- main body of gland consistency, tenderness.
- anterior limit
- superior third of the gland
- inferior third of the gland
- postero inferior part of the gland
30. Contd:
c) Inspect the Stensen’s duct orifice from inside. Apply
pressure over gland from without.
d) Palpate the duct
e) deep lobe of the gland from inside.
2) TEST THE FACIAL NERVE
3) EXAMINE THE CERVICAL NODES
4) EXAMINE OTHER SALIVARY GLANDS
5) PERFORM SYSTEMIC EXAM.
38. The objective of Surgery is to eliminate all the tumour
with minimum of deformity(by preserving the facial
nerve) and to reconstruct any residual defect.
40. FACIAL NERVE IDENTIFICATION:
1) Tragal pointer of cartilage of external auditory canal--
----1 cm deep, slightly inferior & ant. to tragal
pointer.
2) 6-8 mm deep to inferior end of tympanomastoid
suture line.
3) Between the styloid process & the attachment of
diagastric to diagastric ridge of mastoid process.
41. 4) Follow the posterior facial vein superiorly as it
enters the parotid gland & here marginal
mandibular nerve crosses superficial to post.
Facial vein which is followed posteriorly to main
trunk.
5) “V”Sulcus between bony external auditory canal
and mastoid process. Identify buccal branch as it
courses parallel to the parotid duct which is
identified anteriorly as it crosses the masseter
muscle.
7) Remove the mastoid tip and identify the facial
nerve as it exits to the styloid mastoid canal.
8) IdentifyIdentify buccalbuccal branch as it courses parallel to thebranch as it courses parallel to the
parotid duct which is identifiedparotid duct which is identified anteriorlyanteriorly as itas it
crosses thecrosses the massetermasseter muscle.muscle.
42. OTHER METHODS:
Staining method (injection of Methylene blue in
salivary duct).
Nerve stimulator.
Anatomical identification with mechanical stimulation.
55. SUMMARY:
PRINCIPLES OF PAROTID CA MANAGEMENT:
1) T 1 & T 2 low grade Mucoepidermoid CA &Acinic cell CA -----
Superficial or total parotidectomy with Facial N. presevation
2) T 1 & T2 high grade Adeno CA, malignant pleumorphic adenoma,
undifferentited Ca, Sq-Cell CA----
Total parotidectomy with resection of first echelon of lymph nodes
56. Contd.
3) T 3 N* or N+ Any recurrent tumour not in group IV.-----Radical
parotidectomy, sacrifice of Fascial N. with immediate
reconstruction, neck dissection for N+ neck + post op
radiotherapy
4) T4-----Radical parotidectomy with resection of skin, madible
muscles as indicated. Sacrifice of Facial N. with immediate
reconstruction, neck dissection, post op irradiation.
57. POSTOP RADIOTHERAPY:
Radiotherapy may be used as an adjunct to surgery or as palliation in
inoperable cases.
In benign mixed tumours:
- presence of residual disease
- following excision of recurrent tumour.
b) In malignancy for:
- recurrent tumour
- positive margins after surgery
- narrow margin on facial nerve
- multiple nodal metastasis
- perineural invasion
59. Objective: To document the presentation and outcome of
parotid gland tumours in our set up.
Study Design: Descriptive study.
Place of the Study : This study was carried out in the
Department of Surgery, Pakistan Institute of Medical
Sciences (PIMS), Islamabad.
Duration of the Study: Jan 01, 2003 to Dec 31, 2007.
Subjects and Methods:
All patients with parotid gland tumours.
Convenience sampling technique.
Initial assessment and diagnosis was made by history,
physical examination and fine needle aspiration
cytology (FNAC). Local extent of tumour was assessed
with CT scan in selected patients with FNAC proven
malignancy..
Data Collection Instrument and Processing:
61. COMPLICATIONS OBSERVED (n=9)COMPLICATIONS OBSERVED (n=9)
COMPLICATION No. of PATIENTS/ %
1 Transient facial nerve
weakness
2 (3.17%)
2 Permanent facial nerve palsy 2 (3.17%)
3 Symptomatic Numbness of
Great auricular nerve area
2 (3.17%)
4 Frey's syndrome 2 (3.17%)
5 Flap tip necrosis 1 (1.58%)
62. Parotid gland tumours constitute a significant source of morbidity and
hospitalization in our relatively younger population. In our set up,
pleomorphic adenoma constitutes the leading type. Painless lump in the
parotid region, of a relatively longer duration is the usual presenting
feature. Superficial parotidectomy with preservation of facial nerve is the
most frequently instituted definitive treatment.
Parotid gland tumour though less common are encountered in our country.
Problems in their management are largely related to the facial nerve. A
proper consent should therefore be taken from the patient preoperatively
and such patients should perfectly be managed where expertise to handle
complications of surgery can be tackled in a proper and judicious way.
Conclusions