This document provides information on salivary gland tumors. It discusses the incidence, etiology, risk factors, origin, WHO histological classifications of 1991 and 2005, TNM classification and staging system, clinical features of benign and malignant tumors, and management of common tumors such as pleomorphic adenoma, Warthin's tumor, acinic cell carcinoma, and mucoepidermoid carcinoma. Key points include that pleomorphic adenoma is the most common benign tumor, while mucoepidermoid carcinoma has the highest malignancy. Clinical features of benign tumors include slow growth and lack of fixation or pain, while malignant tumors often cause pain, facial nerve involvement, and metastasis. Surgical excision is the primary treatment for benign tumors

1. Dr. Sapna K Vadera Dr. S.R.Shenoi
(P.G. Student) (Prof, Guide and H.O.D)
Dept Of Oral And Maxillofacial surgery
VSPM’S Dental College, Nagpur

2. CONTENT
• Introduction
• Incidence
• Etiology and Risk factors
• Origin
• WHO Histological Classification-1991
-2005
• TNM Classification and Staging
• Clinical features of Benign and Malignant Tumors
• Tumors-Salivary gland

3. CONTENT
• Diagnosis
• Management
• Complications
• Neck dissection
• Radiotherapy
• Chemotherapy
• Conclusion
• References

4. Introduction
Salivary Glands
Major
Parotid Submandibular Sublingual
Minor

5. PAROTID GLAND
Max. 2nd molar
Stensen’s duct

7. SUBMANDIBULAR GLAND
Facial artery
and vein
Submandibular
gland
Poterior belly of
Digastric muscle
Mylohyoid
Anterior belly
of diagastric
Hyoid

8. Submandibular gland
Lingual nerve
Wharton's duct
Ducts of Rivinus
Bartholin's ducts'
Sublingual gland
SUBLINGUAL GLAND

9. MINOR SALIVARY GLAND

10. INCIDENCE
Benign 72%
Malignant 28%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Malignant
Benign
Incidence Rate of Head and
Neck Cancers-
1974-1976- 6.3%
1998-1999- 8.1%
M. Guzzo et al.,Major and minor salivary gland tumors Critical Reviews in Oncology/
Hematology 74 (2010) 134–148
Male > Female
Pleomorphic Adenoma-75%

11. INCIDENCE
• Pleomorphic adenoma-86%
• Adenoid cystic carcinoma-25%
• Mucoepidermoid carcinoma-18%
• Palate-68%
Benign 62%
Malignant 38%
Parotid 60%
Submandibular 16%
Sublingual 1-2%
Minor 22%
Krishnaraj Subhashraj , Salivary gland tumors: a single institution experience in India
British Journal of Oral and Maxillofacial Surgery 46 (2008) 635–638
Pleomorphic adenoma-86%

12. ETIOLOGY AND
RISK FACTORS
Zheng W, Shu XO,Ji BT,et al. Diet and other risk factors for cancer of the salivary
glands: a population-based case-control study. Int J Cancer. 1996 17;67(2):194-8.

13. ORIGIN
Mounting evidence against current histogenetic concepts for salivary gland
tumorigenesis. Eur J Morphol 1998; 36:257-261.
1. Multicellular Theory
originates from already differentiated cells along the
salivary gland unit
2. Reserve cell theory
arise from reserved (stem cells) of the salivary duct
system
Whartin’s / oncocytic : striated duct cells.
Acinic cell tumor : acinar cells.
Mixed : intercalated and myoepithelial cells
Adenonoid cystic carcinoma
Acinic cell carcinoma : intercalated duct reserve cell.
Mucoepidermoid carcinoma
Squamous cell carcinoma : excretory reserve cell.

14. ORIGIN
Mounting evidence against current histogenetic concepts for salivary gland
tumorigenesis. Eur J Morphol 1998; 36:257-261.

15. WHO HISTOLOGICAL
CLASSIFICATION OF SALIVARY
GLAND TUMOR 1991
1. ADENOMAS
1.1 Pleomorphic Adenoma
1.2 Myoepithelioma
1.3 Basal Cell Adenoma
1.4 Warthin’s tumor(adenolymphoma)
1.5Oncocytoma
1.6 Canalicular adenoma
1.7 Sebaceous adenoma
1.8 Ductal Papilloma
1.8.1 Inverted ductal papilloma
1.8.2 Intraductal Papilloma
1.8.3 Sialadenoma papilliferum
1.9 Cystadenoma
1.9.1 Papillary Cystadenoma
1.9.2 Mucinous Cystadenoma
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

16. 2. CARCINOMAS
2.1Acinic cell carcinoma
2.2 Mucoepidermoid Carcinoma
2.3 Adenoid cystic carcinoma
2.4 Polymorphous low grade adenocarcinoma(terminal duct adenocarcinoma)
2.5 Epithelial myoepithelial carcinoma
2.6Basal cell adenocarcinoma
2.7Sebaceous carcinoma
2.8 Papillary Cystadenocarcinoma
2.9 Mucinous adenocarcinoma
2.10 Oncocytic carcinoma
2.11Salivary duct Caecinoma
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

17. 2.12Adenocarcinoma
2.13 Malignant Myoepithelioma(myoepithelial carcioma)
2.14 Carcinoma in Pleomorphic adenoma(malignant mixed tumor)
2.15 Squmous cell carcinoma
2.16 Small cell carcinoma
2.17 Undifferntiated caecinoma
2.18 other carcinoma
3.Nonepithelial tumors
4. Malignant Lymphomas
5. Secondary tumors
6. Unclassified tumors
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

18. 7. Tumor like lesions
7.1 sialadenosis
7.2 Oncocytosis
7.3 Necrotizing Sialometaplasia(infraction)
7.4Benign Lymphoepithelial lesion
7.5 Salivary Gland Cysts
7.6 Chronic Sclerosing Sialadenitis of Submandibular gland( Kuttner tumor)
7.7 Cystic Lymphoid Hyperplasia in AIDS
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

19. WHO HISTOLOGICAL
CLASSIFICATION OF SALIVARY
GLAND TUMOR 2005
1.MALIGNANT EPITHELIAL TUMORS
Acinic cell carcinoma
Mucoepidermoid Carcinoma
Adenoid cystic carcinoma
Polymorphous low grade adenocarcinoma
Epithelial myoepithelial carcinoma
Clear cell carcinoma,not otherwise specified
Basal cell adenocarcinoma
Sebaceous carcinoma
Sebaceous Lymphadenocarcinoma
Borle Rajiv , Textbook of Oral and Maxillofacial Surgery,1st edition ,2014 , Jaypee
Brothers Medical Publishers, New Delhi

20. Csytadenocarcinoma
Low grade Cribriform adenocarcinoma
Mucinous adenocarcinoma
Oncocytic carcinoma
Salivary duct Caecinoma
Adenocarcinoma, not otherwise specified
Myoepithelial carcioma
Carcinoma ex Pleomorphic adenoma
Carcinosarcoma
Metastasizing Pleomorphic aenoma
Squmous cell carcinoma
Small cell carcinoma
Large cell carcinoma
Lymphoepithelial carcinoma
Sialoblastoma
Borle Rajiv , Textbook of Oral and Maxillofacial Surgery,1st edition ,2014 , Jaypee
Brothers Medical Publishers, New Delhi

21. 2.BENIGN EPITHELIAL TUMORS
Pleomorphic Adenoma
Myoepithelioma
Basal Cell Adenoma
Warthin’s tumor
Oncocytoma
Canaicular adenoma
Sebaceous adenoma
Lympadenoma
i.Sebaceous
ii.Non-sebaceous
Borle Rajiv , Textbook of Oral and Maxillofacial Surgery,1st edition ,2014 , Jaypee
Brothers Medical Publishers, New Delhi

22. Ductal Papilloma
i. Inverted ductal papilloma
ii.Intraductal Papilloma
iii.Sialadenoma papilliferum
Cystadenoma
i Soft tissue tumors
Hemangioma
i Hematolymphoid tumors
ii.Hodgkin lymphoma
Diffuse large B-cell Lymphoma
i.Secondary tumors
Borle Rajiv , Textbook of Oral and Maxillofacial Surgery,1st edition ,2014 , Jaypee
Brothers Medical Publishers, New Delhi

23. TNM Classification and Staging of
the Salivary Gland Neoplasms

24. Primary tumor cannot be assessed.
No evidence of Primary Tumor.
Tumor 2cm or less in greatest dimension without extraparenchymal
extention.
Tumor >2cm but not >4 cm in greatest dimension without
extraparenchymal extention
Tumor >4cm and/or tumor having extraparenchymal extention.
Tumor invades skin,mandible,ear canal and/or facial nerve.
Tumor invades Skull base and/or Pterygoid plates and/or encases Carotid
artery.
Primary Tumor(T)
TX
T4b
T4a
TO
T3
T1
T2
Patel SG, Shah JP. TNM Staging of Cancers of the Head and Neck: Striving for
Uniformity among Diversity. C A Cancer J Clin 2005 ;55;242-258

25. Regional Lymph nodes cannot be assessed.
No Regional Lymph node Metastasis.
Metastasis in single ipsilateral lymph node,not more than 3cm in
greatest dimension.
Metastasis in a single ipsilateral lymph node >3cm but not >6cm in
greatest dimension.
Metastasis in muliple ipsilateral lymph nodes, none more than 6cm in
greatest dimension.
Metastasis in bilateral or contrlateral lymph nodes, none more than 6cm
in greatest dimension.
Metastasis in lymph node more than 6cm in greatest dimention
Regional Lymph Nodes(N)
NX
N0
N1
N2c
N2b
N2a
N3
Patel SG, Shah JP. TNM Staging of Cancers of the Head and Neck: Striving for
Uniformity among Diversity. C A Cancer J Clin 2005 ;55;242-258

26. Distant Metastasis (M)
Presence of distant metastasis cannot be assessed.
No distant metastasis.
Distant metastasis.
M0
MX
M1
Patel SG, Shah JP. TNM Staging of Cancers of the Head and Neck: Striving for
Uniformity among Diversity. C A Cancer J Clin 2005 ;55;242-258

27. Stage I T1 N0 MO
Stage II T2 N0 MO
Stage III T3 N0 MO
T1 N1 MO
T2 N1 MO
T3 N1 MO
Stage 4a T4a N0 MO
T4a N1 MO
T1 N2 MO
T2 N2 MO
T3 N2 MO
T4a N2 MO
Stage 4b T4b Any N MO
Any T N3 MO
Stage 4c Any T Any N M1
STAGING

28. CLINICAL FEATURES
BENIGN MALIGNANT
No Pain Pain
Slow growing Fast growing
Soft, Rubbery Hard
Not fixed Fixed
Smaller in size Larger in size
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

29. BENIGN MALIGNANT
Facial nerve not involved
commonly
Facial nerve is commonly
involved
Pseudoencapsulated Nonencapsulated
Uiceration not common Ulceration common
Local invasion Spread to lymph nodes and
metastasis to lung,liver,brain
and bones is common
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India
CLINICAL FEATURES

30. Pleomorphic Adenoma
•Most Common tumor
•Females : Males 6:4
•4th – 6th decade of life
•Lower pole of superficial
lobe of the gland
•10% in deeper portion
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India
•8% in minor salivary Gland.
•Mostly Palate
•Small, Painless, Quiescent
nodule.
•Slowly increase in size.
•No fixation to deeper or
overlying skin.
• Firm, Cystic degeneration
less common.
• Pain-not common
• Local Discomfort
• Facial paralysis rare

31. R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

32. Signs of malignant transformation
• Weakness in the distribution of the
facial nerve
• May appear fixed to the underlying
bone
• Palpable regional lymph nodes
• Ulceration
• Difficulty in mastication, talking, &
breathing
• Irregular nodular lesion.
• Recurrent lesions however occur as
multiple nodules.
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

33. Treatment:
• Surgical excision
• Introral lesions treated
conservatively- extra capsular
excision.
• Radioresistant ,radiotherapy is
contraindicated
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

34. Warthin’s Tumor
• Exclusively seen in the superficial lobe
of parotid
• 2nd most common tumor
• 1st recognized by Albrecht 1910 &
later Warthin 1929
• Smoking , Epstein-Barr virus
• Men>Women
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India
• 6th – 7th decade
• <3-4 cm in diameter.
• Proliferation of ductal and lymphoid
elements
• Painless swelling doughy in
consistency
• Commonest neoplasm of the tail of
the parotid

35. R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

36. Treatment
• Surgical excision .
• Seldom recurrence
• Malignant transformation
rare.
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

37. Acinic Cell Carcinoma
• Appearance similar to Pleomorphic-
Encapsulated and Lobulated
• 80-90% - parotid gland, intraoral-
lips & buccal mucosa
• Mean age- 44 years
• Women: Men 3:2
• Slow growing,mobile/fixed
• Usually painless
• Pain in 1/3rd of patients
• Facial muscle weakness seen
• Bilateral tumors reported
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

38. R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,IndiaC

39. Treatment
• Surgical excision.
• Radiation therapy- no therapeutic
value.
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,IndiaC

40. Mucoepidermoid Carcinoma
• 29%-34% originating in major
salivary gland.
• 80-90% in parotid gland
• Predilection -palate
• Female : Male 4:1
• 3rd-4th decade,average 47 years
• Most common children
• Higher risk- prior exposure to
ionizing radiation
• Tumor of high-grade malignancy-
grows rapidly
• Trismus, dysphagia,, facial nerve
paralysis is frequent in parotid
tumors.
•Not encapsulated-infiltrate the
surrounding tissue
•Metastasize to regional lymph
nodes
•Distant metastasize to lung,
bone, brain, and subcutaneous
tissues.
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

41. R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

42. Prognosis
• Depends on clinical stage, site,
grading and margins.
Treatment
• Conservative excision with
preservation of facial nerve, if
possible for low & intermediate
grade
• Radical Neck Dissection is
performed in patients with clinical
evidence of cervical node
metastasis or any patient with T3
lesion.
• Postoperative irradiation only for
high-grade malignancies.
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

43. Adenoid Cystic Carcinoma
• Parotid, submandibular, and in
minor salivary glands palate and
tongue.
• ‘Cylindroma’
• Slow growing, aggressive
remarkable capacity - recurrence
• Women> Men
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India
• 5th-6th decade.
• Early local pain, facial nerve paralysis,
fixation to deeper structure and local
invasion.
• Intra oral lesions- surface ulcerations.
• Perineural spread

44. R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

45. Treatment
• Surgical coupled with x-ray
radiation
• Metastasis in later course
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

46. Carcinoma EX Pleomorphic
adenoma
• 75% occur in parotid gland<
submandibular gland<palate.
• Arise from/in pleomorphic
adenomas
• 6th -8th decade.
• Facial paralysis-1/3rd patients.
• Associated with a rapid
change in size of a
previously stable tumor
• Classified as high grade
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

47. R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

48. Prognosis
If treated prior to invasion, good.
Depends on local extent and
histological type
Treatment
• Surgical resection with facial nerve
preservation
• Neck dissection for nodal disease
• Adjuvant radiotherapy
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

49. Squamous Cell Carcinoma
• 0.9%- 4.7% of all major salivary
gland neoplasm.
• Male:Female 2:1.
• 60 years of age.
• 9 Parotid Gland > submandibular
gland.
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India
• Firm, enlarging mass
• Fixed to surrounding tissue
• Pain
• Facial nerve weakness

50. R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

51. Treatment
Surgical resection
Prognosis
Depends of stage of tumor
R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology, 6th Edition
Elsevier,Noida,India

52. DIAGNOSIS
1. Conventional Radiography
2. Sialography
3. Ultrasonography
4. Computerized tomography
5. Radionuclide Imaging
6. MRI
7. Biopsy /FNAC
8. PET
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

53. 1. Conventional Radiography
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

54. 2. Sialography
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

55. 3. Ultrasound
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

56. 4. CT Scan
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

57. 5. MRI
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

58. RESULTS:
The sensitivity and specificity of CT and MRI were nearly the same for tumor location,
tumor margin, and tumor infiltration.
koyuncu mehmet et al,Comparision of computed tomography and magnatic resonance
imaging in the diagnosis of parotid tumors,Otolaryngol Head Neck Sury . 2003
Dec;129(6):726-32.

59. CONCLUDED:
• MRI better at distinguishing intrinsic vs extrinsic
• Inaccuracy rate of both MRI and CT was the same regarding the tumor
infiltration
• MRI 3x more expensive than CT
• CT and MRI are morphologically equivalent studies and have the same
diagnostic potential in parotid tumors
koyuncu mehmet et al,Comparision of computed tomography and magnatic resonance
imaging in the diagnosis of parotid tumors,Otolaryngol Head Neck Sury . 2003
Dec;129(6):726-32.

60. 6. Radionucleide Imaging
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

61. 7. Biopsy/FNAC
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

62. 8. PET Scan
Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J Clinics;
24(5):266-73

63. MANAGEMENT
Parotid Gland
Tumor resection
1. Parotidectomy
(a) Superficial parotidectomy with preservation of facial nerve.
(b) Total parotidectomy with preservation of facial nerve.
(c) Radical parotidectomy with or without neck dissection in continuity.
2. Parotidomandibulectomy
3. Temporoparotidectomy
Anna M Pau and Colin D Pero Parotidectomy, Atlas of General Surgical Techniques,
Chapter 4,51-64,2010,Saunders.

64. PAROTIDECTOMY
Anna M Pau and Colin D Pero Parotidectomy, Atlas of General Surgical Techniques,
Chapter 4,51-64,2010,Saunders.
Skin IncisionMobalization of Parotid gland from Tragal CartilageElevation of Flap
Skeletonization of ant border of Sternocledomastoid and Posterior border of
Diagastric

65. PAROTIDECTOMY
Identification of Facial Nerve
C-A Righini, Facial nerve identification during parotidectomy.2012-08-01Z,vol-129; Issue
4,214-219

66. PAROTIDECTOMY
Anna M Pau and Colin D Pero Parotidectomy, Atlas of General Surgical Techniques,
Chapter 4,51-64,2010,Saunders.
Exposure of main trunk of facial nerveDrain placement and wound closureRemoval of deep lobeDissection of peripheral branches and mobalization of
superficial lobe

67. PAROTIDECTOMY
Anna M Pau and Colin D Pero Parotidectomy, Atlas of General Surgical Techniques,
Chapter 4,51-64,2010,Saunders.

68. SUBMANDIBULAR GLAND
Mobalization of submandibular gland from posterior belly of diagastricIdentifying the marginal mandibular branch of facial nerveIncisionWound closureLigation of proximal facial arteryDivision of submandibular ductIdentification of hypoglossal and lingual nerve
Anna M Pau and Colin D Pero Parotidectomy, Atlas of General Surgical Techniques,
Chapter 4,51-64,2010,Saunders.

69. COMPLICATIONS
FistulaFacial ScarDamage to marginal mandibular branch of facial nerve
M Boyd Gillespie & David W Eisele. Complications of Surgery of Salivary Glands
Compications in head & Neck Surgery,Chapter 20,221-239,2nd edition,2009,Mosby
CellulitisSialoceleFlap necrosisTrismusHematomaFrey’s SyndromeSoft tissue deficitHypertrophic scarKeloid

70. • N3 disease
• Multiple gross metastasis involving
multiple levels
• Recurrent metastasis
• Extranodal spread
• Involvement of accessory chain lymph
nodes by metastastic disease
NECK DISSECTION
Anna M Pau and Colin D Pero Parotidectomy, Atlas of General Surgical Techniques,
Chapter 4,51-64,2010,Saunders.

71. • High grade malignancy
• Gross residual disease following neck
dissection
• Recurrent disease
• Inadequate Surgical margins
• Perineural/ Perivascular invasion
• Extracapsular extention
• Multiple positive lymph nodes.
RADIOTHERAPY
Shah. Jatin et al, Cervical lymph nodes,Oral Cancer,2003, Martin dunitz, Taylor and
Francis group,page-222-223

72. • In case of metastasis, it plays only a palliative role.
• Cisplatin- backbone of polychemotherapeutic drug regim.
• Cisplatin + anthracycline/vinorelbine
• Cisplatin + fluorouracil
• Concomitant chemotherapy/radiotherapy- significant benefit
CHEMOTHERAPY
G CortisenaCurrent role of chemotherapy in exclusive and integrated treatment of
malignant tumours of salivary glands. Acta Otorhinolaryngol Ital. 2005 Jun; 25(3):
179–181.

73. A thorough knowledge of the normal and abnormal
physiology of the salivary glands, and the surgical anatomy
of the structures, is necessary for the successful
management.
CONCLUSION
Recurrent PAs will frequently require en block resection due
to their infiltrative and multinodular nature. Cure in this
situation is probably achieved in approximately two-thirds of
cases.
Radiation therapy may be more helpful in earlier stage
disease and lower-grade tumors than previously advocated.
Selective neck dissection for the N0 neck maybe justified in
early stage disease given the high reported rate of occult
nodes.
The facial nerve should be preserved in parotid cancer unless
it is directly infiltrated by the tumor.
Management of malignant parotid tumors will depend on
both the histologic diagnosis and the staging of the tumor.

74. • M. Guzzo et al.,Major and minor salivary gland tumors Critical Reviews in
Oncology/Hematology 74 (2010) 134–148
• Krishnaraj Subhashraj , Salivary gland tumors: a single institution experience in
India British Journal of Oral and Maxillofacial Surgery 46 (2008) 635–638
• Zheng W, Shu XO,Ji BT,et al. Diet and other risk factors for cancer of the
salivary glands: a population-based case-control study. Int J Cancer. 1996
17;67(2):194-8.
• Mounting evidence against current histogenetic concepts for salivary gland
tumorigenesis. Eur J Morphol 1998; 36:257-261
REFERENCES

75. • R Rajendran,B Sivapathasundharam Shafer’s Textbook of Oral Pathology,
6th Edition Elsevier,Noida,India
• Rajiv M Borle , Textbook of Oral and Maxillofacial Surgery,1st edition ,
2014 , Jaypee Brothers Medical Publishers, New Delhi
• Patel SG, Shah JP. TNM Staging of Cancers of the Head and Neck: Striving
for Uniformity among Diversity. C A Cancer J Clin 2005 ;55;242-258
• Diagnosis of salivary gland tumors,Friedman EW,Schwartz AE-CA Cancer J
Clinics; 24(5):266-73
REFERENCES

76. • Anna M Pau and Colin D Pero Parotidectomy, Atlas of General Surgical
Techniques, Chapter 4,51-64,2010,Saunders.
• C-A Righini, Facial nerve identification during parotidectomy.2012-08-01Z,vol-129;
Issue 4,214-219
• M Boyd Gillespie & David W Eisele. Complications of Surgery of Salivary Glands
Compications in head & Neck Surgery,Chapter 20,221-239,2nd edition,2009,Mosby
REFERENCES

77. THANK YOU……..