Parotid Tumor is an abnormal cell growth that occurs in the parotid gland, but its nature is not malignant. The parotid gland is one of three salivary glands ( saliva ) present in the human body. This gland is the largest salivary glands and is located on the front of the ear. The most common disorder of salivary glands is in the parotid gland. The cause may vary and the tumor is one of them, in addition to the stones in the salivary glands ( sialolithiasis ), salivary gland infections, and cysts.
Benign tumors of the parotid gland can appear in a person in various forms. Classification of benign parotid tumors can be distinguished as follows:
- Mixed Tumor (Pleomorphic Adenoma) . Mixed tumors or pleomorphic adenomas are the most common parotid gland tumors in humans. This tumor is caused by the continuous parotid splitting of epithelial and parotid mioepithmic, followed by increased fluid in the parotid gland space. The form of pleomorphic adenoma tumor is lobular, not closed to normal tissue well, and has a slow growth rate. This type of parotid tumor is the most common cause of parotid tumors, which is about 80 percent of all parotid tumor cases that occur, with the risk of post-parotidectomy recurrence of 1-5 percent.
- Warthin Tumor (Adenolymphoma) . Warthin tumor is the second most common type of parotid tumor after pleomorphic adenoma, which is about 5 percent of all cases of parotid tumor. Warthin tumor is the most common cause of benign tumors in the parotid gland. Warthin tumor is detected from lymphocyte infiltration and the formation of epithelial cysts followed by the proliferation of the cyst. Most Warthin tumors occur in the elderly, ie, at the age of 60-70 years. In addition, the risk of this tumor in men greater than in women.
- Oncocytoma . Is a rare tumor, which is about 1 percent of all incidence of parotid tumors. The oncocytoma type tumor is a tumor consisting of oxyphic or oncocyte type cells.
- Monomorphic Tumor . Tumors that appear on this epithelial tissue are also rare.
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Symptoms of Parotid Tumor
Symptoms of benign parotid tumors that are often found are as follows:
- The appearance of a bump on the face. Usually observed while washing your face or shaving.
- Pain in the face (rare). Pain appears usually more due to tumor rupture or invasion of malignant tumors to other tissues.
- Paralysis of the facial nerve. Paralysis of the facial nerve is primarily caused by the appearance of a lump in the parotid that has a malignant possibility. However, most paralysis of facial nerves is due to Bella's Palsy.
- The appearance of a lump on the base or end of the parotid.
- Facial nerve weakness.
- Bump enlargement.
- The appearance of ulcer and hardening of the mucosa or skin around the tumor.
- The occurrence of numbness in the area around the lump.
- The appearance of pain is getting worse over time.
- Have a history of skin cancer, Sjogren's syndrome , or radiation therapy on the head or neck.
Causes of Parotid Tumor
Parotid tumors are caused by DNA mutations in the cells of the parotid gland. Mutations in DNA cause the cells of the parotid glands to divide rapidly and continuously. Cells that undergo this cleavage will form a tumor and if malignant enough to form cancerous tissue. Some factors that can increase a person's risk of parotid tumor are as follows:
- Age Although a parotid gland tumor can occur in any person, the sufferer is generally elderly.
- Exposure to radiation. Radiation for the treatment of head or neck cancer may increase the risk of tumor in the parotid gland.
- Exposure to certain chemical compounds. Some people who work on asbestos mining, pipe factories or rubber factories have a higher risk of getting salivary gland tumors.
- Virus infection. Examples of viruses associated with the emergence of tumors in the water glands are HIV and Epstein-Barr virus.
- Smoking habit. Smoking habits increase a person's risk of developing Warthin tumor 8 times greater than nonsmokers.
- Mobile phone usage. Several studies have suggested there is an ongoing connection between continuous cell phone use and the risk of parotid gland tumors.
Diagnosis of Parotid Tumor
The key to the diagnosis of parotid tumor is to determine the level of malignancy (malignancy) of the tumor suffered by the patient. The steps of diagnosis of parotid tumor are as follows:
- Physical examination of the head and neck. Physical examination can be done through palpation with two hands (bimanual palpation) on the neck to check the lump on the part as well as on the submandibula and sublingual parts.
- Parotid biopsy. A biopsy is performed to take a sample of parotid gland tissue and be observed through a microscope. Accuracy of examination through biopsy can reach 96 percent.
- Scanning. Some steps of physical scanning to perform diagnosis of parotid tumor are as follows:
- Photo Rontgen. Unconcentated plain radiographs of X-ray may help to detect calcification of the parotid gland.
- Sialography. Although rarely used, sialography can help to detect abnormalities of the function or anatomy of the parotid gland tract.
- CT scan . CT scan can detect lumps on the parotid gland effectively. However, CT scans can not distinguish benign and malignant lumps.
- MRI. MRI can detect a lump in the parotid gland and can detect benign tumors better than CT scans due to having better image contrast.
- PET scan. PET scans can detect lumps, especially malignant bumps, and can tell whether the malignant lump is already spread or not.
- Ultrasonography. Ultrasound can assist physicians to detect the characteristics of Warthin tumors and pleomorphic adenomas, including tumor form detection, tumor vascularity, and cyst prevalence if present.
- Laboratory examination. Laboratory tests can help diagnose the tumor through hematologic and serologic examinations.
Treatment of Parotid Tumor
Treatment of parotid tumors is done with the aim to eliminate tumor tissue as much as possible, and prevent tumor recurrence. Some of the most common treatments for parotid tumors are as follows:
- Superficial parotidectomy. Parotidectomy is the cutting of parotid tissue that becomes a tumor. Superficial parotidectomy is done by partially cutting off the parotid glands that surround the tumor. At the time of superficial parotidectomy, the doctor will maintain the integrity of the facial nerve tissue near the parotid gland as much as possible. To maintain the integrity of the facial nerve, it is important to estimate the location of the neural network close to the location of the tumor before surgery.
- Parotidectomy of the inner lobe or total parotidectomy. The parotidectomy of the inner lobe is done if the tumor occurs in the inner parotid gland or the size of the tumor is large enough. There is no anatomical limitation to determine whether the parotidectomy to be performed is superficial or total. Total parotidectomy may be performed if the parotid tumor has spread to the tissue around the parotid gland.
- Extracapsular dissection. This method can be used to treat pleomorphic adenoma with fewer side effects compared to superficial parotidectomy. Side effects that can be avoided by the method of extracapsular dissection primarily is the facial nerve damage and paralysis of the face.
- Enukleasi.Â This method is effective for treating Warthin tumor and removing lymph glands affected by tumors. In the treatment of pleomorphic adenoma, it is not recommended to use enukleasi method because it can increase the risk of tumor recurrence in patients and cause damage to neural network.
- Radiotherapy. Therapy using radiation can be done post-parotid gland surgery. If the tumor is too large to prevent surgery, radiotherapy may be used instead of surgery to kill tumor cells.
- Chemotherapy. If the benign tumor of the parotid gland has developed into a malignant tumor (cancer) and spread to other body parts, chemotherapy can be done. Currently chemotherapy is not a standard method in the treatment of benign parotid tumors.
Complications of Parotid Tumor
Some complications from parotid tumors are as follows:
- Facial nerve damage that causes temporary or permanent paralysis. Facial nerve damage may be caused by suppression by tumor or injury at the time of parotidectomy surgery. The risk of nerve damage will increase if surgery is repeated. Monitoring of preoperative facial nerve conditions may decrease the risk of this damage.
- Recurrence of benign or malignant tumors. Pleomorphic adenomas should be maximally removed at the first surgery because tumor recurrence may occur multifocally and more difficult to treat.
- Benign tumor changes become malignant. A pleomorphic adenoma that is a benign tumor can turn into a malignant tumor called carcinoma ex-pleomorphic adenoma . These changes are characterized by rapid and sudden tumor growth. This cancer is very aggressive and has a poor prognosis.
- Frey's syndrome. Frey syndrome is a complication that can occur post-parotid gland surgery. People who experience this syndrome, his cheeks will be flushed and sweating when he eats, sees, or thinks of certain foods, especially foods that stimulate salivation production. This complication is caused by a nervous breakdown of the salivary glands.
- Decreased sensitivity (hypesthesia) the senses of the listener. This complication can occur if there is damage to the ear nerves due to surgery or suppression by the tumor.