How to confirm the etiology of any parotid region swellings and how to manage them

1. Differential Diagnosis and
Management of Parotid
swellings
By:
Ahmed Taha Badr
34
Under supervision of general surgery
department
general and bariatric unit

2. Intended Learning Outcomes
•know the site , the surface anatomy and relations
of the parotid gland.
•Know the approach to reach the diagnosis of a
parotid swelling.
•Know the possible etiology of a swelling in the
parotid region.
•Differentiate between the causes through history
and examination.
•Know the possible investigation to detect a
pathology in the parotid lesion.
• Know the methods through which doctors control
and treat diseases with the parotid gland.
After this lecture you would be able to
:

3. Angle of Mandible z
Sternomastoid
Auricle
Site and surface anatomy of the
parotid gland

4. Relations

5. Swelling
others
skin
Sebaceou
s cyst
abcess
Sc
tissue
lipoma
neuro-
fibroma
Musculos
keletal
fibrosarcoma Bone
metastasi
s
L.N
Tumo
r
Inf.
hematoma
hemangioma
Parotid Gland

6. Parotid
ds
Inflammation.
Infective
.
Auto-
immune
Stone.
Congenital.
Cyst&
Fistula.
Neoplasia.
Post
truamati
c/infecti
ve.
•Sialectasis
•Ectopic parotid
•Cystic hygroma
•Bacterial
.
•Viral.
•Fungal.
•Sjogren $

7. Benign (80%)
Pleomorphic
Adenoma
Monomorphic
Adenoma
Malignant
Mucoepidermoid
carcinoma
Adenoid cystic carcinoma
Acinic cell carcinoma
Adenocarcinoma
Undiffertiated carcinoma
Parotid gland
tumors

8. Management
Diagnosis
H&E
INV.
Treatment
Medical
surgical

9. History of parotid region swelling
Greetings
Introduce yourself
Personal history: name, age, sex,address & residence, occ, special
habitsComplaint and its duration
- **May be ASYMPTOMATIC **
- Swelling
- Pain
- FAHM
- Halitosis
- Xerostomia
-- Discharge
- Difficulty of mastication
-Other systems history
Past history
Family history
History of drugs and allergies
-Dysfunction of related nerves :
FACIAL N.
*Drooping of saliva and tears
*Increased lacrimation and
recurrent conjunctivitis
*Accumulation of food between the
cheeks and jaws
(( on the same side ))

10. Examination of parotid Gland Swelling
Examination
General
Local
Inspection
4S
Palpation
Site
Size
Shape
Skin
Confirm
Hotness
Tendernes
Surface
Consistency.
Attachment
Mobility
Draining L.N

11. Examination of Stensen’s duct orifice
(opposite the upper 2nd molar tooth) using
wooden probe (you might need to squeeze
the gland
Swelling of the deep lobe of the parotid
as seen by examination of the pharynx
Never forget :
• Examination of Stensen’s duct
• Examination of the ipsilateral pharynx
• Examination of the facial N.
• Examination of all slaivary glands bilatrally

12. Examination
of the
Facial Nerve
Occipito-
frontalis
Orbiculari
s occuli
BuccinatPerioral-
muscles
Left sided facial
nerve paralysis

13. Preauricular L.N
Hemangioma
Hematoma.
Adenoma
Parotid fisutla
Preauricular dermoid

14. Some Important
Points about Parotid
Gland Swellings
 swelling of the parotid
gland (taking the
anatomical shape of the
gland) is usually non-
neoplastic
 Parotid swellings usually
fill the gap between the
angle of the jaw and the
mastoid bone Parotid
swelling &raising lobule
of the ear

15. Investigation of a parotid swelling
Inv.
invasive
biopsy
Lab imaging
•X-ray
•U/S
•CT scan
•Tc99 scan
•Sialography
•Bone scan
•ESR
•CBC
•CRP
•Open biopsy
•Fine needle
biopsy

17. Parotid Abscess

18. CT showing the mass in the
right masseter with central
necrosis

19. acial nerve neuroma

20. carcinoma of the parotid gland |

21. MRI showing Hemangioma
in the Parotid region

22. •A,B parotid scan
using Tc99 to detect
vascularity &
function of the tumor
cells
•Differentiation bt.
Benign tumors(hot) -
warthins - and
malignant ones
(cold)
Bone scan and spot
images of the
mandible-increased
uptake in the
mandible extending
bilaterally

23. Fine needle aspiraion is
preferred to open biopsy to
avoid facial N. injury
Sialography of parotid gland showing:
• inflammation of the gland( prunting of a
tree )
•Irregular duct (sausage shape )

24. Focal lymphocytic
sialadenitis (FLS)
comprised of
mononuclear cell
infiltrate throughout
the parotid gland
parenchyma
Normal parotid gland
tissue

25. Pleomorphic adenoma
parotid gland
Low-grade
mucoepidermoid
carcinoma with prominent
High-grade mucoepidermoid
carcinoma with predominant
epidermoid cells

26. Hey Parotid,
What is your last
wish??

27. Surgical TTTMedical TTTDisease
•Modified Blair incision under
GA
(Hilton teqhnique)
•Drainage
•Antibiotics. /Antiviral.
•Rest
•analgesics
Sialoadenitis
Superficial conservative
parotidectomy
Avoid PDF as infectionSTONE
•Avulsion of aurico temporal n
•Superficial conservative
parotidectomy
Parasympatholytic drugsFistula
Aspiraion and drainageTtt of infecionSialocele
Antibiotics during attacksCongeintal
sialectasis
•Superficial conservative
parotidectomy
•total conservative
parotidectomy (preserving VII
ConservativeBenign tuomrs
:Treatment of a parotid region swelling is
according to the cuase

28. Modified Blair incision
Called lazy S incision

30. Reconstrucion by
taking a flap of a
muscle into the
parotid gland

31. Removal of a pathology deep to the facial N. branches

32. Refrences
• Researchgate.net
• Oncolink.org
• Headandneckcancerguide.org
• Ncbi.nlm.nih.gov
• Radiopaedia.org
• Emedicine.medscape.com