1. Most parotid masses represent benign neoplasms, most commonly pleomorphic adenoma, originating from the superficial lobe of the gland. In this clinical scenario, surgical excision is usually all that is required to provide both definitive diagnosis and adequate treatment.

2. FNAB is helpful in treatment planning for patients presenting with parotid masses. The accuracy of this technique depends on sample adequacy, tumor cellularity, and the experience of the cytopathologist.

3. The routine use of imaging in small well-defined masses of the superficial lobe of the parotid gland is probably not warranted. However, tumors presenting with clinical findings suggestive of malignancy, tumors arising from the deep lobe of the parotid gland, or tumors extending to the parapharyn-geal space are better evaluated with high-resolution imaging.

4. During parotid gland surgery for excision of malignant tumors the facial nerve is usually dissected and preserved, unless there is evidence of gross invasion or microscopic infiltration of the nerve by tumor, or there was evidence of preoperative facial weakness or paralysis.

5. The incidence of occult nodal metastasis in patients with large and/or high-grade malignant tumors is relatively high; therefore, an elective neck dissection should be considered in these patients.

6. Postoperative radiation therapy is generally recommended for patients with poor prognostic indicators including highgrade tumors, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins.

7. Fast-neutron radiotherapy is a promising treatment option for patients with inoperable primary or recurrent malignant salivary gland tumors.


Hanna and Suen—CHAPTER 66

1. Orell SR. Diagnostic difficulties in the interpretation of fine needle aspirates of salivary gland lesions: the problem revisited. Cytopathology 1995;6:285-300

2. Candel A, Gattuso P, Reddy V, Matz G, Castelli M. Is fine needle aspiration biopsy of salivary gland masses really necessary? Ear Nose Throat J 1993;72:485-489

3. Roland NJ, Caslin AW, Smith PA, et al. Fine needle aspiration cytology of salivary gland lesions reported immediately in a head and neck clinic. J Laryngol Otol 1993;107: 1025-1028

4. Bhatia A. Fine needle aspiration cytology in the diagnosis of mass lesions of the salivary gland. Indian J Cancer 1993;30:26-30

5. Chan MK, McGuire LJ, King W, et al. Cytodiagnosis of 112 salivary gland lesions. Correlation with histologic and frozen section diagnosis. Acta Cytol 1992;36:353-363

6. Abad MM, G-Macias C, Alonso MJ, et al. Statistical evaluation of the predictive power of fine needle aspiration (FNA) of salivary glands. Results and cytohistological correlation. Path Res Pract 1992;188:340-343

7. Pitts DB, Hilsinger RL Jr, Karandy E, et al. Fine-needle aspiration in the diagnosis of salivary gland disorders in the community hospital setting. Arch Otolaryngol Head Neck Surg 1992;118:479-482

8. MacLeod CB, Frable WJ. Fine-needle aspiration biopsy of the salivary gland: problem cases. Diagn Cytopathol 1993;9:216-224; discussion 224-225

9. Heller KS, Dubner S, Chess Q, et al. Value of fine needle aspiration biopsy of salivary gland masses in clinical decision-making. Am J Surg 1992;164:667-670

10. Higashi T, Shindo J, Everhart FR, et al. Technetium-99m pertechnetate and gallium-67 imaging in salivary gland disease. Clin NuclMed 1989;14:504-514

11. Gritzman N. Sonography of the salivary glands. Am J Roentgenol 1989; 153:161-155

12. Heller KS. Salivary gland cancer-diagnostic evaluation. In: Johnson JT, Didolkar, eds. Head and Neck Cancer. Vol III. New York: Elsevier Science; 1993;589-594

13. Kaneda T, Minami M, Ozawa K, et al. Imaging tumors of the minor salivary glands. Oral Surg Oral Med Oral Path 1994;78: 385-390

14. Hanna E, Janecka I. Perineural spread in head and neck and skull base cancer. Crit Rev Neurosurg 1994;4:109-115

15. Ajayi BA, Pugh ND, Carolan G, et al. Salivary gland tumours: is colour Doppler imaging of added value in their preoperative assessment? Eur J Surg Oncol 1992;18:463-468

16. Martinoli C, Derchi LE, Solbiati L, et al. Color Doppler sonography of salivary glands. Am J Roentgenol 1994;163:933-941

17. Keyes JW Jr, Harkness BA, Greven KM, et al. Salivary gland tumors: pretherapy evaluation with PET. Radiology 1994; 192:99-102

18. Hanna E, Suen JY. Neoplasms of the salivary glands. In: Cummings CW, Fredrickson JM, Harker LA, Kraus CJ, Schuller DE, Richardson MA, eds. Otolaryngology-Head and Neck Surgery. Vol II. 3rd Ed. St. Louis, MO: CV Mosby; 1998; 1255-1302

19. Woods JE. The facial nerve in parotid malignancy. Am J Surg 1983;146:493-496

20. Woods JE, Chong GC, Beahrs OH. Experience with 1,360 primary parotid tumors. Am J Surg 1975;130:460-462

21. Armstrong JG, Harrison LB, Thaler HT, et al. The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer 1992;69:615-619

22. Rodriguez-Cuevas S, Labastida S, Baena L, et al. Risk of nodal metastases from malignant salivary gland tumors related to tumor size and grade of malignancy. Eur Arch Oto Rhinol Laryngol 1995;252:139-142

23. Theriault C, Fitzpatrick PJ. Malignant parotid tumors: prognostic factors and optimum treatment. Am J Clin Oncol 1986; 9:510-516

24. Borthne A, Kjellevold K, Kaalhus O, et al. Salivary gland malignant neoplasms: treatment and prognosis. Int J Radiat Oncol Biol Phys 1986;12:747-754

25. Sakata K, Aoki Y, Karasawa K, et al. Radiation therapy for patients of malignant salivary gland tumors with positive surgical margins. Strahlenther und Onkol 1994;170: 342-346

26. Shingaki S, Ohtake K, Nomura T, et al. The role of radiotherapy in the management of salivary gland carcinomas. J Craniomaxillofac Surg 1992;20:220-224

27. Stelzer KJ, Laramore GE, Griffin TW, et al. Fast neutron radiotherapy. The University of Washington experience. Acta Oncol 1994;33:275-280

28. Koh W, Laramore G, Griffin T, et al. Fast neutron radiation for inoperable and recurrent salivary gland cancers. Am J Clin Oncol 1989;12:316-319

29. Saroja KR, Mansell J, Hendrickson FR, et al. An update on malignant salivary gland tumors treated with neutrons at Fer-milab. Int JRadiat OncolBiolPhys 1987;13:1319-1325

30. Catterall M, Errington RD. The implications of improved treatment of malignant salivary gland tumors by fast neutron radiotherapy. Int J Radiat Oncol Biol Phys 1987;13: 1313-1318

31. Henry LW, Blasko JC, Griffin TW, et al. Evolution of fast neutron teletherapy for advanced carcinomas of the major salivary glands. Cancer 1979;44:814-818

32. Laramore GE: Fast neutron radiotherapy for inoperable salivary gland tumors: is it the treatment of choice? Int J Radiat Oncol Biol Phys 1987;13:1421-1423

33. Buchholz TA, Laramore GE, Griffin BR, et al. The role of fast neutron radiation therapy in the management of advanced salivary gland malignant neoplasms. Cancer 1992; 69:2779-2788

34. Wang CC, Goodman M. Photon irradiation of unresectable carcinomas of salivary glands. Int J Radiat Oncol Biol Phys 1991;21:569-576

35. Laramore GE, Krall JM, Griffin TW, et al. Neutron versus photon irradiation for unresectable salivary gland tumors: final report of an RTOG-MRC randomized clinical trial. Int J Radiat Oncol Biol Phys 1993;27:235-240

0 0

Post a comment