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Otorinolaringologia 2016 September;66(3):75- 92

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

The current management of primary epithelial salivary gland neoplasms

Patrick J. BRADLEY

Department of Head and Neck Oncologic Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, England, UK

Diagnosis and management of primary epithelial salivary gland neoplasms can be a challenge to the trainee and the generalist surgeons. These neoplasms are classified as benign and malignant, with the majority of neoplasms presenting as a slowly growing asymptomatic mass. Signs such as pain, ulceration, nerve palsy, bleeding are extremely rare, and the diagnosis of malignancy needs to be excluded rather than an assumption that the lesion is benign. The prevalence is rare and the frequency of benign neoplasms is 5 to 7 times more frequent than the malignant. The current histologic classification declares that there are 10 benign and 24 malignant epithelial salivary neoplasms. Surgery is the treatment of choice following diagnostic evaluation, employing tissue biopsy (fine needle biopsy or core tissue biopsy) and imaging to allow for tumor staging. Surgery for benign neoplasms is complete tumor margin-free excision, whereas with malignant neoplasms a wider tumor margin-free excision is required, with consideration to treatment of the draining lymph node levels. Many of the malignant salivary neoplasms are of the high-grade and the potential for loco-regional recurrence and risk of distant metastases can be minimized by radiotherapy following primary surgical management. Over the past decade, the surgical techniques used are classed as minimal invasive surgery, using extracapsular excision for selected benign neoplasms, and endoscopic robotic surgery for sub-mucosal located malignant neoplasms. There is great expectation that with identification of molecular and genetic markers that more effective chemotherapy and novel agents can be used selectively for specific malignant neoplasms.