Thyroid, Salivary Gland & Sialendoscopy Conditions
Thyroid, Salivary Gland & Sialendoscopy Procedures
Salivary Gland Tumours
What are Salivary glands ?
There are three major paired salivary glands; Parotid Glands, Submandibular Glands and Sublingual Glands and, multiple minor salivary glands distributed all over in the mouth and throat. The glands produce thicker mucin which lubricates food in our mouth and thin fluid like saliva which contain enzymes that initiate digestion. The average production of saliva in a day is 0.75 to 1.7 litres.
Parotid glands are located in front of the ears over the jaw bone through which passes the nerve of facial expression; the glands open via a duct on the inside of the cheek on either sides.
Submandibular glands are located beneath the lower jaw that open into the mouth under the front part of the tongue.
Sublingual glands are located under the front part of the tongue which opens along with the duct of submandibular gland.
What are Salivary glands lumps or tumours ?
Lumps occur in the salivary glands due to overgrowth of some part of the gland tissue. Lumps are also called tumours. Tumours are of two types. The majority are benign , which means they are Non Cancerous, and do not spread to other parts of the body. Less commonly, malignant or Cancerous tumours can affect the salivary glands.
Non Cancerous (Benign) tumours of salivary glands:
These are the most common type of tumours or growths in the salivary Glands. These are most commonly found in the parotid glands. They are slow growing, mobile, painless, felt or visible under the skin of cheek. The most common benign Parotid tumour is Pleomorphic Adenoma.
Pleomorphic Adenoma is treated by surgical removal and have excellent cure rates.
There is however has a tendency of converting to cancer, if left untreated for a long time of 15-22years, (known as Carcinoma ex pleomorphic adenoma) . This type of Cancer unfortunately have poor cure rates in comparison to pleomorphic adenoma even with surgery and postoperative radiation therapy.
The second common Benign tumour is a Warthin Tumour. This commonly affect elderly smokers usually affecting the tail of parotid glands. The have excellent cure rates as well.
Cancerous Tumours of salivary glands:
Cancers of the Salivary Gland are less common compared to benign lesions, but if present are aggressive and have rapid growth rates. They are firm, nodular, can be fixed to adjacent tissues and stuck to the overlying skin. The types of Cancers we see in the Salivary Glands are :
- Mucoepidermoid carcinoma: This is the most common cancer of salivary glands; It can be found in both the parotid gland and submandibular glands and affects individuals in the third to fifth decade of life. The histological grading of the cancer will determine the further treatment and prognosis.
- Adenoid cystic carcinoma: This commonly affects the minor salivary glands of the mouth as well as the glands of windpipe in the fifth and sixth decade of life. These tumours have a tendency for nerve spread and thus people present with excruciating pain and nerve paralysis.
- Acinic cell carcinoma mostly affects parotid gland in patients in the fifth decade.
- Carcinoma ex pleomorphic adenoma . As described above, this is an aggressive adeno-carcionoma of parotid and submandibular glands with poor prognosis.
What are the common symptoms of a Salivary Gland Tumour ?
- You may find a painless or painful mass in the concerned area – side of the face in front of or below the ear lobe , under the jaw or chin , or in the floor of the mouth.
- Nerve paralysis of the face and numbness over the face or jaw.
- Pain and paralysis , which could indicate cancer involving nerve.
- Mobile or immobile lump.
How to we diagnose a Salivary Gland Tumour ?
Our ENT Head Neck Specialist will firstly discuss your condition in great detail and obtain a history of the development of the lump. We will carry out a thorough examination of the lump, mouth, head and neck.
We will ask for certain common investigations to obtain more information. This is usually and Ultrasound of the Head and Neck and also an FNAC/B (Fine Needle Aspiration Cytology/Biopsy) for initial evaluation. This helps the doctor understand better the nature of the lump and discuss further course of action with you.
If necessary , we may then ask for further evaluation such as a Contrast enhanced CT scan or MRI , to determine extent or spread of the disease and any evidence of nerve involvement
How do we treat lumps or tumours of the Salivary Gland ?
The treatment that we will advise you will be based on the findings of the above clinical evaluation and results of the appropriate investigations.
Surgery is the treatment of choice for most salivary gland tumours. In cases of Benign ( non cancerous) tumours, complete removal with surgery is the definitive treatment by itself.
If the tumours are Cancerous , the treatment may include Radiation Therapy as an additional treatment after surgical removal. The treatment is tailored to each individual based on all of the factors considered, and our ENT Head Neck Surgeon will discuss this with the patient and family in each case.
Chemotherapy is not usually effective for treatment of Salivary Gland Tumours.
Read here for more information on the Surgery for Parotid Gland (Parotidectomy) and Surgery for Submandibular Gland .