Salivary Tumours

What are salivary tumours?

Tumours can occur in any of the salivary glands, however they are most commonly seen in the parotid gland. Most tumours within the parotid gland are benign, there is a higher rate of malignant tumours in the submandibular and sublingual glands.

What are the common salivary tumours?

The commonest tumours are:

• Benign
  • Pleomorphic adenomas
  • Warthins tumours – common in smokers
  • Basal cell adenomas
• Malignant
  • Mucoepidermoid cancer
  • Adenoid cystic carcinoma
  • Lymphoma
  • Squamous cell carcinoma (usually spread from elsewhere in the head and neck region)

What are the signs & symptoms of salivary tumours?

Salivary tumours often begin as a painless mass within the gland that slowly increases in size. As they progress they may cause weakness of facial muscles, voice changes and swallowing problems. This is especially true for malignant tumours. There may also be spread to the local lymph node with firm masses elsewhere in the neck.

How are salivary tumours diagnosed?

Further investigation is performed with imaging studies such as an ultrasound or computed tomography (CT) scan of the neck. The lesion is then biopsied using a needle to determine whether it is benign or malignant. If a malignant salivary tumour is confirmed further imaging with a magnetic resonance imaging (MRI) scan or positron emission tomography (PET) scan may be performed.

How are salivary tumours managed?

Malignant tumours and some benign tumours are best managed by complete surgical excision. Radiotherapy (uses high-energy waves that destruct the rapidly multiplying cancer cells) can be used for more aggressive tumours and chemotherapy (the use of medications to destroy the cancer cells) plays are role in in-operable cases.

How is surgery for salivary tumours performed?

Salivary gland surgery is usually carried out under general anaesthesia.

Surgery to the parotid gland is performed by making an incision in front of the ear that extends slightly down the neck. The parotid is divided into a superficial and deep lobe. The facial nerve usually runs in between these two lobes. Care is taken to minimize injury to this nerve and its function may be monitored during the operation. If detected early, a tumour may be limited to the superficial lobe and only that lobe is removed preserving the facial nerve. For malignant or deep tumours, the entire gland is removed and a portion of the facial nerve may need to be sacrificed. Surrounding structures involved by the cancer may also have to be removed. The excised portion or gland is sent to a pathologist for examination.

Removal of the submandibular salivary gland is carried out by making a 2-inch incision below the lower jaw. Branches of the facial nerve running near the gland are protected as far as possible during surgery.

Sublingual gland surgery is usually performed through an oral approach. You will require an overnight hospital stay following the procedure.

What is the post-operative care after salivary tumour surgery?

Following removal of a salivary gland you may experience numbness at the incision site. Your doctor will prescribe medications to help relieve any pain and discomfort.

Nerve function may recover after a period or with rehabilitation. In some cases, surgery may be necessary to improve function.

What are the risks and complications of salivary tumour surgery?

As with any surgery, salivary gland surgery may be associated with some complications which may include:

• Bleeding
• Infection
• Facial nerve damage can cause temporary or permanent loss of facial muscle control and can result in drooping of the face.
• Damage to other nerves in the face might cause problems with tongue movement, swallowing and speech. Your appearance may be altered depending on the extent of the operation.