--- title: "Benign Salivary Gland Tumors" description: "ENT notes on Benign Salivary Gland Tumors - Causes, WHO Classification, Symptoms, Investigations and Treatment." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/benign-salivary-gland-tumors" categories: ["Oral Cavity and Salivary Glands"] video: "https://www.youtube.com/watch?v=VQ5YfVeWaI8" image: "https://media.theentresident.com/og-images/benign-salivary-gland-tumors.png" --- # Benign Salivary Gland Tumors ENT notes on Benign Salivary Gland Tumors - Causes, WHO Classification, Symptoms, Investigations and Treatment. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=VQ5YfVeWaI8 ## 🦷 Benign Salivary Gland Tumors ### πŸ“Š Incidence of Benign Salivary Gland Tumors - **Parotid** - most common site: **~80%** of all salivary neoplasms. - **Submandibular** β€” **~ 15%** of salivary tumours. - **Minor & Sublingual glands** β€” together **~ 5%**. >Which salivary gland has the highest chances of malignancy? >What is the most common benign salivary gland tumor? >What is the most common site of pleomorphic adenoma? **Common age:** 4th–6th decades (peak around the **6th decade**). **Gender:** overall **female predominance** for salivary gland tumours >Which benign salivary gland tumor is predominantly in men? --- ### 🧬 Etiology / Risk Factors of Benign Salivary Gland Tumors - Prior head & neck irradiation - Smoking - Viral infections β€” e.g., HPV-16 associations reported. - Hormonal influences - Occupational/environmental exposures β€” rubber, asbestos, woodworking, plumbing (associations reported) - Chronic irritation/trauma >Which benign salivary gland tumor is associated with smoking? --- ### 🩺 Clinical Features of Benign Salivary Gland Tumors - Most benign tumours are **slow-growing**, **painless**, **smooth**, **mobile** swellings. - Lack of pain and preserved mobility are suggestive of benignity. - Symptoms from mass effect possible (e.g., deep lobe parotid masses β†’ oropharyngeal/parapharyngeal swelling, stertor, voice change, Eustachian tube dysfunction). #### Parotid - Firm swelling around **angle of mandible / pre- and retromandibular region**; may extend anterior to tragus or into cheek. - **Superficial lobe** lesions present as external swelling. - **Deep lobe** lesions may present as **intra-oral / parapharyngeal** swelling. #### Submandibular gland - Swelling in **submandibular triangle** >How can you differentiate a swelling involving submandibular gland from submandibular lymph node? #### Minor Salivary Glands - Palate, lips, buccal mucosa, floor of mouth β€” present as **firm submucosal swelling**; ulceration is uncommon unless traumatized. >What is the most common site of Minor Salivary Gland tumor? --- ### 🚩 Red Flags Suggesting Malignant Transformation - **Pain** - **Rapid growth** or sudden increase in growth rate - **Paresthesia / numbness** - **Facial nerve palsy** (parotid) or other cranial nerve deficits - **Fixity to skin / deep structures**, **skin ulceration** or **irregular surface** - **Firm, irregular, non-mobile** lesion --- ### 🧾 WHO Classification of Benign Salivary Gland Tumors - **Epithelial tumours (common)** - Pleomorphic adenoma - Warthin tumor - Oncocytoma (oxyphilic adenoma) - Myoepithelioma - Basal cell adenoma (monomorphic adenoma subgroup) - Canalicular adenoma - Other ductal/sebaceous adenomas >What is the other name of Warthin tumor? - **Mesenchymal tumours (less common)** - Hemangioma, lymphangioma, lipoma, neurofibroma, schwannoma, chondroma, osteoma --- ### Oncocytoma (Oxyphilic adenoma) - **Frequency:** < 1% of salivary tumours. - **Cell of origin:** oncocytes - **Age:** older adults (7th–8th decade). - **Site:** superficial parotid common. - **Gross/histo:** well-circumscribed, encapsulated; oncocytes; tyrosine crystals may be seen. - **Special:** **Increased uptake on Tc-99m** scintigraphy. - **Treatment:** **Superficial parotidectomy**; low recurrence (recurrence usually due to multifocal nodules). >What are Oncocytes? ### Myoepithelioma - Arises from **myoepithelial cells**; rare; may affect any salivary gland; age range variable. - Treated similar to pleomorphic adenoma (surgical excision). ### Basal Cell Adenoma / Canalicular Adenoma - **Basal cell adenoma:** monomorphic basaloid cells in solid/trabecular/tubular/membranous patterns. - **Canalicular adenoma:** variant with bilayered ribbon-like columnar cells separated by vascular stroma (common in minor glands). ### Hemangioma - Present at birth or early infancy; rapid growth phase then spontaneous involution in many cases. - Management: often conservative; excision if persistent/problematic. ### Lymphangioma - Cystic, soft, congenital; does **not** involute reliably β†’ usually **surgical excision**. >What is the Most common benign parotid tumour in children? --- ### πŸ§ͺ Investigations of Benign Salivary Gland Tumors 1- **Ultrasound (first-line)** - Distinguishes **solid vs cystic**, intra- vs extra-glandular, vascularity. - Useful for **USG-guided FNAC** to improve sampling accuracy. 2- **CT / MRI** >What are the indications of CT and MRI in Benign Salivary Gland Tumors? >What is the gold standard investigation for Benign Salivary Gland Tumors? 3- **Fine Needle Aspiration Cytology (FNAC)** - Diagnostic accuracy around **~90%** for distinguishing benign vs malignant when combined with imaging. - **USG-guided FNAC** increases yield. 4- **Core Needle Biopsy** - Generally **avoided** for salivary tumours due to **risk of tumour seeding** and potential facial nerve injury; reserved for selected cases when FNAC is inconclusive and results would change management. 5- **Sialography** - Historical; rarely used now. May show ductal filling defects. 6- **Scintigraphy (Tc-99m pertechnetate)** - **Warthin tumour** often shows a **hotspot**. >Why does Warthin tumor show hotspots on scintigraphy? --- ### πŸ›  Treatment Principles of Benign Salivary Gland Tumors - **Surgery is the definitive treatment** for benign salivary tumours. - **No role for radiotherapy/chemotherapy** in benign disease. >What are the factors influencing surgical approach to Benign Salivary Gland Tumors? 1️⃣ **Parotid tumours** - **Superficial parotidectomy** - indicated when tumour confined to **superficial lobe**; preserve facial nerve. - **Total conservative parotidectomy** (both lobes removed but **facial nerve preserved**) - indicated for **deep lobe involvement**, large dumbbell tumours, or if tumour spillage occurs during surgery. 2️⃣ **Submandibular gland** - **Total excision of the gland** with tumour - Sample adjacent nodes if suspicious. 3️⃣ **Sublingual gland** - Excision of gland via intraoral approach 4️⃣ **Minor salivary glands** - **Wide local excision** with margin of normal tissue (e.g., palatal tumours down to periosteum). - Reconstruction (local flap / obturator / mucosal repair) as required. --- ### 🩺 Follow-up & Recurrence of Benign Salivary Gland Tumors - Regular follow-up is important (clinical exam Β± imaging when indicated). - **Pleomorphic adenoma** has notable recurrence risk if tumour capsule violated or incomplete excision; recurrence may occur years later - long-term follow-up recommended. --- ## About This Note This free ENT note on Benign Salivary Gland Tumors was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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