GENERAL PAROTID CONDITIONS
Infections are the commonest either viral (mumps) or bacterial (with or without duct obstruction).
Auto Immune Diseases e.g. Sjogrens Syndrome
Tumours. These can be benign or malignant and if malignant may be primarily of the parotid or secondary metastatic disease. I will be focusing on benign parotid tumours.
ANATOMY
The parotid is the largest of the major salivary glands (submandibular and sublingual being the others).
The parotid lies in the font of the ear over the lower jaw and mid face.
The facial nerve runs through it dividing it into a superficial and deep lobe.
The parotid secrets a thin watery saliva via a duct opening near the upper second molar.
INCIDENCE AND CAUSE
The parotid neoplasms accounts for 80% of salivary tumours.
80% of these are benign.
These usually occur in females in their 5th decade of life.
They commonly occur in Caucasians, and the cause is unknown.
HISTORY AND EXAMINATION
This is essential to excluded signs and symptoms suggestive of malignancy.
80%of these tumours are a painless, slow-growing mass.
DIAGNOSIS
Ultrasound is used often with a Fine Needle Aspirate (FNA).
CT scans are also useful.
Removal of the tumour is both diagnostic and therapeutic in 80% of the cases.
CLASSIFICATION (Most common)
Pleomorphic adenoma
This is the most common parotid tumour occurring in 80% of the cases. There is a low tendency to malignancy.
Warthins Tumour.
This usually occurs in the elderly male who has a high BMI and is a smoker.
It can be bilateral and very seldom turns malignant.
Others include lympho epithelial lesions, commonly found in HIV disease, and lymph nodes (children).
TREATMENT
Surgery is the treatment of choice and is usually a superficial parotidectomy with preservation of the branches of the 7th cranial nerve (monitoring).
COMPLICATIONS OF SURGERY
Facial nerve injury, numbness of the ear and Frey Syndrome. This latter condition is when there is sweating in the parotid region with eating. This usually subsides over time.
CONCLUSION
Parotid Tumours are not uncommon, and if investigated correctly (Ultrasound with or without cell analysis with FNA) – can be easily removed with superficial Parotidectomy (preservation of the facial nerve using electrical monitoring during the operation).