Carcinoma Of Minor Salivary Glands Research Articles

Radiation therapy for minor salivary gland carcinoma

To analyze the outcomes of patients treated for minor salivary gland carcinoma with radiotherapy (RT), either alone or combined with surgery. Retrospective review. Between September 1966 and December 2006, 140 patients were treated with curative intent at our institution for previously untreated minor salivary gland carcinomas (RT alone, 64 patients; combined RT and surgery, 76 patients). Median follow-up for all patients was 5.5 years. The 10-year local control rate was 66%, and multivariate analysis revealed that treatment group (P = .0004) and T stage (P = .0001) significantly influenced this endpoint. Patients treated with RT alone had a lower local control rate than patients treated with RT and surgery. The 10-year local-regional control rate was 61%, and multivariate analysis revealed that treatment group (P = .0174), overall stage (P = .0004), and N stage (P = .0492) significantly influenced this endpoint. The 10-year distant metastasis-free survival rate was 67%, and multivariate analysis revealed that overall stage (P = .0016) significantly influenced this endpoint. The 10-year cause-specific survival rate was 56%, and multivariate analysis revealed that overall stage (P < .0001) significantly influenced this endpoint. The 10-year overall survival rate was 45%, and multivariate analysis revealed that overall stage (P = .0047), N stage (P = .0173), and nerve invasion (P = .0409) significantly influenced this endpoint. Most patients with minor salivary gland carcinoma were cured with RT alone or combined with surgery. Treatment group, T stage, and overall stage significantly influenced the probability of cure. Patients treated with combined surgery and RT had a better prognosis, perhaps due in part to selection bias.

Minor salivary gland carcinomas of oral cavity and oropharynx

This paper reviews 22 cases of minor salivary gland carcinoma of the oral cavity or oropharynx which were treated at Kurume University Hospital between 1976 and 2005. Minor salivary gland carcinoma was observed in eight of 362 patients with cancer of the oral cavity (2 per cent), and in 14 of 275 patients with cancer of the oropharynx (5 per cent). The five-year and 10-year survival rates of patients with oropharyngeal minor salivary gland carcinoma were 90 per cent. No statistically significant difference was observed between survival rates for oropharyngeal minor salivary gland carcinoma and for oropharyngeal squamous cell carcinoma (p = 0.06). The five- and 10-year survival rates of patients with oral cavity minor salivary gland carcinoma were 75 and 37 per cent, respectively. No statistically significant difference was observed between survival rates for oral cavity minor salivary gland carcinoma and oral cavity squamous cell carcinoma.Patients' survival results correlated well with the clinical stage of their lesions. A significant difference in survival was observed, comparing stage IV with stages I, II and III (p = 0.04). In contrast, no significant relationship was found between either survival and tumour type or survival and treatment. Adjuvant therapy is recommended for patients with grade III adenoid cystic carcinoma with perineural infiltration or intravascular infiltration.

Response to Oxaliplatin with Cetuximab in Minor Salivary Gland Adenoid Cystic Carcinoma

Esophageal localization of adenoid cystic carcinoma of minor salivary glands is rare; it may occur in the early to mid-sixties' age group and is more frequently encountered in men than women. In the majority of cases, it arises from subepithelial glands of the middle to lower third of the esophagus, a similar distribution as squamous cell carcinoma. Prognosis depends mostly on tumor staging and resectability, which represents the only chance of cure. Due to the extreme rarity of this condition, there is limited experience with systemic therapy for advanced disease. We report a case of a patient with metastatic primary esophageal adenoid cystic carcinoma progressing on platinum- and irinotecan-based regimens, who achieved an objective response with oxaliplatin-based chemotherapy in combination with cetuximab.

Advanced malignant minor salivary glands tumors of the oral cavity

Intraoral minor salivary gland carcinomas (MSGC) are rare tumors with different frequency, distribution, and prognostic factors relating to overall survival. From 1992 to 2006, a total of 95 patients with MSGC originating in the oral cavity were analyzed by univariate and multivariate analysis using the log-rank test and Cox-regression. Fifty-four percent of all patients had a low-grade disease and 46% had a high grade disease. The 2-, 5-, and 10-year overall survivals were 82%, 73%, and 58%, respectively. The T (P = .007), N category (P = .010), UICC stage (P = .021), and resection margin status (P < .0001) statistically influenced survival, whereas the M status did not (P = .16). Salvage treatment influenced the patients' overall survival significantly (P < .0001). This study confirms that in MSGC salvage surgery and tumor stage correlates well with prognosis. More studies are necessary to confirm prognostic factors and determine the true frequency of MSGC in the oral cavity.

Patterns and Incidence of Neural Invasion in Patients With Cancers of the Paranasal Sinuses

To characterize the incidence and pattern of neural invasion (NI) in patients with cancers of the paranasal sinuses and anterior skull base. Retrospective study. A tertiary referral cancer center. The study included 208 patients with cancer of the paranasal sinuses. Patients with brain invasion or neurogenic tumors were excluded. Analysis of clinical and pathologic data on patients with cancer of the paranasal sinuses. Forty-one specimens (20%) had evidence of NI. Sinonasal undifferentiated, adenoid cystic, and squamous cell carcinoma had a high propensity for NI, whereas melanoma and sarcoma rarely invaded nerves. Intraneural invasion was found in 32% of these cases, and 34% invaded more than 1 cm distal to the tumor. Neural invasion was associated with a high rate of positive margins, maxillary origin, and previous surgical treatment (P < .04) but not with stage, orbital invasion, or dural invasion. Patients with NI were more likely to undergo adjuvant radiotherapy (P = .003), which significantly improved survival in patients with minor salivary gland carcinomas (P = .04). Multivariate analysis showed that pathologic evidence of NI was not an independent predictor of outcome. Paranasal carcinomas have high propensity for NI, whereas melanoma and sarcoma rarely invade nerves. Patterns of NI include both perineural and intraneural invasion. Neural invasion is associated with positive margins, maxillary origin, and previous surgery.

The role of bronchoscopy and gastroscopy in intraoral minor salivary gland carcinomas at initial staging

Intraoral minor salivary gland carcinomas are rare tumours the incidence, distribution, and prognostic factors of which differ. The prognosis of patients depends on the presence of metastases or synchronous malignant diseases that usually affect the lungs. The incidence of metastases has been reported to be about 9% at the time of primary staging. The aim of this study was to assess the value of bronchoscopy and gastroscopy in the routine staging of minor salivary gland cancers. We retrospectively reviewed the casenotes of 95 patients who had presented with newly diagnosed intraoral minor salivary gland carcinomas. Data were collected about abnormalities detected during endoscopic screening; a biopsy was taken if reasonable and if the resulting diagnosis influenced the planned treatment. Thirty-eight patients with abnormalities were detected (40%); 31 diagnoses were confirmed by bronchoscopy and 44 by gastroscopy. Bronchoscopy confirmed a total of 6 malignancies: 4 were synchronous carcinomas of the lung and 2 metastases of the primary tumour. One oesophageal cancer was detected by gastroscopy. The proposed treatment was affected in five of these seven. For therapeutic, diagnostic, and prognostic reasons bronchoscopy and gastroscopy should be included routinely into staging of intraoral minor salivary gland carcinomas.

Malignant minor salivary gland tumors of the larynx

To study the clinical features, treatment and prognosis of malignant minor salivary gland tumors of the larynx. Treatment and outcome were retrospectively analyzed in a consecutive series of 15 patients with malignant minor salivary gland tumors of the larynx treated in this hospital from 1959 to 2005. Ten patients (66.7%) had adenoid cystic carcinoma and 2 (13.3%) had adenocarcinoma. The other three patients had mucoepidermoid carcinomas, polymorphic adenocarcinoma and base cell carcinoma respectively. Eleven (73.3%) were located in the supraglottis and 4 (26.7%) in the subglottis. Fourteen had surgery (7 with adjuvant radiotherapy) and one was treated with radiotherapy plus chemotherapy. Five patients were found to have recurrent disease, 4 of whom underwent salvage surgery, 1 of whom had palliation radiotherapy. With a median follow-up of 8 years (ranging from 2 to 16 years), 7 patients are alive. Five patients have no evidence of disease, 1 of whom had surgery alone, 4 of whom were treated with surgery plus radiotherapy. Four patients died of distant metastases in a range of 2 to 10 years. The other 4 patients were lost to follow-up after treatment (ranging from 2 years to 16 years). Seven patients developed recurrent disease, 1 of whom had local recurrence alone, 1 had regional recurrence alone, 2 had distant metastases alone, and 3 had local and distant metastases. Minor salivary gland carcinomas of the larynx are rare and they are prone to the local recurrence and the distant metastasis in advanced stage. Distant metastases remain the principal cause of treatment failure. Surgery is the primary treatment modality used in most cases and the radiotherapy combining surgery has better local and regional control rate.

Adenoid cystic carcinoma of intraoral minor salivary glands

We present a retrospective multicentric study of 67 patients with adenoid cystic carcinomas of the intraoral minor salivary glands, who were diagnosed and treated between 1986 and 2004 in the Operative Units of Maxillofacial Surgery of the University of Parma and of the Bellaria Hospital in Bologna. There were 28 males and 39 females with a mean age of 54.5 years (range 28-84 years). The palate was the most common site of involvement, with 71.6% of cases. All the patients were treated with surgery as the primary modality. Neck dissection was performed in 9% of the patients, and more than half (59.7%) were treated with adjuvant radiation therapy. All surviving patients had a minimum of 2 years follow-up, with a range of 2-20 years (median: 12 years). Of the 67 patients examined in this study, 19 were dead at the end of the follow-up, 16 of them due to tumor disease. Distant or loco-regional recurrence was documented in 29 of the 67 patients (43.3%). Disease-free intervals ranged from 1 month to 12 years. Twenty-two percent of patients had loco-regional failure, whereas 29.8% had distant metastases. The disease specific survival rates were 76.1% at 5 years and 74% at 10 and 15 years.The actuarial loco-regional control rates at 5-, 10- and 15-years were 79.7%, 74.8% and 70%, respectively. The actuarial freedom from distant relapse was 76.5% at 5 years, 64.9% at 10 years and 61.1% at 15 years. Stage T, cervical lymph node metastasis and surgical margin status proved to make a statistically significant contribution when describing the outcome.

Malignant tumors of intraoral minor salivary glands

Between 1995 and 2004, 43 patients with intraoral minor salivary gland carcinomas were diagnosed and treated at the Department of Maxillofacial Surgery, University of Parma, Italy. The palate was the most common site of involvement and comprised 53.5% of the cases. Adenoid cystic carcinoma was the most common histological type (60.6%), followed by mucoepidermoid carcinoma (27.9%). All patients were treated with surgery as the primary modality. Neck dissection was performed in 20.9% of patients, and more than half (72.1%) were treated with adjuvant radiation therapy. The range of the follow-up was 24-132 months (mean: 66 months). Of the 43 patients examined in this study, 12 died due to the tumor. Treatment failure was documented in 18 of the 43 patients (41.9%). Disease-free intervals ranged from 1 month to 9 years and 13.9% of the patients had local failure, whereas 25,6% had distant metastases. The survival rates at 2, 5, and 10 years were 90.7%, 71.8%, and 68%, respectively. The local control rates were 93.1% at 2 years and 83.1% at 5 and 10 years. The 2-, 5-, and 10-year rates for freedom from distant relapse were 95.2%, 83.4%, and 57.5%, respectively. The T stage, cervical lymph node metastasis, surgical margin status and perineural invasion were statistically significant to the outcome.

Skull base surgery: the first 50 years

It is nearly 50 years ago that Alfred Ketcham started his work on developing an operation for surgical removal of malignant tumors of the paranasal sinuses transgressing the anterior skull base. His Wrst report in 1963 opened the doors for modern day skull base surgery for malignant tumors involving the skull base [1]. Over the course of the past 40 years, tremendous advances in diagnostic imaging, neuronavigation and the development of technical instrumentation as well as operating microscopes and endoscopic equipment has revolutionized the surgical approach to neoplastic diseases transgressing the skull base. Numerous investigators from all parts of the world have reported signiWcant experience with the surgical technique. Five-year, disease-speciWc, survival rates in the range of 60% are reported by most investigators. In spite of the tremendous amount of technical and technological advances, improvement in survivorship, however has not been reported in the last four decades. Due to a large variety of tumors arising in this location, no single author or institution has suYcient experience to produce meaningful outcomes data for the more commonly arising conditions in this region. Therefore, an international collaborative study with participation of 17 investigators was undertaken, accumulating over 1,500 craniofacial resections done for neoplastic diseases. Cumulative data from this large study again show a 5 year disease-speciWc survivorship of 60%. Histology of the tumor plays a great role in prognostication. Esthesioneuroblastomas, and low-grade sarcomas have the most favorable outcome with 5 year disease-speciWc survivorship exceeding 80%. On the other hand, poorly diVerentiated carcinomas, high-grade sarcomas and melanoma have the worst prognosis with a Wve-year survivorship of 20%. All other histologies such as minor salivary gland carcinomas, squamous cell carcinomas and sarcomas have approximately a 60% 5 year survivorship. In a multivariate analysis of factors aVecting outcome, in addition to histology, intracranial extent of tumor (invasion of dura or brain) and positive margins were independent prognostic parameters inXuencing outcome. These data have provided benchmark statistics for comparison of any individual series or techniques in the future [2]. In this issue of European Archives, three articles are presented covering three diVerent topics pertaining to skull base surgery. PJ Donald presents in detail the contraindications for skull base surgery for malignancy. He rightfully points out anatomical boundaries for a safe surgical resection, tumor factors and tumor biology as well as patient factors, which will inXuence the decision for a safe surgical conduct. While anatomical limits of resection will be largely dictated by the extent of the tumor and the biology of local progression of the tumor, technical expertise and experience of the surgeon is equally important in accurately deWning the limits of resection. A heroic operation may be technically feasible, but the biology of the tumor may defeat such an undertaking. Surgical safety, patient tolerance, reduction in morbidity and anticipated life expectancy are all factors that should be considered in making a decision regarding operability of the tumor. If palliation is the goal of the operation, clearly the morbidity of the operation should not exceed the anticipated beneWt. We must not forget the basic dictum in any surgical endeavor of “primum non-nocere”. J. P. Shah (&) E W Strong Chair in Head and Neck Oncology, Chief, Head and Neck Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA e-mail: shahj@mskcc.org

Adenoid Cystic Carcinoma of Minor Anterior Lingual Salivary Gland: Case Report and Review of the Literature

Adenoid cystic carcinoma arising from the anterior third of the tongue, especially from an anterior lingual salivary gland, is extremely rare. An 80-year-old Japanese woman with an adenoid cystic carcinoma arising from an anterior lingual gland is reported.

Extramammary Paget’s Disease of the Floor of Mouth Associated With Minor Salivary Gland Carcinoma and Concurrent Invasive Squamous Cell Carcinoma

fibrillary acidic protein, vimentin, epithelial membrane antigen, actin, and desmin, supporting myoepithelial differentiation. Subsequently, a wide local excision was performed, and the defect was reconstructed with a bone graft and a fixed dental prosthesis. The tumor recurred after 10 years, presenting as a 1-cm mass expanding into the maxillary labial vestibule, beneath the nasal ala. A second wide local resection was performed, and the defect was reconstructed with an obturator. Eleven years after the initial presentation of the tumor, the patient is alive without evidence of disease. This tumor represents the unusual occurrence of an intraosseous salivary gland neoplasm, apparently arising from salivary tissue within the incisive canal.

Mucoepidermoid carcinoma of minor salivary glands: a clinical study of 16 cases and review of the literature

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of salivary glands with a widely diverse biologic behavior that is correlated with the histological grade of the tumor. The purpose of this study was to evaluate the clinical outcomes of MEC of minor salivary glands in a group of 16 patients, who were treated in our clinic, and to discuss the management of this carcinoma. Between 1985 and 2000, 16 patients with MEC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the 'G. Papanikolaou' General Hospital, in Thessaloniki. The age range was 16-65 years. The distribution of the primary sites was: hard plate (one), soft palate (two), hard and soft palate (three), hard and soft palate with spread in paranasal sinus and nasal cavity (one), buccal mucosa (three), hard palate, alveolar process and buccal mucosa (two), and retromolar triangle (our). The tumors were clinically staged according to the tumor nodes metastase (TNM) system (Seifert, 1991). All patients were treated radically with surgery. The surgery was combined with radiotherapy in nine patients. Radiotherapy was delivered using Co-60. Doses ranged from 50 to 60 Gy and the duration of the therapy ranged from 25 to 35 days. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. The mean follow-up range was 4-14 years. From the 16 patients with MECs 10 (62.5%) were alive and five (35.6%) had died from the disease. Four patients were free of the disease for more than 5 years (range 8-14), five patients were free of the disease for 5 years and one patient was free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence developed in one patient 10 years after the initial treatment. Lymph node metastases occurred in one patient within the first year after the initial surgical treatment. Distant metastases (two in bones and one in lungs) occurred in three patients within 2 years after completing the treatment. The Pearson chi-square statistical analysis was used for comparing the Ki-67 values in correlation with histological grade of the tumors. The Ki-67 expression was only 1% in low-grade MECs, while in intermediate-grade tumors it was estimated between 3 and 4%. The high-grade tumors had increased expression (10%) of tumor cells. Complete surgical excision is the treatment of choice for MECs. Adequate excision is important in all grades of tumors. Prognosis of MECs is a function of the histological grade, adequacy of excision and clinical staging. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.

Management of Adenoid Cystic Carcinoma of Minor Salivary Glands

Adenoid cystic carcinoma (ACC) is a rare malignant tumor originating from the salivary glands. The characteristic clinicopathologic features of this tumor are perineural spread, local recurrences, and distant metastases. Radical surgery combined with radiotherapy, as mentioned in the literature, is the best method of treatment. This clinical review article is intended to analyze the outcome of management of a group of 22 ACC patients, who were treated in our clinic. Between 1985 and 2000, 22 patients with ACC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the "G. Papanikolaou" General Hospital, in Thessaloniki. The age range was 22 to 87 years. The distribution of the primary sites was buccal mucosa (3), floor of the mouth (1), hard palate (3), soft palate (2), junction of hard and soft palate (7), and hard or soft palate with spread in the paranasal sinus etc (6). All the patients were treated radically with surgery. The surgery was combined with radiotherapy in 17 patients. A total dose of 60 Gy in a 30- to 40-day period was given, using conventional 2 Gy fractions per day. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. The mean follow-up range was 4 to 14 years. From the 22 patients, 15 (68.18%) were alive for more than 5 years and 6 (27.7%) had died from the disease. Eight patients were free of the disease for more than 5 years (ranging from 7 to 14), 4 patients were free of the disease for 5 years, and 3 patients were free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence was developed in 2 patients. One recurrence occurred within the first year after the treatment and the second local recurrence occurred 13 years after the initial treatment. Lymph node metastases occurred in 2 patients, 3 years and 7 years after completing the treatment. Distant metastases (lung) occurred in 2 patients, 2 years and 6 years after completing the treatment. The Mann-Whitney statistical analysis was used for comparing the Ki-67 values in correlation with prognosis and location of ACCs. The Ki-67 value was significantly higher in tumors from patients with treatment failure than in nonfailures (P < .001). The Ki-67 expression was also higher in large tumors characterized by wide topical spread (P < .005). The most proper method of treatment for ACC seems to be radical resection combined with radiotherapy. The treatment failure is associated with positive margins of the excised surgical specimen and named nerve involvement. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.

Melanin bearing myoepithelial cells in a pigmented salivary gland carcinoma: a new avatar of myoepithelial cell? A case report

Melanocytes can be found in the stroma of salivary glands and their tumors. However, the presence of melanin pigment in the tumor cells of salivary gland origin is exceedingly rare. A 42-year-old man presented with a nasal tumor that was black in color. The histology was that of a minor salivary gland carcinoma with foci resembling an adenoid cystic carcinoma. The myoepithelial cells of this tumor contained melanin pigment. The possible histogenesis of this lesion and an explanation for the occurrence of melanin pigment in a salivary gland tumor are discussed.

Primary lymphoepithelioma-like carcinoma of minor salivary gland: A case report with immunohistochemical and in situ hybridization studies

Lymphoepithelioma-like carcinomas (LEC) of salivary glands represent rare epithelial malignancies, with most cases affecting the parotid gland. To our knowledge, there was only one LEC arising from the minor salivary gland described in the English-language literature. We report the second LEC of the minor salivary gland in the buccal area of a 50-year-old Taiwanese woman, who underwent surgical resection and adjuvant radiotherapy and remained alive and well after 120 months of follow-up. Histologically, irregular tumor nests of undifferentiated epithelial cells with syncytial cell boundaries were found embedded within rich lymphoplasmacytic stroma. The tumor cells also showed strong c-KIT expression and evidence of Epstein-Barr virus (EBV) infection. Our case suggests potential pathogenic implications of both c-KIT and EBV in LEC of the minor salivary gland that can be cured by the combination of surgery and radiotherapy and has a very favorable long-term prognosis.

Intraoral minor salivary gland tumors: a review of 75 cases in a Libyan population

Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection. During the period of 1977–2000 a group of 75 patients (31 males and 44 females, median age 44.2 years and range 15–86 years) with minor salivary gland tumors were diagnosed, based on the 1991 WHO classification. The peak occurrence of the tumors was in the fifth decade for males and sixth decade for females. The frequency of benign tumors was 38.6% ( n = 29) and malignant tumors 61.3% ( n = 46). Pleomorphic adenoma was the most common histological type of benign tumor identified whereas mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant tumors. The most common primary location of the tumors was the palate followed by the cheek. A benign tumor usually presented as an asymptomatic swelling and ulceration, pain being more frequently associated with the malignant tumors. This study shows that intraoral tumors of minor salivary glands vary widely in presentation, and should be taking into account by medical and dental practitioners in any differential diagnosis when assessing intraoral pathology. Any lesion arising from the hard palate (the most common site in this series) should be considered as a possible minor salivary gland tumor. Referral to a multidisciplinary head and neck clinic following diagnosis is strongly recommended.

PD.244 Mucoepidermoid carcinoma of minor salivary glands. A clinical study of 16 cases and review of the literature

PD.244 Mucoepidermoid carcinoma of minor salivary glands. A clinical study of 16 cases and review of the literature

Differential Diagnosis Between Adenoid Cystic Carcinoma and Pleomorphic Adenoma of the Minor Salivary Glands of Palate

Tumors arising from minor salivary glands of the palate may exhibit an overlap of clinical and biologic features that may produce diagnostic and therapeutic dilemmas. Surgical treatment can be very different, depending on the dimensions and malignant or benign nature of the tumors, and therefore should be planned on the basis of an accurate differential diagnosis. A retrospective analysis in 24 patients with pleomorphic adenoma and adenoid cystic carcinoma of minor salivary glands of the palate was performed to investigate the accuracy of fine needle aspiration cytology (FNAC) and biopsy with histology in the preoperative diagnosis. Preoperative diagnoses obtained with FNAC and biopsy were compared with findings of the definitive histopathologic examination performed on the resected mass. Correspondence between the preoperative diagnoses determined by FNACs and the definitive histopathologic results was observed in 22 of 24 cases, whereas a complete equivalence was found with regards to histology. In the analysis, FNAC was associated with 91.6% accuracy and an error rate of 8.4% in the diagnosis of pleomorphic adenoma and adenoid cystic carcinoma of the palate. From the results of the analysis, histologic examination is still the most accurate diagnostic tool in such tumors. FNAC can be considered in tumors of the head and neck regions that are difficult to reach by means of a common biopsy.

Late-Onset Chemosis in Patients with Head or Neck Tumors

To describe a series of patients with chemosis and a history of head or neck tumor, and to propose possible mechanisms for the findings. Retrospective, consecutive case series (1993-2001), with review of: site and histopathologic type of the primary tumor; dates and details of tumor treatment; approximate date of chemosis onset; ocular findings and results of orbital, head, and neck imaging upon referral to the authors; and follow-up outcome. Three male and 3 female patients ranged from 35-68 years of age. Primary tumors were adenoid cystic carcinomas of minor salivary glands of the buccal sulcus (1) and the anterior palate (1), squamous cell carcinomas of the posterior hard palate (1) and the nasopharynx (1), and pleomorphic adenomas of the parotid gland (2). Tumor treatment involved surgery alone (2), surgery and radiation (3), or radiation alone (1). Exposure of regional lymphatics ranged from 50-68 Gy; in 2 cases, orbital exposure was 58-60 Gy. Intervals from treatment to chemosis onset ranged from 5-59 months (mean, 25 months). Imaging showed no orbital mass, recurrence at the primary site, or nodal enlargement in any case. Chemosis remained relatively stable, and no tumor recurrence was noted in additional follow-up of 12-132 months (median, between 26 and 33 months). Patients with chemosis and a history of head or neck tumor should be evaluated for tumor recurrence at the primary site, in regional nodes, and in the orbital apex. However, the finding may be a delayed sequela of surgery and/or radiation.