Salivary gland tumors
INTRODUCTION
I- ANATOMO-HISTOLOGICAL CLASSIFICATION: WHO 2005
A-Epithelial tumors:
-Benign tumors or adenomas
-Malignant epithelial tumors or carcinomas
B-Non-lymphoid connective tissue tumors:
-Benign tumors
- Vascular tumors
- Nerve tumors
- Lipoma
-Malignant tumors
C-Malignant lymphomas
D-Secondary tumors
II- CLINICAL, DIAGNOSTIC AND THERAPEUTIC STUDY.
- Parotid tumors:
1.1 Primary tumors
1.1.1 Epithelial tumors
A-Benign epithelial tumors
Pleomorphic adenoma
-Clinical
-Additional examinations
-Macroscopy
-Histology
-Evolution and prognosis:
-Differential diagnosis
-Clinical variants of pleomorphic adenomas
Cystadenolymphoma (Warthin’s tumor)
-Etiopathogenesis
-Clinical
-Additional examinations
-Macroscopy
-Histology
-Differential diagnosis
-Evolution and prognosis
Myoepithelioma (Myoepithelial adenoma)
Oncocytoma (Oncocytic or oxyphilic adenoma)
Other adenoma
Cysts
- Salivary cysts
- Intraparotid tonsillar cysts
B-Malignant epithelial tumors
Mucoepidermoid carcinoma
-Clinical
-Additional examinations
-Macroscopy
-Microscopy
-Differential diagnosis
-Evolution and prognosis
Acinar cell carcinoma
-Clinical
-Additional examinations
-Macroscopy
-Differential diagnosis
-Evolution and prognosis
Adenoid cystic carcinoma (Cylindroma)
-Clinical
-Additional examinations
-Differential diagnosis
– Evolution and prognosis
Adenocarcinoma, squamous cell carcinoma and undifferentiated carcinoma
-Clinical
-Additional examinations
-Evolution and prognosis
Carcinoma developed on a pleomorphic adenoma
-Clinical
-Additional examinations
-Histology
-Differential diagnosis
-Evolution and prognosis
1.1.2 Non-epithelial tumors
A- Benign non-epithelial tumors
a- Vascular tumors
Hemangioma
-Clinical
-Additional examinations
Cystic lymphangioma
Hemolymphangioma
-Clinical
-Additional examinations
-Evolution
b- Nerve tumors :
- Neuroma or Schwanoma
- Neurofibroma
c- Connective tissue tumors :
- Lipoma
B-Malignant non-epithelial tumors
a-Sarcomas:
b-Rhabdomyosarcoma:
c-Lymphomas
1.2 Secondary tumors
1.3 Diagnosis
1.3.1 Differential diagnosis
1.3.2 Positive diagnosis
1.4 Treatment
- Benign tumors
- Malignant tumors
2- Tumors of the submaxillary gland
-Epidemiology
-Clinical
-Additional examinations
-Differential diagnosis
-Evolution and prognosis
– Treatment
3- Tumors of the sublingual gland
-Epidemiology
-Clinical
Differential diagnosis
-Treatment
4- Tumors of the accessory salivary glands
-Epidemiology
-Clinical
-Topographical forms
- Palatal forms
- Lip shapes
- Jugal forms
- Pelvic-buccal forms
- Mandibular retromolar forms
- Lingual forms
-Treatment
Conclusion
I-INTRODUCTION:
The interest in the study of GS tumors is dominated by the varied clinical presentations, the diverse possibilities of paraclinical investigations, the great diversity of anatomopathological forms and the often complex treatments, particularly on the surgical level.
-GS tumors represent 3% of head and neck tumors
-63% of them concern the GSP (90% affect the parotid gland)
-37% affects GSAs
-95% of tumors are epithelial: 66% benign of which 80% are pleomorphic adenomas, 10% cystadenolymphoma
-34% are malignant tumors of which 29% are mucoepidermoid carcinomas, 13% are acinar cell carcinomas, 9% are cylindromas
-in children the two most frequent tumors: hemangioma for benign tumors, rhabdomyosarcoma for malignant tumors
II- Anatomo-histological classification of salivary gland tumors:
Benign epithelial tumors
- Pleomorphic adenoma
- Cystadenoma
- Adenoma myoepitheliae (myoepithelioma)
- Warthin tumors (adenolymphoma)
- Oncocytoma
- Basal cell adenoma
- Canalicular adenoma
- Sebaceous adenoma
- Inverted ductal papilloma
- Sebaceous lymphadenoma or not
- Intraductal papilloma
- Sialadenoma papillaeferum
- Epithelial and lymphoepithelial cysts.
Salivary gland tumors
Malignant epithelial tumors
- cancerous cell carcinoma
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
- Polymorphous adenocarcinoma
- Basal cell adenocarcinoma
- Epithelial carcinoma
- Clear cell carcinoma
- Sebaceous carcinoma
- Sebaceous lymphadenocarcinoma
- Cystadenocarcinoma
- Metastasizing pleomorphic adenoma
Non-epithelial tumors
- Benign tumors:
A- vascular tumors:
– Hemangioma
– lymphangioma
– Hemolyphangioma
B- nerve tumors
-Neurinoma or schwanoma
-Neurofibroma
C-Lipoma
- Malignant tumors
-Sarcoma
-Rhabdomyosarcoma
-Hemangioperiocytoma
-Malignant lymphomas
-Secondary TUMORS
III- CLINICAL, DIAGNOSTIC AND THERAPEUTIC STUDY .
- Parotid tumors:
1.1 Primary tumors
1.1.1 Epithelial tumors
A-Benign epithelial tumors
Pleomorphic adenoma
- Clinical
- Frequency: women between 40-60 years old
- Rounded or bumpy nodule, but circumscribed
- Firm, regular consistency
- Location: superficial lobe of the parotid gland +++
- Painless, slow-growing, not fixed
- No facial paralysis or satellite adenopathies
- Additional examinations
- Sialography
Rounded lacunar image, in a normal parotid parenchyma (ductal basket, ball-in-the-hand image)
- Ultrasound:
Hypoechoic intraparenchymal lacuna, not very homogeneous but well-defined.
- Scanner and MRI
Not very interesting for small tumors
- Puncture:
Prohibited whenever the DGC of a cyst, suppuration or hematological ADP is uncertain.
- Evolution and prognosis
- Recurrence: remains frequent
- Cancerization: is rare 5% of cases
- Metastases: linked to intravascular migration of myxoid substance during initial excision (lungs, liver, bones).
- Differential diagnosis
- Affirm that this retromandibular nodule is located in the parotid lodge
-sebaceous cyst
-tumor of a pre-masseter lobule or of the submandibular parotid border
- In the lodge the clinical diagnosis between tumors and certain inflammatory lesions of the parotid gland should never be erroneous
- With inflammatory lesions, lithiatic or primary parotitis
- Parotid tumor ADPs
- parotid localization of lymphoma
- Parotid adenitis
- Cavitary angiomas
- Nerve tumors
- Lipoma
- Clinical Variants
- Large adenomas
- Internally growing pleomorphic adenomas
- Multiple recurring pleomorphic adenomas
Cystadenolymphoma
- Etiopathogenesis
- role of smoking
- The identification of sex hormone receptors on the membrane of Warthin tumor cells could explain the observed hormonal dependence.
- Clinical
- Frequency: 2nd in frequency, men between 40-70 years old
- Small, rounded tumor, smooth on the surface, sometimes bumpy, fluctuating, slowly evolving
- Seat; post-inf part of the parotid
- No ADP, no PF
- Additional examinations
- Sialography
Clear RX lacuna in the infero-post border of the gland with repression of the peripheral ducts
- Ultrasound :
Image of a +/- cystic lesion,
- Scintigraphy :
Early, intense and prolonged fixation of the isotope
- Differential diagnosis
- A salivary cyst
- Another type of adenoma or a pleomorphic adenoma
- An early mucoepidermoid tumor or parotid angioma
- Evolution and prognosis
- It is done towards a progressive increase with inflammatory flare-ups
- Possibility of regression
- A possible malignant transformation
Myoepithelioma (myepithelial adenoma)
- 1-5% of salivary gland tumors,
- Occurs at any age
- The parotid seat represents 40%
- Evolution: Myoepithelioma is considered more aggressive than AP. Its growth is said to be faster and its recurrences more frequent.
Oncocytoma
- 1% of salivary gland tumors,
- common in women between 55-70 years old
- Firm, rounded, well-circumscribed tumor characterized by proliferation of oxyphilic cells
- Sialography shows a rounded lacuna that pushes the ducts back
- Scintigraphy gives an image of a hot nodule
Other adenomas
- Basal cell adenoma
It is almost always located in the parotid gland and is the prerogative of the elderly.
Three histological forms are described.
– peripheral palisade seat
– compact, tubular architecture
– membranous forms
- Clear cell adenoma
Very rare, made of clear cells +/- rich in glycogen.
- Basal cell adenoma
- 2% of salivary gland tumors
- Mobile, non-painful tumor
- Sebaceous cell adenoma and sebaceous lymphadenoma
- Rare
Cysts
- Salivary cysts:
- retentional cyst, 3 to 4 cm in diameter
- present as relentless swellings
- Wall made up of fibrous tissue poor in inflammatory cells
- Sialography
- associates a gap (canal corbel) and inflammatory signs
- Ultrasound
- A well-defined hypoechoic tumor
- Tonsil cysts:
- Small, unilobular cyst.
B/ Malignant epithelial tumors
Mucoepidermoid carcinoma
- Clinical
- Sometimes the tumor appears benign.
- more frequently it is an irregular, hard, diffuse tumor, fixed to neighboring elements and to the skin, of rapid growth associated with facial paralysis and pain
- Additional examinations
- Sialography:
- low-grade tumor:
- gap pushing back the channels
- high-grade tumor:
- Destroyed canal tree
- Very inhomogeneous parenchymal opacification
- Contrast extravasation images
- TDM:
- Low grade: fairly well-defined nodule
- At high grade: the image becomes irregular and diffuse
- MRI: appears as hypointense in T1 and T2
- Differential diagnosis
Depending on the degree of differentiation with:
- pleomorphic adenoma
- adenoid cystic carcinoma or poorly or undifferentiated carcinomas
- Evolution and prognosis
- The prognosis is uncertain, with 25% recurrence and 10% metastases.
- the evolution is slow (recurrence after 7 to 10 years)
Acinar cell carcinoma
- Clinical
- Represents 13% of salivary gland tumors
- Painless, slow-growing, firm tumor.
- Facial paralysis + associated pain, and satellite ADP
- Additional examinations
- Sialography:
Shows, depending on the degree of malignancy, a +/- peripheral lacuna pushing back the canals or canal-parenchymal disorganization, extravasation of the contrast product
- CT scan and ultrasound: show a generally irregular lobulated nodule that is more or less limited.
- Differential diagnosis
- Pleomorphic adenoma
- Mucoepidermoid carcinoma
- Adenocarcinoma
- Clear cell carcinoma
- Evolution and prognosis
- The average duration of recurrence after excision is 14 years.
- The average 5-year survival is between 47-90% with a 25-year survival of around 50%.
- Recurrences should be treated aggressively.
Salivary gland tumors
Adenoid cystic carcinoma (Cylindroma)
- Clinical
- Represents 14% of salivary tumors and 9% of malignant tumors, rarer in the parotid gland 2 to 6%
- firm and mobilizable nodule
- palpation can be very evocative,
- In very advanced forms, the appearance of a hard, mammary tumor and sensitivity to palpation are in favor of cylindroma.
- Additional examinations
- Sialography
Lacunar, pushing back the canals to a greater or lesser extent. These canals often show signs of amputation
- TDM :
Shows a more or less irregular and diffuse gap.
- Differential diagnosis
- Pleomorphic adenoma
- Mucoepidermoid tumor
- Basal cell adenocarcinoma
- Evolution and prognosis
- The prognosis is very reserved
- Late lymph node and visceral metastases after numerous local recurrences
Adenocarcinoma, squamous cell carcinoma and undifferentiated carcinoma
- Clinical
- They represent 7-10% of malignant tumors, more frequent in children and the elderly.
- Hard, painful and +/- fixed tumors
- ADP + facial paralysis
- Additional examinations
- Sialography :
– Poorly limited gap,
-Amputation of the canals and extravasation of Lipiodol
- Evolution and Prognosis
- Frequent locoregional invasion,
- Lymph node metastases are common
Carcinoma developed on a pleomorphic adenoma
- Clinical
- It is a large, painless mass known for years, which has recently changed (increase in size, pain, facial paralysis, etc.)
- This nodule exhibits rapid growth and may ulcerate.
- Additional examinations
- The sialographic and CT features are those of benign pleomorphic adenoma, with time carcinomatous aspects become evident.
- Differential diagnosis
- Is that of carcinomas, however the chondromyxoid material can sometimes be difficult to find in histological specimens
- Evolution and Prognosis
- Recurrences are frequent 50-75% and affect the prognosis, distant metastases darken the prognosis.
– Survival is 50% at 5 years, 30% at 10 years.
1.1.2 Non-epithelial tumors
A/Benign non-epithelial tumors
a/ Vascular tumors
Hemangioma
- 1-4% of salivary gland tumors, mainly in children.
- This is most often a capillary or cavernous hemangioma.
- The most common symptom is swelling of the affected area.
- The swelling is diffuse, soft, and increases in volume when the head is in a tilted position.
- Additional examinations
- Sialography
- Displacement of the repressed gland by the mass
- Irregular gap in the parenchyma.
- Salivary gland tumors
- Ultrasound :
Whether it is cystic lesions or mixed vascular and cystic lesions, the essential echo-Doppler reveals intra-tumoral hypervascularization related to venous ectasia.
Salivary gland tumors
Cystic lymphangioma
- Benign lesion of the lymphatic system
- Characterized by multiple cystic dilations
- Appear in 80% before the age of 2, mainly in the cervical region
- Clinical
Compressible tumors, can be emptied and refill when the patient tilts the head between the legs
- Ultrasound reveals trans-spatial, multicompartmental, polylobed lesions.
- Echo-Doppler demonstrates tumor hypervascularization and venous ectasia.
Hemolymphangioma
- Clinical
- Soft, polylobed, mobile swelling under the skin, adherent to deep layers in their uncomplicated, painless, irreducible, pseudo-fluctuant or relentless cystic form.
- Additional examinations
- Ultrasound
- Reveals the +/- anechogenic nature and specifies its extensions
- Evolution
- Benign without risk of malignant transformation.
- Salivary gland tumors
b/ Nerve tumors
Neuroma or schwanoma
- Sits mainly on the facial nerve,
- Only exceptionally results in a PF
- May present as a painful tumor
Neurofibroma
- Observed during RECKLIN GHAUSEN
- Painful and extensive tumor
c/ Connective tissue tumors
Lipoma
- Lipocytic, common and elementary diagnosis,
- May be isolated or found as part of diffuse lipomatosis.
B/ Malignant non-epithelial tumors
a/Sarcoma
- These tumors are exceptional, angiosarcomas, fibrosarcomas, liposarcoma, embryonal sarcoma, adenosarcoma, myosarcoma and Kaposi’s sarcoma.
b/Rhabdomyosarcoma
- Embryonal rhabdomyosarcoma are fairly common tumors in children.
- They are particularly located in the cavum or sinus cavities but are not exceptional in the parotid gland.
- Diagnosis can only be made by exploratory parotidectomy or biopsy.
c/Lymphomas
- The presence of parotid intraglandular lymph nodes makes the occurrence of parotid lymphoma possible, whatever their type.
- A multinodular or bilateral parotid intraglandular mass is highly suggestive of lymphoma, especially if associated with recurrent facial paralysis.
- It may be a large, poorly defined tumor mass that is indistinguishable from a malignant epithelial tumor.
1.2. Secondary tumors
- This most often involves direct invasion of the gland by regional cancers, squamous cell carcinoma, melanoma of the cervical facial integuments, extension to the parotid tissues of a malignant tumor arising from one of the vascular elements.
- More rarely, the starting point is nasopharyngeal carcinoma or thyroid cancer.
1.3. Diagnosis
1.3.1. Differential diagnosis
a) nodule:
- Superficial adenopathy, pre-tragial or in contact with the lower pole of the gland.
- Sebaceous cyst: pasty, sebaceous fistula, adhering to the skin with inflammatory flare-ups, is easily recognized
- A false nodule: Anatomical structure: atlas, styloid process
- Pseudotumorous parotitis
- superficial lipoma
- schwanoma and facial neurofibroma
- Neuroma of the superficial cervical plexus observed following a parotidectomy.
- Salivary gland tumors
b) overall swelling of the gland:
- Lymphoma: Clinically it manifests as a parotid intraglandular mass, multi-nodular or bilateral, associated with facial paralysis.
- Viral parotidomegaly (HIV++)
- Vascular dysplasias, whatever the type, are usually poorly limited and extend beyond the lodge. Their increase in volume in the dependent position.
c) overall swelling of the gland:
- Deep tumors of the region, of a connective nature and often benign, born within the gland or in its vicinity and pushing it back or dissociating it, such as tumors of the posterior subparotid space, are best explored by modern imaging;
- Finally, it would be unforgivable not to recognize a lesion of the ramus, responsible for swelling of the region and likely to disrupt mandibular dynamics (trismus, laterodeviation when opening the mouth) and to cause intraoral signs, all signs justifying an X-ray.
Salivary gland tumors
1.3.2. Positive diagnosis
1) Benign tumors
- Slow progression, absence of pain, absence of PF and no deficit signs
- Additional examinations
- Sialography:
It is reflected on a sialogram, correctly performed and analyzed, by the classic image of a “ball in the hand”. The tumor, not taking the contrast, is objectified by a gap within the fine “lipiodolé” cloud of the parenchyma, otherwise normal. Round or oval, the clear outline is surrounded by the image of the normal, fine, harmoniously repressed channels.
- CT scan: it allows a topographic diagnosis to be made by locating the tumor precisely. However, it is not possible to make a diagnosis of the nature of a tumor by CT scan.
CT scans show a well-defined mass whose density contrasts with that of the surrounding normal parenchyma.
This examination has lost a significant part of its interest with the advent of MRI.
- MRI: allows to eliminate contiguity lesions (subcutaneous, subdigastric adenopathy, cyst of the 2nd branchial arch). It allows to distinguish tissue lesions from cystic lesions. The pleomorphic adenoma most often presents with a typical appearance.
It presents as a well-defined, encapsulated tumor with a characteristic lobulated appearance, in T1 hyposignal and T2 hypersignal, enhancing homogeneously after injection.
Warthin’s tumor is more difficult to study because the aspects are variable and the MRI semiology has been little described in the literature.
- Fine needle aspiration cytology
Fine needle aspiration cytology of salivary gland tumors, and particularly parotid gland tumors, has been used for almost a century. This examination is performed with or without ultrasound control.
When cytology is performed to obtain a precise histological diagnosis, the reliability of cytology varies according to the nature of the tumor. Thus, for pleomorphic adenoma the reliability is close to 92% while it drops to 75% for Warthin tumor.
2) Malignant tumors :
Speed of progression, pain, ulceration, PF and deficit signs.
Salivary gland tumors
- Additional examinations:
- Sialogrphy: irregular lacuna containing spots or real pools of lipiodol. On contact the channels are widened, irregular, amputated.
- Additional examinations:
- CT scan: CT scans reveal a mass with a more or less heterogeneous hyperdensity. However, the infiltrative nature of the tumor in relation to the anatomical spaces and neighboring muscles is better defined by MRI.
- MRI: hypointense appearance in T1 and hypo or isointense in T2
The criteria for malignancy on MRI are:
– Irregularity of contours
– Hyposignal in T2
– Size greater than 2 cm
– Signal heterogeneity.
– Multiplicity of lesions.
– Perilesional and perineural infiltration.
1.4. Treatment
- Treatment of benign tumors
A) total parotidectomy, conservative:
*indications:
-multifocality of the tumor
-tumor volume or false encapsulation
*sequelae:
Transient PF, scar, depression, auricle hypoesthesia, Frey’s syndrome
B) partial parotidectomy:
*arguments in favor:
-single nodule
– observation of anapath negativity of the deep pole of the gland
-less significant post-op after-effects
- Malignant tumors
- Surgical TRT
- Radiotherapy TRT
- TRT chemotherapy
Surgery : total parotidectomy, lymph node dissection.
Radiotherapy
Chemotherapy : indicated for chemo-sensitive cancers and used as a therapeutic adjuvant for metastases.
Salivary gland tumors
2/Tumors of the submandibular gland:
- Epidemiology
- Represents 5-10% of GS tumors
- frequent in the elderly and women
- Malignant tumors are more common than for the parotid gland (more than 50%).
- The most common tumors are pleomorphic adenomas, adenoid cystic carcinomas and mucoepidermoid carcinomas.
- Clinical
- The tumor is palpable in the submandibular region, under the horizontal branch of the mandible. Bidigital palpation allows the tumor to be best assessed.
- The elements in favor of benignity are regularity, its painless and well-limited character, mobility both in relation to the cutaneous and deep planes, the absence of suspicious cervical adenopathy or visceral metastases.
- However, since these elements are present, it is not possible to formally affirm benignity.
- Salivary gland tumors
- Clinical aspects:
- Centroglandular nodule :
- Bidigital palpation detects within the gland the painless, circumscribed nodule, more or less large, regular in outline or sometimes bumpy and whose hardness contrasts with the rather elastic consistency of the gland. These characteristics are better defined by the pulp of the index finger which palpates the posterior floor of the mouth.
- Peripheral glandular nodule :
- The picture is misleading when the tumor is palpated on the cutaneous side of the gland. Sometimes, this nodule, not accessible to the intraoral finger, poorly embedded in the gland, is clearly protruding under the skin and simulates adenopathy, which is much more frequent.
- Posterior pole tumor
- It poses the problem already mentioned about a lower parotid nodule. A tumor of the upper pole of the gland would be directly accessible under the intraoral finger, behind the mylohyoid. A tumor of the supramylohyoid extension, apparently very rare, would raise the question of its belonging to the sublingual gland.
- Nodule with accompanying signs :
- Apart from suspicious-looking adenopathies, the painful nature
- of a nodule indicates a possible malignancy.
- Additional examinations
Depending on the case, it is essential or not. The images produced are superimposable on those previously described for a parotid tumor and here again, no image is truly specific.
- Sialography
- Benign tumors : Lacunar image with repression of the ducts without alteration of the parenchyma
- Malignant tumors : Image of amputation and alteration of the parenchyma.
- Ultrasound
- TDM
- MRI
- chronic submaxillitis, usually lithiasic.
- ADP attached to the gland
- schwannoma,lipoma,angioma
- Congenital cysts: dermoid cyst, tonsillar cyst.
- Evolution and Prognosis
- Recurrence or metastasis of malignant tumors in 40-60% of cases within one year
- 5-year survival does not exceed 40%
- Treatment
- Benign tumors:
total submandibulectomy
- Malignant Tm
- submandibulectomy + lymph node dissection
- In case of tumor invasion into adjacent structures:
An interruptive or non-interruptive pelvic mandibular ectomy is indicated with repair and reconstruction using musculocutaneous flaps.
- Radiotherapy
- Salivary gland tumors
3/ Tumors of the sublingual gland
- Epidemiology
- Very rare tumors, 0.3-5.2% of GS tumors
- Common in women and occurs around the age of 50
- They are malignant in the vast majority of cases (84% to 92.3%), the most frequent of which are adenoid cystic carcinomas.
- Clinical
- The sublingual gland is not anatomically as well defined as the parotid or submandibular gland.
- Tumors are located not only in the anterior part of the floor of the mouth but also along the horizontal ramus of the mandible and in the posterior part of the floor.
- Their diagnosis is difficult, often late because the signs are non-specific; such as a bulging of the floor of the mouth.
- Differential diagnosis
- Sublingual frog
- GSA pelvic oral tumors
- Cancers of the floor of the mouth
- Treatment
- Benign tumors:
Oral excision fairly wide
- Malignant tumors
Expanded with hollowing out of the lodge under the mand + radiotherapy
4/ Tumors of the accessory salivary glands
- Epidemiology
- GSA tumors represent 22% of all GS tumors.
- 60-80% are malignant
- The most common malignant tumors are CAK, CME,
PA is the most common benign tumor
- More than half of benign tumors are located in the palate, the upper lip is the second most common location with 15%.
- Clinical
- Submucosal nodule that gradually develops, firm or hard, spherical or bumpy in shape,
* It can be unique, painless, mobile (except for the palate) under the mucosa which it lifts without modifying it.
* Malignancy is suggested by an ulcerated or ulcerative budding, painful appearance
- Topographical forms
- Palatal tumors
- By far the most frequent, they are usually located posterolaterally. Clamped between the bony vault and the thick, healthy fibromucosa, the tumor deforms the region into a “watch glass”.
- Sometimes it extends into the internal alveolar region and it is obvious that any mobility of the teeth opposite indicates bone damage .
- It is very rare that it appears to be clearly overhanging, as if pedicled on the vault and then of juxtamedian seat.
- TDM :
- A small tumor may not alter the vault or it may cause a regular “dome” repression, with or without thinning of the bone.
- In fact, due to its volume, it often results in a perforation of the bone with a regular and clean edge.
- In contrast to this rather favorable aspect, irregular and invasive bone destruction indicates a malignant process.
- Salivary gland tumors
- Differential diagnosis:
- Subperiosteal abscess
- A sinus tumor externalized to the palatine vault is usually malignant and of the squamous type.
- Tumors of the soft palate
- Salivary tumors are fortunately rare there.
- a nodule embedded in the hemiveil arches its buccal face.
- Sometimes the nodule deviates the uvula or takes up the thickness of the anterior pillar of the tonsil, which should be distinguished from a tumor of the paratonsillar space.
- The distinction with a peritonsillar phlegmon is easy in the absence of trismus and inflammatory context.
- Lip tumors
- The upper lip is the preferred seat.
- The nodule, hard, well-defined and closer to the mucous membrane than to the late-curving skin, is easily detected by the patient and palpated between two fingers .
The discussion is with :
* a mucoid cyst,
* an exceptional lithiasis of a labial gland,
* It is more or less easy depending on the context to eliminate a scar nodule, or even a botryomycoma.
* Lipoma of the labial surface is not uncommon. It is easily recognized by its elastic consistency and yellowish coloration that shows through the raised and thinned mucosa.
* Sometimes it is a neurolipoma
- Jugal tumors
Rare, develop mainly in the peristenon region (rich in accessory salivary glands).
- Differential diagnosis:
Lipoma, calculus, ductal cancer (orientative hemosialorrhoea)
- Pelvic-oral tumors
- The anterior floor of the mouth, particularly rich in salivary tissue, makes it difficult, if not impossible, to determine the origin of a tumor developed at this level.
The frequency of malignant tumors, CME and CAK in particular, is noteworthy.
A froglet, a Wharton canal lithiasis, a dermoid cyst with endobuccal extension are easily eliminated.
Salivary gland tumors
- Lower retromolar trigone tumors
- Exceptional, they are often overlooked.
- A tumor arches the top of the region and extends more or less onto the lingual side.
Sometimes the tumor more or less encroaches on the foot of the anterior pillar of the tonsil or extends towards the intermaxillary commissure. In the absence of dental signs on the third molar, the diagnosis should be systematically considered.
- Lingual tumors
They are remarkably rare, explaining why the diagnosis of schwannoma, rather than fibroma, is usually considered before the anatomopathological examination.
- Treatment
- Whatever the location, the excision of such a tumor must in principle be carried out at a distance, even in the case of a clearly benign tumor.
- Any direct incision with lifting of mucosal flaps, in order to allow suturing at the end of the procedure, should be avoided.
- Remote excision therefore requires the deliberate sacrifice of the mucosal covering, opposite the tumor .
- Palatal tumor: excision plus hard bone curettage or even half-thickness cutting of a bone flap – Obturator prosthesis.
- – Veil tumor: excision, surgical or prosthetic correction.
- – Lip tumor: excision with immediate surgical correction
- – Jugal tumor: remote excision. Catheterization of the Stenon canal.
- Pelvic-oral tumor: excision, canal catheterization, sublingualectomy as a rule.
- Lingual tumor: responds to the principles of excision of soft tissue tumors
- Salivary gland tumors
EXTEMPORARY EXAMINATION
- In these various locations, extemporaneous examination is easy to undertake after removal of the tumor.
- Since it is certain that the intraoral salivary tumor is malignant, the question arises as to the appropriateness of cervical curettage.
- It is not discussed in the presence of suggestive adenopathies
- The indications for radiotherapy and chemotherapy do not differ from those outlined for tumors of the major salivary glands.
- Conclusion
The odotostomatologist plays a very important role, a role in the diagnosis and early detection of these tumors, a therapeutic role and a role in the TRT of complications of the therapies used in tumor pathology of the salivary glands.
Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain