Hello georgeraven,
If it is you who has a benign salivary gland tumor, you and I have
something in common! I had my parotid gland removed some years ago
(pre-Internet) for a benign parotid tumor, and even though over 2,500
cases a year are diagnosed, I have never seen another patient with
this condition! (I?m in the health care field) I hope you will find
reading some of my own anecdotal experiences helpful, as well as the
researched information.
You didn?t say exactly to which salivary gland you were referring, so
most of my answer will center on the parotid gland, as over 80% of
salivary gland tumors affect the parotid. The major salivary glands
are the parotid, submandibular, and sublingual. Smaller salivary
glands are somewhat scattered around the palate, lip, pharynx,
nasopharynx, larynx, parapharyngeal space, and are not often affected
by neoplasms (tumors). The parotids are the largest of the three
major salivary glands, which produce the saliva necessary to moisten
food while chewing, and jump-starting the digestive process. Parotid
tumors usually are located in the tail section of the gland,are very
slow growing, but can grow as large as a baseball, if left unattended.
Of all parotid tumors, about 75% are benign, occurring more often in
women, and Caucasians.
http://www.entnet.org/healthinfo/throat/salivary.cfm
Pleomorphic adenoma is the medical name for a benign salivary gland
tumor. A few surgeons will perform a needle biopsy to detect any
malignancy, and remove just the tumor is it is benign. However, even
though most salivary gland tumors are benign, in general, surgeons
prefer to skip the biopsy, and prophylactically remove the tumor along
with the entire parotid gland and lymph nodes in the neck This
greatly reduces the risk of any tissue becoming malignant in the
future.
http://www.emedicine.com/plastic/topic371.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001040.htm
See an illustration of the parotid gland:
http://yalenewhavenhealth.org/hwdb/images/hwstd/medical/otolaryn/n5551288.jpg
See an illustration of the major salivary glands:
http://www.waycross.edu/faculty/gcook/anatomy/alimentary/major%20salivary%20glands.jpg
Treatment:
I?m afraid the only real option you have is surgery. Since the tumor
is non-malignant, chemotherapy and/or radiation would not be of any
help, and could actually harm your salivary glands.
?Surgical excision is the preferred treatment, with superficial or
total parotidectomy depending on the stage and histology of the tumor.
Small low-grade tumors are treated with a superficial parotidectomy
when possible. Neck dissection should be considered when evaluating
node positive disease. A locally invasive tumor may require resection
of the facial nerve, skull base, or mandible.?
http://www.emedicine.com/radio/topic530.htm
?Surgical removal of the tumor is the standard treatment option
whether the growth is a benign parotid gland tumor or a malignant
cancer. Radiation therapy is used if the tumor is large or if the
cancer returns after initial treatment. Radiation therapy carries the
risk of permanently damaging salivary glands.?
http://www.salivary-glands-disease.com/html/salivary-gland-tumors.php3
?Surgical removal is always the management choice, with attention to
the preservation of the facial nerve in benign tumors and of the
parotid gland in malignant tumors when no evidence of neural invasion
is observed. When direct invasion is present, sacrificing the facial
nerve and immediate nerve grafting is commonplace.
Surgical removal of the submandibular gland exposes the lingual and
hypoglossal nerves to potential injury. The mandibular branch of the
facial nerve could also be in jeopardy because of anatomical
proximity.
Contraindications: Experienced clinicians agree that surgical excision
is indicated for all patients in whom a parotid or salivary gland
enlargement develops, unless associated medical problems preclude
general anesthesia.?
http://www.emedicine.com/med/topic2789.htm
http://www.marshfieldclinic.org/cattails/01/sepoct/tumors.asp
If you have a benign salivary gland tumor, I urge you to have it
surgically removed and not wait. Although it is unusual for a benign
tumor to become malignant, it *can* happen.
?Very rarely, benign tumors may become malignant if left untreated for
a long period of time or if they are not completely removed and recur
(grow back) several times.?
http://health.yahoo.com/health/cancer_center/acs_crc/salivary_gland/
Here is a photo of a surgical scar left from a parotidectomy. The size
of the scar depends too, on the size of the tumor. (My scar is
significantly longer, and many people have asked me, upon catching a
glimpse of the scar, if I had had my throat slit at one time!)
http://patientsforum.com/johnpics/afterparotidgland4a.jpg
You can see some photos of patients with benign parotid tumors here:
http://www.ghorayeb.com/PleomorphicAdenoma.html
http://members.tripod.com/~medicalmissions/vnam98/vn98202a.jpg
Warthin tumor, which accounts for about 6% of parotid tumors, is
another form of salivary gland tumor that seems to occur more often
in older Caucasian men, men who smoke, and sometimes occurs on both
sides of the face. Graphic images on this page!
http://www.ghorayeb.com/WarthinsTumor.html
http://www.sma.org/smj/97apr11.htm
?Warthin's tumor is a benign neoplasm of the salivary glands. An older
name is papillary cystadenoma lymphomatosum. It accounts for 4-15% of
salivary gland neoplasms and is more common in men during their 6-7th
decades. It almost exclusively occurs in the parotid gland and
bilateral or multifocal tumors. The tumors present as a painless
swelling, usually within the lower portion of the salivary gland.?
http://www.thedoctorsdoctor.com/diseases/warthinstumor.htm
Cautions:
Two things can occur, although rarely, to people who have a
parotidectomy, surgical removal of the parotid gland: Bell?s Palsy and
gustatory sweating.
Bell?s palsy is an irritation of the seventh cranial nerve, and in
conjunction with a parotid tumor, is due to surgical trauma. This may
cause a bit of facial paralysis, giving the appearance that you have
had a stroke. You may have trouble smiling, closing your mouth on the
affected side, winking and opening your eye. Within a few weeks to
several months this will fade however.
http://www.entnet.org/healthinfo/topics/bells.cfm
http://www.neurologychannel.com/bellspalsy/
??Transient facial nerve paralysis (paresis) takes few weeks to
spontaneously resolve but can last as long as 6 months. Direct trauma
to the nerve, devascularization, or postoperative nerve inflammation
is believed to cause paresis.?
http://www.emedicine.com/med/topic2789.htm
About 5% of people who have had a parotidectomy will also develop
?gustatory? sweating after surgery. This means that the part of the
face, where the parotid gland had previously been, will become
reddened and sweat when eating! This is a small annoyance, and should
it happen to you, you will learn to automatically wipe your cheek, as
well as your mouth, when eating. (This is one of the side effects that
happened to me, and sometimes, when eating a food that requires a lot
of chewing, the left side of my face will drip into my lap, or onto
the table if I don?t remember to blot often enough!)
The good news is that the surgery will NOT cause dry mouth or
chewing/eating problems, once you are fully recovered.
?Gustatory sweating results from a disruption of the auriculotemporal
nerve pathways. Damage to the nerve or its branches may cause a
misdirected re-growth that results in parasympathetic innervation of
sympathetic receptors.
Following the re-growth period,patients may report that gustatory
stimulation leads to episodes of facial sweating and flushing?
http://www.neurology.ufl.edu/Publications/Okun/frey.pdf
?Frey syndrome is a known complication after parotidectomy, and
manifestations range from erythema related to eating to copious
gustatory sweating. The cause is believed to be aberrant connection of
the parasympathetic fibers to the sweat gland of the overlying flap of
skin. To minimize the chance of the patient developing postoperative
Frey syndrome, raise a thick parotid flap just above the parotid
fascia.?
http://www.emedicine.com/med/topic2789.htm
http://www.medterms.com/script/main/art.asp?articlekey=9270
One of the first recorded incidences of gustatory sweating occurred
to a small boy who had a puncture wound to the cheek, in 1757. ?He
reported peculiar
symptoms: ?Every time he chews his food, a transudation of clear
droplets started to emerge on the skin that covers the face . . . it
is evident that the liquid was the saliva that came through the skin
since its natural pathway (Stenson?s duct) has been damaged by the
injury?
One would expect that folks over 200 years ago would assume this
?transudation of clear droplets? to be saliva, and I myself thought so
too, at first. When I first noticed I had a wet cheek from eating, I
happened to be at work, in a hospital. I swabbed my face with a Dacron
swab and ran an amylase test on it. (Amylase is an enzyme found in
large quantities in saliva). I was completely surprised that there was
no amylase present, as this meant the liquid was not saliva! On my
next checkup, I asked the surgeon about it, and was told me the
?droplets? were composed of sweat, and not saliva! Hence the name
?Gustatory Sweating? and not ?Gustatory Drooling?!
http://www.neurology.ufl.edu/Publications/Okun/frey.pdf
A personal account, a man named John gives a very detailed account of
his surgery on this Patients Forum site:
http://patientsforum.com/JohnStory.htm
I hope this clears things up for you, georgeraven. I realize this may
not be the answer you were hoping for, but surgery is still considered
the treatment of choice.
If this answer is unclear in any way, please request an Answer
Clarification, before rating. This will allow me to assist you
further, if possible. I wish you the best!
Sincerely,
crabcakes
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Salivary gland tumor
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