SURGICAL APPROACH AND OUTCOMES IN SALIVARY GLAND SWELLING

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Introduction: Salivary gland tumours are rare tumours and majority of these are benign and about 20% are malignant. The incidence of salivary gland cancers ranges from 0.5 to 2 per 100,000 in different parts of the world. Salivary gland swellings in the parotid or submandibular glands usually present as an enlarging mass and may be associated with neurological symptoms like facial nerve paralysis or pain. Minor salivary gland tumours present as a submucosal intraoral mass which subsequently ulcerates. Acute inflammatory conditions generally can be diagnosed by history and physical examination alone, whereas chronic inflammatory diseases and granulomatous disorders require supplemental diagnostic information including lab tests, imaging studies and biopsy. FNAC of salivary gland tumours is advantageous to both the patient and the clinician because of its immediate results, accuracy, lack of complications and economy. Appropriate therapeutic management may be planned earlier, whether it is local excision for a benign neoplasm, radical surgery for a malignant one or any other alternate treatment.
 Material and Methods: All patients admitted to surgical wards due to obstructions of the salivary duct and neoplasia were included in the study. Demographic data from all the patients were collected, also they were evaluated for clinical examination, routine laboratory investigations and specific investigations. After evaluation of the swellings by clinical examination and by specific investigations, a surgical plan was formulated. The final decision was taken by the operative surgeon.
 Results: 40 cases of salivary gland swellings were admitted during study period. Age of the patients varied from 9 years to 80 years. 62.5% (25 cases) were found in the parotid gland, 30% cases (12) in submandibular gland and 7.5% cases (3) in the sublingual gland. Surgery was the treatment for all cases of tumors. Superficial parotidectomy was done in all the 21 cases of parotid tumour (56.41%) without deep lobe involvement and total parotidectomy was done in 3 cases (7.6%) with deep lobe involvement. In all the cases of submandibular gland lesions, excision of submandibular gland was done. Excision of the sublingual gland was done in 3 cases of ranula. One case of adenoid cystic cacinoma was referred to higher center because of the advanced malignancy.
 Conclusion: Salivary gland tumors occur more commonly in the parotid gland, most often benign, pleomorphic adenoma constitute majority of all neoplasm. Surgery is the main modality of treatment in salivary gland sialolithiasis. Most commonly done surgery is excision of submandibular salivary gland & superficial parotidectomy and also for salivary gland tumors. Awareness and early referral is necessary, as prognosis is good if treated early.
 Keywords: SALIVARY GLAND, TUMOUR, NEOPLASM, SURGERY