Salivary Gland Disease and Surgery

2.14.1 Discuss the two main theories on the cellular origins of salivary gland neoplasms.

2.14.2 Give us a table of the incidence of benign vs. malignant tumors in parotid vs. submandibular vs. minor salivary glands in adults. Discuss the commonly-cited “Rule of 80’s” as it applies here.

2.14.3 Describe the innervation of the parotid and submandibular glands, including the types of nerve fibers and named nerves that these fibers travel on to reach the respective glands.

2.14.4 Describe 5 distinct ways to identify the facial nerve in parotid surgery. What are the external facial anatomic landmarks that are useful when identifying the facial nerve distally for retrograde dissection?

2.14.5 What are some common autoimmune and/or systemic diseases that affect the parotid glands?

2.14.6 What is Frey’s syndrome? How do you diagnose this condition? What are the various treatment options for it?

Linder TE, Huber A, Schmid S. Frey's syndrome after parotidectomy: a retrospective and prospective analysis. Laryngoscope. 1997 Nov;107(11 Pt 1):1496-501. PMID:9369396

Rubinstein RY, Rosen A, Leeman D. Frey syndrome: treatment with temporoparietal fascia flap interposition. Arch Otolaryngol Head Neck Surg. 1999 Jul;125(7):808-11. PMID:10406323

Laccourreye O, Muscatelo L, Naude C, Bonan B, Brasnu D. Botulinum toxin type A for Frey's syndrome: a preliminary prospective study. Ann Otol Rhinol Laryngol. 1998 Jan;107(1):52-5. PMID:9439389

2.14.7 How would you manage a post-parotidectomy sialocele? Seroma?

2.14.8 With respect to malignant parotid neoplasms, who should get an elective neck dissection and who should get post-operative radiation therapy?

2.14.9 What are the current indications for sialendoscopy as it relates to sialolithiasis, salivary stasis, and stricture/stenosis?

Koch M, Zenk J, Iro H. Algorithms for treatment of salivary gland obstructions. Otolaryngol Clin North Am. 2009 Dec;42(6):1173-92. PMID:19962014

2.14.10 Name the six most common malignant neoplasms of the salivary glands? With respect to the two most common neoplasms, discuss the implications of tumor "grade" and "perineural invasion."

2.14.11 After successful superficial parotidectomy for a suspected benign parotid lesion, the final pathology comes back as "high grade mucoepidermoid carcinoma with negative margins." Is any further treatment warranted at this time? If so, what?

2.14.12 Ten years after a superficial parotidectomy for pleomorphic adenoma, your patient develops subcutaneous nodules within the overlying dermis and surgical scar. Fine needle aspiration of the nodules is positive for pleomorphic adenoma. How will you take care of this problem?

Leonetti JP, Marzo SJ, Petruzzelli GJ, Herr B. Recurrent pleomorphic adenoma of the parotid gland. Otolaryngol Head Neck Surg. 2005 Sep;133(3):319-22. PMID:16143173

2.14.13 Discuss the indications for pre-operative imaging of a parotid neoplasm? In what situations might ultrasound, CT and/or MRI be indicated?

2.14.14 Discuss the indications for pre-operative fine needle aspiration of a parotid mass?

2.14.15 Educate us on the microbiology and treatment of acute suppurative sialadenitis.

Brook I. Aerobic and anaerobic microbiology of suppurative sialadenitis. J Med Microbiol. 2002 Jun;51(6):526-9. PMID:12018662