Treatment Of Pleomorphic Salivary Adenoma

Treatment of Pleomorphic Salivary Adenoma

Pleomorphic adenoma is also known as mixed parotid tumor or mixed salivary tumor.

• This is the most common tumor ofthe major salivary gland.
• Pleomorphic adenoma is benign epithelial tumor.
• Epithelial cells proliferate in strands or may be arranged in form of acini or cords.

“Comprehensive Overview Of Pleomorphic Adenoma Symptoms”

Pleomorphic adenoma is mixed tumor because of the presence of epithelial cells, myoepithelial cells, mucoid material, pseudocartilage, and lymphoid tissue.

Mixed parotid tumor Etiology

• Dardick’s theory: A neoplastically altered epithelial cell with potential for multidirectional diffrentiation can be responsible for pleomorphic adenoma.
• Differentiation of the ductal reserve cells: Intercalated ductal reserve cells may be differentiated into ductal and myoepithelial cells and later on these cells undergo Mesenchymal metaplasia as they inherently consist of smooth muscle-like properties.

“Causes Of Pleomorphic Salivary Adenoma”

Mixed parotid tumor Clinical Features

• It occurs in middle aged women around 40 years are commonly affected.
• It is usually unilateral, present as single painless, smooth,firm, lobulated mobile swelling in front of parotid with positive Curtain sign, i.e. as the deep fascia is attched above to zygomatic bone, it acts as curtain, not allowing parotid swelling to move above the level of zygomatic bone. This is curtain sign.
• Obliteration of retromandibular groove is common.
• Ear lobule is raised or lifted.
• Swelling is rubbery or fim. Soft area indicates necrosis. In long standing cases it can be hard, surface can be nodular.
  • Skin is stretched and becomes shiny.
• When deep lobe is involved, swelling is located in lateral wall of pharynx, posterior pillar and over soft palate.
  Deep lobe tumor passes through Patey’s submandibular tunnel pushing tonsils, pharynx, soft palate often without any visible swelling or only small swelling when only deep lobe tumor is present.
• Being a benign tumor it is neither adherent to the skin nor to masseter.
• After few years pleomorphic adenoma shows features of transformation into malignancy.

“Best Ways To Manage Pleomorphic Salivary Adenoma”

Mixed parotid tumor Investigations

• Fine needle aspiration cytology: It is done to confim diagnosis and rule out the malignancy.
• CT scan: This is to be done when tumor arises from deep lobe.
  It defies the extra glandular spread and extent of parapharyngeal disease as well as cervical lymph nodes.
• FNAC oflymph nodes: Palpable lymph nodes in neck are to be examined for malignancy.
• X-ray of bones: For seeing the bony resorption.
• MRI is the bettr method compared to CT scan. MRI provides bettr soft tissue delineation, i.e. superior perineural invasion.

Mixed parotid tumor Complications

• Recurrence in 5 to 50% of cases.
• Malignancy is seen in 3 to 5% of tumors
• Malignancy is seen in 10% of tumors in long duration.

“Understanding The Causes Of Pleomorphic Salivary Adenoma”

Mixed parotid tumor Treatment

• Surgery is the fist line treatment.
• If only superficial lobe is involved, then superficial parotidectomy is done wherein parotid superficial to facial nerve is removed.
• Various steps in superficial parotidectomy:

• Give incision, incision should start in front of tragus, vertically descend downwards,curve round the ear lobule till mastoid process and is carried till the neck.
• Facial nerve should be recognized which lies 1cm inferomedial to pointed end of tragal cartilage of external ear. Trace posterior belly of digatric till mastoid process. Facial nerve lies between muscle and tympanic plate.

“The Role Of Surgery In Treating Pleomorphic Adenoma”

• Both facial nerve and retromandibular vein divides the parotid gland into deep and superfiial lobes. Benign tumors do not invade faciovenous plane of Patey.
• Gentle handling, good suction and nice hemostasis provide visibility to nerve.
• Tumor along with lobe should be removed In Toto to avoid spillage.
• If both the lobes are involved then total conservative parotidectomy is done. In this, tumor along with the normal lobe is removed by retaining facial nerve. Avoid rupture of gland.