NEOPLASMS OF THE SALIVARY GLAND

Primary salivary gland neoplasms are extremely rare and form less than 3% of head and neck malignancies. The incidence is 0.4–13.5 cases per 100 /uni00A0 000 for benign neoplasms and 0.4–2.6 per 100 /uni00A0 000 for malignant tumours. These neoplasms present after the fourth decade and a ﬀ ect both sexes equally . Warthin’s tumours are more common in older men, while pleomorphic adenomas are slightly more common in women. With a varied spectrum of pathologies, salivary gland neo - plasms present a diagnostic and therapeutic challenge. The World Health Organization (WHO) ﬁrst classiﬁed these in - 1972, and its last update was in 2017 ( Table 54.3 ). Most sali - - vary gland tumours (>80%) occur in the major saliv ary glands and the majority of them are benign. Minor salivary gland tumours, in contrast, are more likely to be malignant (>50%) ( Figure 54.9 ). The commonest benign neoplasm is the pleo - morphic adenoma (mostly seen in the parotid glands), w hile the commonest malignant tumour is the mucoepidermoid carcinoma. Radiation exposure has been implicated in the develop - ment of both benign and malignant salivary gland tumours , while there is a strong association of smoking with Warthin’s tumour. Viral infections , environmental factors and industrial exposure, such as rubber manufacturing, nickel compounds and hair dyes, have been reported to be associated with the development of salivary gland tumours. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Thomas Hodgkin , 1798–1866, curator of the museum and demonstrator of Morbid Anatomy , Guy’s Hospital, London, UK, described lymphadenoma in 1832. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Malignant epithelial tumours Acinic cell carcinoma Mucoepidermoid carcinoma Adenoid cystic carcinoma Polymorphous low-grade adenocarcinoma Epithelial–myoepithelial carcinoma Clear cell carcinoma, not otherwise speci /f_i ed Basal cell adenocarcinoma Sebaceous carcinoma Sebaceous lymphadenocarcinoma Cystadenocarcinoma Low-grade cribriform cystadenocarcinoma Mucinous adenocarcinoma Oncocytic carcinoma Salivary duct carcinoma Adenocarcinoma, not otherwise speci /f_i ed Myoepithelial carcinoma Carcinoma ex pleomorphic adenoma Carcinosarcoma Metastasising pleomorphic adenoma Squamous cell carcinoma Small cell carcinoma Large cell carcinoma Lymphoepithelial carcinoma Sialoblastoma Histological grades of salivary gland cancers High grade High-grade mucoepidermoid carcinoma Salivary duct carcinoma Adenoid cystic carcinoma Carcinoma ex pleomorphic adenoma Squamous cell carcinoma Anaplastic or undifferentiated carcinoma Malignant mixed carcinoma Figure 54.9 Mucoepidermoid carcinoma of the palate. Benign epithelial tumours Pleomorphic adenoma Myoepithelioma Basal cell adenoma Warthin’s tumour Oncocytoma Canalicular adenoma Sebaceous adenoma Lymphadenoma Sebaceous Non-sebaceous Ductal papillomas Inverted ductal papilloma Intraductal papilloma Sialadenoma papilliferum Cystadenoma Soft-tissue tumours Haemangioma Haematolymphoid tumours Hodgkin’s lymphoma Diffuse large B-cell lymphoma Extranodal marginal zone B-cell lymphoma Secondary tumours Low to intermediate grade Low-grade mucoepidermoid carcinoma Acinic cell carcinoma Polymorphous low-grade adenocarcinoma Epithelial–myoepithelial carcinoma

AVO I DA B L E FAC TO R S T H AT COMPOUND THE RESP

AVO I DA B L E FAC TO R S T H AT COMPOUND THE RESPONSE TO

Agonists and antagonists an uncertain balance

Alterations in hepatic protein metabolism the acu

Alterations in hepatic protein metabolism the acute-phase protein response

Alterations in skeletal muscle protein metabolism

C A a n

CHANGES IN BODY COMPOSITION FOLLOWING INJURY

ENHANCED RECOVERY AFTER SURGERY

FURTHER READING

Homeostasis

Hypothermia

INJURY

Immobilisation

Immobility

Introduction

Learning objectives

MANAGING THE CATABOLIC STRESS RESPONSE

MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tiss

MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tissue damage and inﬂammation

METABOLIC CHANGES AFTER SURGERY AND TRAUMA

Modern surgical care

Neuroendocrine response to injury

RESPONSE

Starvation

Systemic inﬂammation and tissue

Tissue oedema

Volume loss

b b o

l i i

s s m m

t a a

underperfusion

Analgesia

DEFINITION

DISCHARGE FROM HOSPITAL

Direct robotic systems and hybrid robotic surgery

Disadvantages of robotic surgery

Drains

Endoluminal endoscopy and natural oriﬁce surgery

Endoscopic surgery

FURTHER DEVELOPMENTS Augmented reality and minimal access surgical adjuncts

FURTHER DEVELOPMENTS Augmented reality and minimal

GENERAL INTRAOPERATIVE PRINCIPLES

History of minimal access surgery

History of robotic surgery

Hybrid minimal access surgery

Introduction

LIMITATIONS OF MINIMAL ACCESS SURGERY

Learning objectives

MINIMAL ACCESS APPROACHES Laparoscopy

Mobility and convalescence

Operative problems

Oral feeding

Oral ﬂuids

Orogastric or nasogastric tube

PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY

POSTOPERATIVE CARE

Perivisceral endoscopy

Port site pain and numbness

Preparation of the patient

Principles of electrosurgery during laparoscopic s

Principles of electrosurgery during laparoscopic surgery

ROBOTIC SURGERY

SURGICAL TRAUMA IN OPEN, MINIMALL Y INVASIVE AND R

SURGICAL TRAUMA IN OPEN, MINIMALL Y INVASIVE AND ROBOTIC SURGERY

Shoulder tip pain

Single-incision minimal access surgery

Skin sutures

THE FUTURE

THEATRE SET-UP AND TOOLS

Thoracoscopy

Uptake of robotic surgery

Urinary catheter

surgery

ACKNOWLEDGEMENTS

ASSESSMENT Light microscopy

AUTOPSY

BRAF V600E mutation

Basic methods in diagnostic molecular pathology