Clinico-Pathological Study and Management of Parotid Gland Tumours

Abstract

Background and Objective:Salivary gland tumours are rare, generally benign and affect mainly the parotid glands. Although parotid tumours can occur from birth onwards throughout the lifespan, incidence varies with respect to age and sex of the individual. Diagnosis and management of parotid tumours is complicated by their relative infrequency, the limited amount of pre-treatment information available and wide range of biological behavior seen. Parotid tumours are interesting to surgeons, as they are unique in the way they present, that is with a diverse array of clinical patterns and varied histological patterns. So the diagnosis is frequently aided by the use of FNAC. So in this study, subjects presenting with symptoms of parotid gland tumours will be assessed clinically, diagnosed with the aid of FNAC and therapeutic procedures will be carried out accordingly. Aim & Objectives: The objectives of the study are 1.To study the age and sex distribution of various types of tumours occurring in Parotid gland.2.To study their various modes of clinical presentation 3.To study the diagnostic accuracy of FNAC.4.To study the various treatment modalities offered. 5. To identify the complications ensuring there in, as a consequence of intervention.Methodology:Registered subjects registered in surgery department of Kamineni Institute of Medical Sciences with diagnosis of parotid gland tumours in FNAC report from January 2019 to February 2020 will be taken up for the study. Primary source of information technique will be used as the source of information with “Informed written consent” method for the subject’s consent. Subjects presenting with signs and symptoms of Parotid gland swellings in KIMS surgery OPD will be subjected to a detailed history and clinical examination. Long term follow up is necessary to study the tumor recurrence, which was not possible in this study.Results:Parotid gland tumours commonly occur between 3-5th decade. Benign tumours are more common in 20 to 50 years. Mean age for benign tumours was 37.51 years and malignant tumourswas 35 years. The salivary gland neoplasms more common in females M:F::1:3.6. So out of which 8 patients were male and 22 patients were female. M:F ratio for benign tumours is 1:3.1, and for malignant tumour was 1:0. Parotid gland is the most common site for salivary gland tumours, accounting for 80%. Among parotid tumours 96.67% were benign and 3.33% were malignant. 66.7% of benign tumours presented within 5 years. Facial palsy was the commonest complication observed after surgery postoperatively 8 patients developed facial palsy, out of which 6 were temporary and 2 were permanent. Wound infection developed in 7 patients. FNAC is a good tool in diagnosing salivary gland with exact cytohistological 96.55% for benign tumours and 100% for malignant tumours. Regarding accuracy of clinical examination in diagnosing parotid gland malignancies, the sensitivity is 100% and specificity is 100%.The overall prognosis was fare for all kinds of parotid gland tumours including benign and malignant tumours. There was no mortality that was observed during the course of this study. No recurrence was reported during the course of this study.
Interpretation and Conclusion:Parotid gland tumours are less often encountered in surgical practice. Parotid gland tumours most commonly occur in third and fifth decade.. Surgery is the mainstay of treatment of parotid gland tumours and superficial parotidectomy is the most commonly performed surgery for benign as well as low grade malignant parotid tumours. Most important complications of parotid surgery were wound infection and facial palsy. In facial palsy temporary facial palsy is the one which was encountered most. Long term follow-up is necessary as pleomorphic adenomas tend to recur after long time. Since the most common malignant tumours are asymptomatic and long standing benign tumours especially pleomorphic adenoma can undergo malignant change, community awareness, early detection and earliest referral from primary health care set up to tertiary centres are necessary.