What Is a Salivary Gland Neoplasm?

Salivary gland tumors (Salivary gland) are the most common diseases in salivary gland tissues. Most of them are epithelial tumors, and tumors of Jianye tissue are rare. The pathological types of salivary glandular epithelial tumors are very complicated. Different types of tumors have different clinical manifestations, imaging manifestations, treatments, and prognosis.

Salivary gland tumor

Overview of Salivary Gland Tumors

The incidence of salivary gland tumors

1. Incidence rate: There are significant differences in incidence rates in different countries, reported in the literature as 0.15-1.6 / 10 million.

2. Age of occurrence: Any age can occur. Adults are more benign than malignant, and children are more benign than benign.

3. Gender ratio: There are more women than men with pleomorphic adenomas and mucoepidermoid carcinomas, and more men than women with Worsing tumors.

4. The ratio of salivary gland tumors to systemic tumors: Large salivary gland tumors account for 5% of all benign and malignant tumors except the skin, and account for 20.6% of oral and maxillofacial tumors.

5. Occurrence site: Among all salivary gland tumors, the incidence of parotid gland tumors is the highest, accounting for about 80%; submandibular glands account for 10%; sublingual gland tumors account for 1%, and small salivary gland tumors account for 9%. It is most commonly found in the small salivary glands.

6. Proportion of benign and malignant tumors: The proportion is different in different parts. Benign / malignant tumors in the parotid gland are approximately 3: 1; 3: 2 in the submandibular gland; up to 90% of malignant tumors in sublingual gland tumors and up to 60% in small salivary glands.

7. The relative proportion of tumors in different tissue types: Worthing tumor and eosinophilic adenoma occur almost only in the parotid gland; acinar cell carcinoma, salivary ductal carcinoma, and epithelial-muscular epithelial cancer are more common in the parotid gland; Malignant tumors are more common in the small salivary glands of the palate; 90% of tubular adenomas occur in the labial glands. Mucinous epidermoid carcinoma is the most common glandular tumor in the posterior molar region; sublingual gland tumors are rare, but once they occur, they are likely to be adenoid cystic carcinoma.

8. Multiple primary salivary gland tumors: seen from time to time, most commonly the parotid gland. The most common pathological types are Worthing tumor, followed by pleomorphic adenoma, and malignant tumors are rare.

Classification of salivary gland tumors

1. According to the nature, it can be divided into benign tumors and malignant tumors;

2. It can be divided into parotid gland tumor, submandibular gland tumor, sublingual gland tumor, small salivary gland tumor, post molar molar tumor, tongue gland tumor, labial gland tumor, etc. according to the occurrence site.

3. According to the type of pathology, it can be divided into pleomorphic adenoma, Worthing tumor, mucoepidermoid carcinoma, adenoid cystic carcinoma, and eosinophilic adenoma.

Clinical manifestations of salivary gland tumors

Clinical characteristics of different tumors

1. Benign: Painless masses with slow growth, movement, no adhesion, no dysfunction, surface smooth or nodular.

2. Malignant: Faster growth, more pain, invasive growth, adhesion to surrounding tissues, and even infiltration of nerve tissue and cause dysfunction. Some low-grade malignancies can also show benign manifestations at an early stage and have a longer course, which is easy to be confused by benign tumors.

Clinical characteristics of tumors in different parts

1. Parotid tumor:

1.80% is located in the superficial lobe of the parotid gland, showing a mass under the earlobe, anterior ear area, and posterior lower parotid gland.

2. Even if the benign tumor is huge, the symptoms of facial paralysis will not appear.

3. Malignant tumors may have different degrees of facial paralysis. Invasion of the skin may cause surface ulceration; invasion of the masseter muscle may cause restricted mouth opening; a few cases of lymph node enlargement; when the parotid tumor protrudes to the pharyngeal side, pharyngeal swelling or soft palate swelling may occur.

4. Occurred in the paraparotid gland, as a buccal mass, mostly located under the zygomatic arch or condyle.

Submandibular Gland Tumor

1. Presented as a mass in the submandibular triangle.

2. Benign tumors often have no symptoms.

3. Malignant tumors invade and lingual nerves cause tongue pain and numbness. Involvement of hypoglossal nerves results in restricted tongue movement. When the tongue is stretched, it is biased to the affected side, and tongue muscle atrophy and tongue muscle tremor may also occur.

4. The tumor cannot move when it invades the periosteum of the mandible. When it invades the skin, it is plate-like.

5. Partial lymphadenopathy appears.

Tumors of the sublingual gland

1. Not easy to detect, and partly without conscious symptoms. Some patients consciously have pain or numbness on one side of the tongue, or restricted tongue movement, which affects speaking and swallowing.

2. A palpable hard mass of the sublingual gland can be found on palpation. Sometimes it is connected with the periosteum of the mandibular tongue and cannot move. The mucous membrane at the bottom of the mouth is often intact.

Four, small salivary gland tumors

1. The crotch is the most common. It usually occurs in the posterior part of the iliac crest and the junction of the soft and hard condyles. It does not occur in the midline and anterior part of the condyle, so it does not contain the glandular glands.

2. Hard palate tumors cannot be moved, so benign and malignant cannot be judged by this.

3. Malignant tumors may be associated with pain or burning sensation, often accompanied by numbness of the affected suborbital area or upper lip. Difficulty in opening mouth when invading wing muscles. Protruding into the mouth can make eating difficult.

4. Benign tumors cause compressive absorption of the sacrum and alveolar process, and malignant tumors erode the bone.

Five, post molar molar gland tumors

Mucoepidermoid carcinoma is more common, and the tumor contains mucus secretions.

Six, tongue tumor

1. Mostly located at the base of the tongue, more common malignant tumors.

2. The main symptoms are pain, foreign body sensation and dysphagia.

3. The lesion is located under the mucosa, and it is not easy to be found clinically, and it is often relatively large.

4. Abundant blood and lymph circulation in the tongue, and frequent local movements, prone to lymph node and distant metastasis.

Seven, labial gland tumors

Rarely, the upper lip is more than the lower lip, and it is mostly benign. Basal cell adenomas and tubular adenomas are the most common, showing a clearly defined mass.

Diagnosis of salivary gland tumors

First, the clinical diagnosis: through medical history, clinical examination, combined with the age and sex of the patient can often determine the nature of the tumor.

Imaging diagnosis

Tumors of the parotid and submandibular glands are contraindicated!

B- :

1.It is more practical for the lesions of the salivary gland;

2. Can determine the presence of space-occupying lesions and tumor size, and preliminary assessment of the nature of the lesions;

3. Due to its safety, fastness, repeatability, and low price, B-ultrasound can be listed as the first choice.

CT :

1. The relationship between the tumor site and surrounding tissues can be determined.

2. Particularly suitable for those with deep lobe tumors of the parotid gland, especially those difficult to distinguish from parapharyngeal tumors, and those with a wide range.

Salivary gland radiography:

1. It is of higher diagnostic value for salivary gland inflammation and Sjogren's syndrome.

2. In addition to some diseases in the salivary glands, salivary angiography has been rarely used in the diagnosis of salivary gland tumors since the 1980s due to the widespread application of B-ultrasound and other examination methods.

99mTc nuclide imaging:

1. High diagnostic value for Worthing tumor.

2. Tc is concentrated in the tumor area, that is, "hot nodules", and other tumors are "cold nodules" or "warm nodules."

MRI :

1. Has no damage, no radioactivity and soft tissue.

2. Clear display and other advantages.

3. MRI can clearly show the relationship between tumors and blood vessels, and it shows better tumors and surrounding normal tissues than CT.

4. It is of great value for determining the invasion and scope of malignant tumors and the location of the relationship with surrounding tissues. In addition, it is also more suitable for larger tumors.

5. But magnetic resonance imaging is also difficult to distinguish the histological type of salivary gland tumors.

Fine needle aspiration biopsy

A needle with an outer diameter of 0.6mm is used to absorb a small amount of tissue and smears are used for cytological examination. The accuracy of qualitative diagnosis is high.

Limitations: There are few tissues, and a small number of tissue smears are difficult to summarize the overall picture of the tumor. A deep tumor may be missed. The experience of the reader directly affects the accuracy of the diagnosis.

3. Histopathological diagnosis (gold standard)

1.Frozen sections are often used during surgery;

2.The exact diagnosis of salivary gland tumors often depends on paraffin section diagnosis;

3. If necessary, use immunohistochemistry to assist diagnosis.

According to tumor biological behavior, salivary gland malignancies are roughly divided into three categories:

Highly malignant tumors: high metastasis rate, easy recurrence after surgery, and poor prognosis. Includes poorly differentiated mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary ductal carcinoma, nonspecific adenocarcinoma, squamous cell carcinoma, myoepithelial carcinoma, and undifferentiated carcinoma.

Low-grade malignant tumors: The metastasis rate is low. Although recurrence may occur, the prognosis is relatively good. Including acinar cell carcinoma, highly differentiated mucoepidermoid carcinoma, pleomorphic low-grade malignant adenocarcinoma, and epithelial-myoepithelial carcinoma.

Moderate malignancy: Biological behavior and prognosis are somewhere in between. Including basal cell adenocarcinoma, papillary cystadenocarcinoma, and carcinoma in pleomorphic adenoma.

treatment

1. Principles of surgical treatment of parotid tumors:

Benign tumor of the superficial parotid gland: Facial nerve anatomy + tumor + superficial parotid resection of the deep parotid gland: benign tumor of the facial nerve + superficial parotid resection + tumor and deep parotid resection of the parotid malignant tumor: tumor + total parotid excision Consider whether to retain the facial nerve as appropriate 2. Treatment of the facial nerve:

There is no adhesion between the tumor and the facial nerve. The facial nerve should be kept as much as possible, and mechanical damage should be minimized. The tumor and facial nerve have slight adhesion, but when it is still separable, it should be kept as far as possible, and radiation therapy is added after the operation. Facial paralysis has been performed before surgery, or the facial nerve was found to pass through the tumor, or it is a highly malignant tumor. The facial nerve should be sacrificed and then repaired. 3. Management of cervical lymph nodes:

Low-grade malignant tumors: Clinically found enlarged lymph nodes and suspected lymph node metastasis, you can choose therapeutic lymph node dissection for those who have not touched the enlarged lymph nodes or suspected metastasis. In principle, no selective cervical lymph node dissection is required. Malignant tumors: Selective cervical lymph node dissection should be considered (except for some malignant tumors such as adenoid cystic carcinoma) 4. Postoperative radiotherapy:

Salivary gland malignancies are not sensitive to radiation and it is difficult to achieve a curative effect with radiation therapy alone. However, for some tumors, radiation therapy can significantly reduce the recurrence rate after surgery, such as adenoid cystic carcinoma and other highly malignant tumors, incomplete surgical resection, tumor remnants, tumors closely attached to the facial nerve, and facial nerve retention after separation . 5. Postoperative chemotherapy:

Salivary gland malignancies may undergo distant metastasis, especially adenoid cystic carcinoma and salivary gland duct carcinoma. The distant metastasis rate is about 40%. Therefore, postoperative chemotherapy is required to prevent it, but it has not been found to be very effective Chemotherapy drug.

Prognosis

Patients with salivary adenocarcinoma had higher short-term survival rates after treatment, but long-term survival rates continued to decline, with 3-year, 5-year, 10-year, and 15-year survival rates significantly decreasing. ^[1]

Salivary gland tumor prescription

Prescription:

1. Oral prescription: 15g of Xinyi, 15g of Cork, 15g of habitat, 15g of cocklebur, 9g of araliae, 3g of asarum, 30g of light onion, 30g of Erythrina parasite, 1 pig nose.

2. For external use: 3 onion whites, 3 saponins, 0.15-0.2g musk, 6-9g fresh goose. Add 1 dose of water to make Qi decoction, 1 dose per day, and take 7-8 days after adding P. chinensis and P. sclerophylla, and then take 1 dose every other day, 5-7 doses, begonia fruit, peanut shell and jellyfish crab The shells are dried and ground, followed by the master, taking 1 dose every 3 days, and even 6-12 doses. Both sides use cotton dipped in medicinal juice to plug the ears. If the nose and ears bleed, the medicinal solution can be dripped in.

Addition and subtraction: Oral prescription plus 30g of yellow bark tree parasitism, 30g of bitter tree parasitic tree; nosebleeds and deafness and deafness plus 7 begonia fruit (outer skin), 20 peanut shells, 3-5 jellyfish crab shells; lump and Deafness plus 30g of Davidia involucrata parasites, 30g of goose does not eat grass.

Efficacy: A total of 4 cases were treated, 3 cases were significantly relieved, and 1 case was cured by taking 21 doses of this prescription, so far no recurrence.

Fang Yuan: Rural Wangshan Brigade, Wenchang County, Guangdong.

3. Take 0.3g of bezoar, 30g of prunella vulgaris, 1 dose per day, decoction of prunella vulgaris, and bezoar infusion (the longest surviving after treatment is 11 years).

Remedy:

30g of osmanthus root and 20g of gynostemma pentaphyllum.

30 grams of East China medicine tincture, first fry for two hours, then add wolfberry root, 30 grams each of yarrow, and 15 grams of seven leaves and one branch. Strain the decoction to take the juice.

Introduction and health guidance for salivary gland tumors

Knowledge about salivary gland tumors

(1) Conceptual salivary glands, also known as salivary glands, include three pairs of parotid glands, submandibular glands, and sublingual glands, as well as small salivary glands located in the oral cavity, pharynx, nasal cavity, and superior sinus. . Among them, mixed parotid tumors are the most common, accounting for about 80% of salivary gland tumors. It is a pleomorphic adenoma that contains parotid gland tissue, mature fluid, and soft monthly tissue. Mixed parotid tumors are more common in young adults. Although benign, they may be malignant.

(2) The cause of radiation exposure has been more clearly identified as one of the causes of salivary adenocarcinoma. Chemically toxic substances may be related to the development of salivary gland tumors. Long-term exposure to chemically toxic substances and viral infections can also induce salivary glands. In addition, abnormal hormone secretion, decreased immune function, and genetic factors are related to the occurrence of salivary gland tumors.

(3) Clinical manifestations: Most salivary gland tumors grow without palatal growth, but some salivary gland tumors are accompanied by obvious neurological symptoms and localized pain or radiation pain. Malignant tumors invade the facial nerve and facial paralysis; tumors invade the tongue nerve and numbness ; Violation of the hypoglossal nerve causes dyskinesia. The mixed parotid tumor is located below the earlobe, and can extend to the neck when it is large; the tumor has large nodules, which are not attached to the skin or basal tissue, and can be pushed. Deep lobe tumors of the parotid gland are sometimes deep, and sometimes pain in the joint area or restricted mouth opening can occur. Ultrasound imaging, sting scanning, and magnetic resonance imaging can determine the nature of the tumor and make a clear diagnosis.

(D) The treatment of salivary gland tumors is mainly surgery

Health Guidelines for Salivary Gland Tumors

(I) Preoperative health guidance is often supplemented by radiation therapy and chemotherapy o

1. Avoid colds, colds, quit smoking and alcohol, prevent upper respiratory infections, and keep your mouth clean.

2. Maintain emotional stability and improve various tests and examinations (such as chest X-ray, electrocardiogram, D-ultrasound, cT, magnetic resonance imaging, blood, urine, etc.).

3 Take good personal hygiene to keep your hair, skin, and mouth clean, and shorten your fingernails.

4 Preoperative skin preparation: haircuts, shaving, bathing, changing clothes, short fingernails. Prepare the skin (scrape off the hair on the affected side 2 cm from the hairline). 5. Fast and water for 6 hours before general anesthesia.

6. On the day of the surgery, clean the patient's clothes. Do not wear underwear on the upper body. Female patient combs her hair neatly, ties it with a soft head rope or combs it into three strands

braid. Remove personal belongings (necklace, earrings, ring, watch, movable denture, hair clip, contact lens, etc.) and keep it with your family.

(Two) postoperative health guidance

1. After general anesthesia, supine the supine side of the pillow for 6 hours. After 6 hours, add a pillow to the lateral or semi-recumbent position to avoid strenuous activities.

2. During the use of oxygen, do not adjust the flow or shut down by yourself; pay attention to fire, heat, oil, shock, and do not smoke indoors, so as not to affect safety and treatment results.

3 Master the method of controlling cough and sneezing. Press the middle of the person, the tip of the tongue against the upper neck, and inhale deeply.

4 Keep the surgical site dressing clean, dry, and fixed to avoid looseness and moisture to prevent bleeding and infection.

5. The knife-edge drainage tube is used to drain the exudate from the surgical site. The drainage tube needs to be kept fixed, unobstructed, and squeezed daily. Do not distort or fall off; the drainage bag is effective only after it is deflated; if the drainage swells up or the drainage tube becomes blocked or falls off, please notify the medical staff immediately. It is usually removed at 48.72 hours. After removing the drainage tube, pressure bandaging is required. You may feel tight. Please do not loose the dressing. If there is more exudate, please inform the medical staff in time.

6. Keep your mouth clean and rinse your mouth 3-4 times a day. 7 diet general anesthesia for 6 hours, you can enter a light semi-liquid diet (such as: porridge, blunt, rotten noodles, steamed chicken cakes, etc.), less seasoning in food, avoid too salty, too sour, too sweet, so as not to Stimulate the secretion of residual glands and affect the healing of the incision. No smoking, avoid spicy and irritating food. 8. The sutures were removed about 7 days after the operation, and the hair was washed after 3 days. Patients with wound infections will need to continue dressing.

(3) Health guidance after discharge

1. Prevent colds and colds, strengthen exercise and strengthen your physique. Pay attention to oral hygiene and keep your mouth clean.

2. Quit smoking and drinking, and continue on a light diet for 1 month, which is conducive to the recovery of the knife.

3 Patients with facial paralysis pay attention to the protection of facial kimono eyes, prevent facial burns, frostbite, and timely take medicine, apply eye ointment, and wear eye mask to prevent keratitis.

4 After two weeks of outpatient review, if local discomfort such as redness, swelling, pain, etc., please see a doctor immediately.