Manikandan, U (2020) Prospective Study on Management of Salivary Gland Tumours and Its Outcome in Government Rajaji Hospital, Madurai. Masters thesis, Madurai Medical College, Madurai.
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Abstract
The salivary gland tumours constitutes about 6% of tumours of head and neck. The parotid, submandibular, and sublingual glands constitute the major salivary gland. When functioning properly the glands are rarely noticed but when involved with neoplastic disease, they can be a challenge in diagnosis and treatment. In this study, the patients presented in GRH, Madurai with parotid, submandibular and minor salivary gland tumours were analysed. Age, Sex incidence, histopathologic type and various treatment modalities were analysed in particular reference to FNAC, surgical treatment and post-operative complication mainly of the facial nerve injury. The neoplasms of the parotid is more common in 3rd -7th decade. In our study also the parotid tumours are more common in 4th-6th decade. Previously reported studies show the incidence rate of salivary neoplasms varied considerably by sex. The male : female incidence ratio for benign mixed tumour showed predominance of female patients. In the present study, there is a male predominance. Previous studies showed that the male incidence for Warthin’s tumour, was more than double that of female patients. In this present study the Warthin’s tumour is reported in only one male patient. Incidence rate of all malignant tumours was more than 3 times in males to that of female patients. In this present study also we noticed higher incidence of carcinoma in males.The sensitivity of FNAC in the current study is 96%. In the present study Pleomorphic adenoma was diagnosed in 88% of parotid cases. Out of the 39 pleomorphic adenoma patients, 36 had undergone Superficial Parotidectomy and 3 had undergone Extracapsular dissection. Follow up showed no incidence of recurrence. The recurrence rate of mixed tumours offered in the literature vary widely. The primary reasons of recurrence is inadequate removal at the onset (i.e enucleation versus removal of a margin of uninvolved gland). The tumours persist or recur, because pseudopod or parts of the tumour are not removed at the operation, due to neglect or fear of damaging the facial nerve. Adequate surgical removal i.e., atleast superficial parotidectomy must be performed. For tumours deep to the facial nerve, the procedure of total conservative parotidectomy is performed by removal of the portion of the gland deep to the nerve, with preservation of the nerve and its branches. In our study Warthin’s tumour is encountered in 1 case, (2.3%) of tumours, who underwent Superficial Parotidectomy. Previous reports indicate the presence of Warthin’s tumour almost exclusively in parotid gland which occurred between 4th and 7th decades. In our study the tumour occurred in the 4th decade. In our study malignancy is reported in 4 cases, all of them had undergone Total Parotidectomy. Two cases of mucoepidermoid carcinoma with Preoperative facial nerve involvement underwent Total parotidectomy. One case diagnosed as adenoid cystic carcinoma with facial nerve palsy underwent Total Parotidectomy. In the previous study also, due to its strong tendency to invade nerves and perineural lymphatics facial nerve involvement was high (30%), because of which it has poor prognosis. In our study, the incidence of adenoid cystic Ca was 2.3% which co-relate with the previous studies. Of the 50 salivary gland tumours, 5 cases were diagnosed as submandibular tumours, of which all were benign mixed tumour. It is common in the 4th and 5th decade.In the previous studies 5% of tumours were seen in submandibular gland of which 50% are malignant. In our study 10% of tumours occurred in submandibular glands of which all are benign tumours. FNAC was done in all the 5 cases, of which all showed benign mixed tumour. All the 5 cases had undergone excision. There was no recurrence and postoperative complications. A single male patient in the 7th decade was recorded in the study. It was a benign tumour and excision was done. There was no recurrence and postoperative complications. The most feared complication after parotidectomy is facial nerve paralysis, which is reported to be 3 – 5% permanently and transient facial nerve palsy is reported to be 8.2 to 65%. In our study, permanent facial palsy is seen 2 cases (4%) and transient facial palsy in 2 cases (4%).
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711115 |
| Uncontrolled Keywords: | Parotid, Submandibular, Pleomorphic adenoma, Warthin’s tumour, Mucoepidermoid cancer, FNAC, Superficial parotidectomy, Extracapsular dissection, Facial nerve palsy, Frey’s syndrome. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 02:11 |
| Last Modified: | 10 Feb 2021 02:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13974 |
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