Type of Partoid tumor

They can arise either from the Parotid Glands itself or can metastasize from other parts. They are mainly of 2 types-

• Benign tumors - Typically non-aggressive cell growths that result from a variety of aberrant intracellular events within the gland. These tumors typically grow slowly over time, are painless, and do not invade or destroy adjacent tissues. They can compress adjoining structures and cause malfunction of surrounding structures based purely on their space-occupying effects.
• Benign parotid tumors - can undergo malignant transformation over time if not treated on time. Malignant transformation alters prognosis and affects treatment protocols considerably.

The most common type of Parotid Tumor is the Pleomorphic Adenoma, which is a slow-growing benign tumor having very low chances of malignant transformation.

What are the Symptoms Of Parotid Tumor

Symptoms of benign parotid tumor

• A lump or swelling on or near the jaw, neck, or mouth.
• Usually, a painless swelling
• Asymmetrical face.
• Fullness or swelling of the cheek.
• The sensation of fullness of Parotid Gland.

Symptoms of Parotid cancer or if a benign tumor turns into Parotid cancer

The patient will develop one of more of the following symptoms-

• Painful swelling in the region of the parotid gland.
• Sudden onset of pain in the swelling of the parotid gland.
• Difficulty in swallowing food
• Numbness in part of the face.
• Muscle weakness on one side of the face leads to Paralysis of one side of the face.
• Trouble opening mouth widely
• Difficulty in speech.
• Unexplained weight loss, fever, and night sweats.

What causes Parotid Tumor?

• The main cause is unknown.
• Genetic predisposition is being researched.
• It can metastasize from other parts of the body.
• Smoking is also a contributing factor.

Diagnosis of Pleomorphic adenoma

• Patient History - In-depth history is important for finding out the symptom onset, frequency, intensity, aggravating factors & associated activities.
• Physical Examination - The jaws, neck & throat need to be palpated for any kind of lump or swelling.
• Fine Needle Aspiration (FNA)/Biopsy - FNAC/Biopsy can provide relevant diagnostic information about the tumor whether it is cancerous or non-cancerous. During FNAC, small glandular tissue samples are obtained and examined by microscopy to determine the cellular integrity of the salivary gland. This information can provide a definitive diagnosis or rule out suspicion of cancer.
• Sialendoscopy - Ductal evaluation via sialendoscopy is an innovative minimally invasive diagnostic procedure helpful in assessing salivary gland dysfunction, including obstructive disease of the salivary gland duct system. Invasive cancer or other benign growths can obstruct or compress the ductal system.
• Ultrasound, MRI & CT Scan can be done to understand the size of the tumor and the extent of involvement of the tumor.

What are the surgical options for Parotid tumor?

Any of the following surgical options are advised to the patient depending on the tumor type, location, and chances of facial nerve involvement.

• Superficial Parotidectomy - most commonly advised and done surgery for parotid tumors. In superficial parotidectomy, the parotid gland above the level of the facial nerve is removed and the nerve is preserved. Chances of temporary paresis of the facial nerve are there or injury to one or two branches of the facial nerve is possible owing to difficult dissection of the tumor.
• Extracapsularlar resection of tumor - A tumor with some of the healthy parotid gland tissue is removed. It is done in patients with a small tumor in the superficial lobe and also for those who do not want superficial parotidectomy and are not willing to accept any chances of facial nerve injury associated with it. The chances of recurrence are relatively higher than superficial parotidectomy but this is considered a better surgery than enucleation.
• Total Parotidectomy - In the case of large tumors involving deeper parts of the parotid, cancers, or tumors with nerve involvement -complete removal of the parotid is done with the removal of the facial nerve. The nerve can be reconstructed in the same setting with the help of nerve grafts taken from the leg.

Dr. Amit Agarwal specializes in nerve-sparing total parotidectomy

General anesthesia is administered. Then the incision is placed in the crease of the neck or hidden along the earlobe & hairline, similar to a facelift procedure. Parotid Gland with some adjacent tissue is removed preserving the nerve. The closure is done in layers over a light suction drain.

• Extensive Surgery - If parotid cancer has metastasized into nearby skin and muscles and distant bones and organs, a more extensive operation is performed. All cancer and a small amount of the healthy tissue that surrounds it is removed. Then these invaded areas are reconstructed with microvascular surgery.

Risk and complications after Parotid Tumor

• Bleeding.
• Infection.
• Scarring.
• Salivary fistula - Saliva leaking through the incision.
• Sialocele - Cavity or cyst containing saliva.
• Frey's syndrome - a rare complication of parotid gland surgery that causes sweating or flushing in an area of the face when eating, especially spicy, salty or sour foods.
• Seroma - Pocket of serum that forms near the surgical incision.
• Facial nerve injury leads to weakness or paralysis of one side of the face.