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SALIVARY GLAND  
NEOPLASMS

Presenter:  Dr Gulzar Ahmad Bhat
Moderator:  Dr M. Inam Zaroo
Associate Profesor  Plastic Surgery


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PAROTID
 Major salivary gland
 Ectodermal origon
 Irregular in shape extend from zygoma superiorly to oblique line
of sternomastoid inferiorly and to mid point of massetor muscle
 Superficial & deep lobes
 Processes( glenoid , pterygoid ,facial)
 parotid duct (Stensen’s duct) & accessory gland


 Covered by investing fascia of the neck & contain lymph node mainly in
superficial lobe

 Structures within the gland:

 Facial nerve
 Retromandibular vein
 External carotid artery
 Parotid L.N



STRUCTURES WITHIN GLAND


 Deep lobe lie in parapharyngeal space

 Anterior: Infratemporal fossa

 Posterior: Carotid sheath & styloid process

 Medial: Superior constrictor muscle of pharynx which is
separating the gland from oropharynx & tonsils


RELATIONS


BLOOD SUPPLY

 Superficial temporal & maxillary arteries
 Retromandibular vein

LYMPH DRAINAGE
 Parotid & deep cervical L.N

NERVE SUPPLY
PARASYMPATHETIC
Inf. Salivary nucleus

CN IX

Lesser petrosal Nerve

Otic ganglion

Auriculoteporal N. (CN V3)

Parotid gland


SYMPATHETIC:
Sympathetic trunk

Sup.cervical ganglion

Ext.carotid artrey plexus

Parotid gland


THE SUBAMANDIBULAR SALIVARY GLAND
It is wedged between the mandible & the floor of the mouth (upper part deep to the mandible)
It has large superficial part & small deep part

Its duct opens in the floor of the mouth at the tip of the sublingual papilla


THE SUBLIGUAL SALIVARY GLAND
 A small gland which lies
between the mandible &
tongue
 It raises the floor of the
mouth forming sublingual
papilla
 It opens by many ducts
directly to the floor of the
mouth & into the
submandibular duct


NERVE SUPPLY OF THE SUBMANDIBULAR & SUBLINGUAL
SALIVARY GLANDS
• Parasympathetic: Facial (7th) nerve through the chorda tympani (fibers relay in the submandibular
ganglion)
• Sympathetic: Superior cervical symp. Ganglion
• Sensory: The lingual nerve


PHYSIOLOGY

 25% of total salivary volume secreted by parotid
 Organic & inorganic compounds
 Serous type ( mucin , enzymes)

 Produced & stored in the Acinus & modified in the ductal cells
 Parasympathatic increases the secreation
 Several reflexes (sight,smell,taste…etc) augment the secretion rate


Saliva has several important functions:
1. Lubricant to aid in swallowing food
3. Digestion by an emulgation of food and enzymatic cleavage
3. Mechanical cleaning
4. Immunologic defense
5. Mediation of taste sensations
6.Excretion of endogenous and exogenous materials, for
group–reactive substances, iodine, and viruse
7. Buffering effect

example, antibodies, blood


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CLASSIFICATION

• Mainly classified into four groups

» Adenomas
» Carcinomas
» Miscellaneous
» Tumor-like lesions


Benign/malignant

Tumour type

Clinical site

Clinical feature

Benign

Pleomorphic
adenoma

Parotid commonest

Painless, slow-growing
firm mass

Malignant

Oncocytic tumour Parotid gland
(Warthin’s tumour)

Soft to firm, occasionally
bilateral, mass

Mucoepidermoid Parotid
carcinoma
commonest

Slow-growing firm
mass

Adenoid cystic

Minor salivary
glands
commonest

Slow-growing
submucosal
nodule in the upper
aerodigestic tract

Acinic cell
tumour

Parotid gland

Slow-growing nodule

Adenocarcinoma

Minor salivary
gland

Submucosal lump


CLASSIFICATION
ADENOMAS
1 Pleomorphic adenoma
3 Myoepithelioma (myoepithelial adenoma)
5 Basal cell adenoma
7 Warthin’s tumor (adenolymphoma)
9 Oncocytoma (Oncocytic adenoma)
11 Canalicular adenoma
12 Sebaceous adenoma


CLASSIFICATION (Cont’d)
8 Ductal Papilloma
a) Inverted ductal papilloma
b) Intraductal papilloma
c)

Sialadenoma papilliferum

9 Cystadenoma
d) Papillary cystadenoma
e) Mucinous cystadenoma

CLASSIFICATION (Cont’d)
Carcinomas
1 Acinic cell carcinoma
2 Mucoepidermoid carcinoma
3 Adenoid cystic carcinoma
4 Polymorphous low-grade adenocarcinoma
5 Epithelial-myoepithelial carcinoma
6 Basal cell adenocarcinoma
7 Sebaceous carcinoma
8 Papillary cystadenocarcinoma
9 Mucinous adenocarcinoma
10 Oncocytic carcinoma


CLASSIFICATION (Cont’d)
11 ) Salivary duct carcinoma
12 ) Adenocarcinoma
13 ) Malignant myoepithelioma
14 ) Squamous cell carcinoma
15 ) Small cell carcinoma
16 ) Undifferentiated carcinoma

1


CLASSIFICATION (Cont’d)
Miscellaneous
1) Nonepithelial tumors
2 ) Malignant lymphomas

3 ) Secondary tumors
4 ) Unclassified tumors

Tumour-like lesions
1) Siladenosis
2 ) Oncocytosis
3 ) Necrotizing sialometaplasia (salivary gland infarction)
4 ) Benign lymphoepithelial lesion
5 ) Salivary gland cysts
6 ) Chronic sclerosing sialedenitis of submandibular gland

(Kuttner tumor)

7 ) Cystic lymphoid hyperplasia in patients with acquired immunodeficiency syndrome


INCIDENCE
 Salivary gland tumors >>> 3-4% of all head & neck
neoplasm
 70% originate in parotid gland
 > 70% of them are Benign
 70% of them  Plemorphic adenoma
 10% of parotid tumors  Mucoepidermoid carcinoma