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Overview of Parotid Gland and its Diseases
What is Parotid Gland?
There are few Minor Salivary Glands in the Oral Cavity.
There are three pairs of Major Salivary Glands namely :
Sub Mandibular Gland
Salivary Glands are responsible for producing saliva to aid in chewing and digesting food.
Parotid Gland is located just in front of the ears on each side of the face
The Duct of each Parotid Gland is called Steensen’s Duct
Steensen’s Duct opens into the Vestibule of the Mouth opposite to the crown of the Upper second Molar Tooth.
Parotid Gland can develop Infections, Cysts, Fistulae and Tumours
Majority of Salivary Gland Tumours occur in the Parotid Gland However most of them are Benign that means Non-Cancerous
Parotid Tumours may present as a mass or swelling in the area of the lower jaw or in front of the ear.
The Parotid Gland is Divided into two Lobes i.e. Superficial and Deep
7th Cranial Nerve i.e. the Facial Nerve passes between the Two Lobes
It is this 7th Cranial Nerve which controls the muscles of Facial Expression and Functions in the conveyance of taste sensation from the anterior two-thirds of the tongue
Causes & Effects in Parotid Gland
Parotid Gland affected due to various factors.
The most common Signs & Symptoms is Parotid Swelling
The Swelling Parotid Gland could have Persistent Pain
There could be pain while Swallowing
Parotid Swelling can be due to various reasons such as
Infection Calculi i.e. Stones in the Gland
A tumour which is Swollen Tissues in the Gland which can be both Benign i.e. Non-Cancerous and Malignant i.e. Cancerous
Unilateral or Bilateral Inflammation of the Parotid Gland which is commonly called Parotitis
There could be pain in the front of the Ear or in the Neck
If the Tumour is compressing the Facial Nerve then it may cause muscle weakness on that side of the face
Facts of Salivary Gland related Diseases
Salivary Gland Tumours Accounts for 6-8% of all tumours of the head and Neck Area
Around 80% of Parotid Tumours are Benign i.e. Non-Cancerous
Benign Tumours are more frequent in the major Salivary Glands
The Most Common Benign Tumour is Pleomorphic Adenoma
Mucoepidermoid Carcinoma and Adenoid Cystic Carcinoma are the frequent Malignant Tumours that are Cancerous encountered in the Parotid Gland
Pleomorphic Adenomas are the most common Benign Salivary Gland Neoplasm Encountered in the Parotid Gland
When should you Visit a Doctor for Parotid Swelling
If you have the Swelling on the side of your face you should get diagnosed by a Family Doctor or General Physician
Normally Swelling in Parotid Gland is visible in the Clinical Examination by a Physician and the Physician will refer you to the Head & Neck Specialist Surgeon
In addition to the Clinical Examination, a contrast Enhanced CT Scan or MRI is suggested by the Head & Neck Specialist for more clarity
If there is a Positive Parotid Gland Tumour identified which is affecting the patient then Surgeon will have to plan a Surgery to remove the Tumour
Before the Surgery, a fine Needle aspiration biopsy is carried out to diagnose if the Parotid Gland Tumour is Cancerous or Non- Cancerous
A Tissue Diagnosis is essential to determine the Surgical Plan
If the FNAC reveals a Benign Tumour then the mass is Surgically removed
However, If Malignancy i.e. Cancerous Tissue is detected then the surgery involves removal of the entire Parotid Gland for Adequate Margin and Lymph Nodes.
Malignant Tumour is suspected when a patient reports with the following symptoms :
Facial Nerve Paralysis
Muscle Weakness on one side of the face
How is Parotid Gland Surgery Planned
Parotid Gland Tumour Surgery is the treatment of choice by Patient
A Fine and Experienced Head & Neck Surgeon should be choice for operating a Patient for Parotid Gland
Post-Operative Radiotherapy is advised in cases of advanced stage and/or High-Grade Disease
Deep Tissue Parotid Gland Surgery is highly technique sensitive due to the Facial Nerve involved which travel between the Gland
The Facial Nerve needs to be preserved as any injury to the nerve can lead to Temporary or Permanent Facial Palsy
In cases where the Malignant Tumour is compressing the nerve then the patient may develop Facial Palsy which may cause :
Inability to close the Eye
Drooping of the Corner of Mouth etc
In some cases Facial Nerve needs to be sacrificed in the process of removing the Malignant Tumour
In the event when the Nerve is sacrificed then the Surgeon will Reconstruction nerve by using a Nerve Graft from the Greater Auricular Nerve
Microsurgical Repair of the damaged Facial Nerve is the Highly Technique Sensitive procedure for restoring facial expression
The standard treatment for Benign Parotid Tumours like Pleomorphic Adenomas is Superficial Parotidectomy
In case of Superficial Parotidectomy, the Superficial Lobe of Parotid Gland is removed with preservation of the Facial Nerve.
Total Parotidectomy is the choice of treatment for Benign Tumours involving the Deep Lobe of the Gland or for Malignancies arising in the Gland.
Radical Parotidectomy is done when Facial Nerve will be sacrificed
Radical Parotidectomy is performed when Neoplastic involvement of the facial nerve is present.
Immediate Facial Nerve Reconstruction or Repair is involved
Grafting of Nerves such as the Sural Nerve from the great Auricular Nerve and the Cervical Nerve Branches is done
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