The salivary glands make saliva and release it into the mouth. Saliva has enzymes that help digest food and antibodies that help protect against infections of the mouth and throat. There are 3 pairs of major salivary glands-

• Parotid glands: These are the largest salivary glands and are found in front of and just below your ear. Most major salivary gland tumors begin in this gland.

• Submandibular glands: These glands are found below your jawbone.

• Sublingual glands: These glands are found under the tongue in the floor of your mouth.

There are also hundreds of small (minor) salivary glands lining parts of the mouth, nose,back of your throat and voice box that can be seen only with a microscope.

In most cases the cause of most salivary gland tumour or cancer is not known. Some risk factors are mentioned below:

• Older age

• Treatment with radiation therapy to the head and neck

• Occupation such as rubber manufacturing, asbestos mining or plumbing

Most patients with salivary tumour / cancer do NOT have any significant discomfort or symptoms. It is advisable to get a check upif you have any of the following problems:

• A lump (usually painless) in the area of the ear, cheek, jaw, lip, or inside the mouth.

• Trouble swallowing or opening the mouth widely.

• Numbness or weakness (paralysis) in the face.

• Pain in the face or deep ear that does not go away.

No, most tumour of salivary gland are benign tumour, not cancer.

Tumour refers to any abnormal discrete swelling in your body. These are classified as benign and malignant. It is the malignant variety, which are also called cancer. Benign tumours can continue to grow at the site where they started but will NOT spread into other nearby structures or anywhere else in the body. The malignant tumours can spread into nearby structures as well as elsewhere in your body by travelling through your blood vessels or lymph vessels.

The vast majority of tumours in salivary glands are benign. Tumours are most common in parotid gland where more than 80% of these are benign.

The diagnosis starts with clinical exam during which I examine your jaw, neck and throat for lumps or swelling and test to see that nerves in that area is working normally. If I can feel a swelling than we will usually collect a sample of tissue (biopsy) for laboratory testing by pathologists. For the biopsy in the clinic we insert a needle into the lump and draw out fluid or cells, occasionally while doing an ultrasound. This is vital to know what type of tumour you have as that has an impact on treatment.

Subsequently it is usual to get animaging test, such as magnetic resonance imaging (MRI), computerized tomography (CT) or to help determine the size, location and nature of your salivary gland tumour.

Treatment for salivary gland cancer depends on the type, size and stage of salivary gland cancer you have, as well as your overall health and your preferences. Salivary gland cancer treatment usually involves surgery, with or without radiation therapy.

Surgery

Surgery for salivary gland cancer may include:

  • Removing a portion of the affected salivary gland. If your tumour is small and located in an easy-to-access spot, I may remove the tumor and a small portion of healthy tissue that surrounds it. This is called partial or superficial Parotidectomy for surgery on parotid tumour.
  • Removing the entire salivary gland. If you have a cancer, I may need to remove the entire salivary gland. If your cancer extends into nearby structures — such as the facial nerves, the ducts that connect your salivary glands, facial bones and skin — these also may be removed.
  • Removing lymph nodes in your neck. If there's evidence that cancer has spread to the lymph nodes in your neck, I may have to remove the lymph nodes in your neck (neck dissection). Neck dissection may involve removal of other muscles and nerves in your neck, as well.
  • Reconstructive surgery. If bone, skin or nerves are removed during your surgery, these may need to be repaired or replaced with reconstructive surgery. During reconstructive surgery, I repair tissue to improve your ability to chew, swallow, speak or breathe after surgery. You may need grafts of skin, tissue or nerves from other parts of your body to rebuild areas in your mouth, throat or jaw.

Salivary gland surgery can be difficult because several important nerves are located in and around the glands. For example, a nerve in the face (Facial Nerve) that controls facial movement runs through the parotid gland. Similarly the nerve supplying power to the corner of your mouth (marginal mandibular nerve) runs over the submandibular gland and the nerve that provides sensation to your tongue (Lingual nerve) runs close to your sublingual salivary gland. Removing tumors involving these glands thus carries the risk of damaging these nerves.

Radiation therapy

Radiation therapy can be used after surgery to kill any cancer cells that might remain. If surgery isn't possible because a tumor is very large or is located in a place that makes removal too risky, radiation alone may be used to treat salivary gland cancer. Radiation therapy uses high-powered X-rays to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing high-powered beams at specific points on your body.

Chemotherapy

Chemotherapy is NOT currently used as a standard treatment for salivary gland cancer as none of the medicine have shown significant effect against this cancer.

Even though pleomorphic adenoma is benign, I commonly advise surgery if you are medically fit and willing because

  • These tumours never go away by themselves but continue to grow causing facial deformity. Larger size tumours can also make surgery more difficult and lead to higher risk of injury to your facial nerve
  • Studies have shown a small risk of change to malignant tumour (cancer) if these tumours are left for long, usually for more than 10 years and the risk increase with every passing year there after.
  • There is always a concern that the biopsy report or scan may be inaccurate. Removing the tumour with an operation gives us a 100% accurate diagnosis.

This depends on the type of your tumour. For benign tumour, usually no follow-up is required. However for malignant tumours, cancer, I recommend a life long follow-up as some of these are notorious for recurring even after many years following treatment. Follow-up visit includes clinical examination for any lump and may require CT/MRI/PET scan if there is clinical suspicion.

Many good surgeons offer high quality salivary gland surgery across India. Your chances of cure and complication from operation are heavily influenced by the expertise and skills of your surgeon. Cancer of salivary gland are relatively rare and therefore it is important that you get treatment from someone who has experience in their management. An incomplete surgery where part of the tumour may be left behind will lead to worse cancer outcome due to higher chance of the cancer coming back. It is also a huge problem even if you have the benign pleomorphic adenoma, as this will come back in future, usually as multiple tumours all over the salivary gland. This is a very difficult condition to remove completely by surgery and carries a tremendous risk of injury to the important nerves nearby. In addition the risk of injury to the nerve nearby is also higher in hands of less experienced surgeons.

By choosing me as your surgeon, you will be choosing someone who has extensive experience in the highest quality salivary gland surgery in the best centers of UK, USA and Australia. I can ensure good quality operation with minimal risk of complications. The difference is in quality. You have one body and it deserves the very best.

In addition, I can also offer reconstructive plastic surgery, if required, ranging from repair of skin, bone to nerve. In addition, I have experience in procedures such as face lift, repair of drooping eye lid etc that can result from sacrificing the facial nerve in case of advanced cancer. You can follow this link to learn more about facial reconstructive surgery that I offer.

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