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 :
    • Parotid Gland
    • Sub Mandibular Gland
    • Sublingual Glands
  • 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
Causes & Effects in Parotid Gland

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
Facts of Salivary Gland related Diseases

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
    • Facial Numbness
    • 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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