Salivary Gland Disease and Neoplasms

Back To Search

Salivary Gland Disease and Neoplasms

Head and Neck Surgery
Author Credentials 

David W. Eisele, MD
Professor and Chairman
Department of Otolaryngology –
Head and Neck Surgery
Johns Hopkins University

Lane Squires, MD
Assistant Professor
Department of Otolaryngology –
Head and Neck Surgery
University of California, Davis
Sacramento, CA

Michael G. Moore, MD
Associate Professor
Director of Head and Neck Surgery
Department of Otolaryngology –
Head and Neck Surgery
University of California, Davis
Sacramento, CA
Correspondence: 
2521 Stockton Blvd.  #7200
Sacramento, CA 95817
email: mgemoore@ucdavis.edu

Module Summary

A diverse group of conditions may affect the major and minor salivary glands. Non-neoplastic disorders usually manifest as diffuse unilateral or bilateral glandular enlargement. Etiologies of diffuse salivary gland enlargement include acute and chronic inflammatory and non-inflammatory disorders. Often a thorough history and physical examination with directed diagnostic investigations will yield a diagnosis. Treatment is dependent on the diagnosis and is often guided by patient complaints.
Salivary gland neoplasms are a diverse group of benign and malignant tumors with varied behavior. Management is typically complete surgical resection with adjuvant radiation therapy for select malignant tumors.

Module Learning Objectives 
  1. Describe the embryology of the salivary glands.
  2. Outline the anatomy and physiology of the salivary glands and their relationship to adjacent structures.
  3. Recognize conditions associated with diffuse salivary gland enlargement.
  4. Recall the diagnostic evaluation and treatment of the patient with diffuse salivary gland enlargement.
  5. Know the pathogenesis and risk factors for salivary gland neoplasms.
  6. Outline the diagnostic evaluation for a patient with a salivary gland neoplasm.
  7. Know the staging system for major salivary gland malignancies and the behavior of the usual tumor types.
  8. Know the surgical treatment for benign and malignant salivary gland neoplasms.
  9. Outline options and indications for non-surgical management of salivary gland neoplasms.
  10. Recognize and manage complications of salivary gland surgery.

Embryology

Learning Objectives 

Understand the embryological development of the salivary glands.

  1. Parotid gland
  2. Submandibular gland
  3. Sublingual gland
  4. Minor salivary glands
References 
  1. Carlson GW. The salivary glands. Embryology, anatomy and surgical applications. Surg Clin North Am. 2000;80:261-73.
  2. Nissim KR, Witt RL, Ship JA. Embryology, physiology, and biochemistry of the salivary glands. In: Witt RK, editor. Salivary Gland Diseases. New York: Thieme; 2005;27-43.

Anatomy

Learning Objectives 

Understand the microscopic anatomy of the salivary gland unit and the gross anatomy of the parotid gland, submandibular glands, sublingual glands, and minor salivary glands, and their related structures, including their relevant innervation.

  1. Salivary gland unit: acini of serous or mucous cells, intercalated duct, striated duct, and excretory duct
  2. Saliva: production, components, roles in digestion and oral health
  3. Parotid gland: location, relationship to the facial nerve, Stensen’s duct, lymphatic drainage, and accessory gland
  4. Submandibular gland: location, relationship to lingual, hypoglossal, and facial nerves, Wharton’s duct, and lymphatic drainage
  5. Sublingual gland: location, related structures, and lymphatic drainage
  6. Minor salivary glands: distribution in upper aerodigestive tract, highest concentration in palate, lymphatic drainage site-specific
  7. Outline the relative amount of serous to mucinous glands in parotid, submandibular, sublingual, and minor salivary tissue.
References 
  1. Strong BC, Johns ME, Johns MM. Anatomy and physiology of the salivary glands. In: Bailey BJ, et al., editors. Head and neck surgery - otolaryngology. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2006:517-25.
  2. Elluru RG, Kumar M. Physiology of the salivary glands. In: Cummings CW, et al., editors. Otolaryngology - head and neck surgery. 4th edition. St. Louis: Mosby; 2005:1293-312.
  3. Rho MB, Deschler DG. Salivary gland anatomy. In: Witt RK, editor. Salivary gland diseases. New York: Thieme; 2005:1-15.

Pathogenesis

Learning Objectives 

Outline the wide variety of clinical disorders that are associated with salivary gland enlargement.

  1. Diffuse salivary gland enlargement
    1. Inflammatory enlargement
      1. Acute: viral, bacterial, radiation-related
      2. Chronic: chronic sialadenitis, granulomatous, autoimmune, human immunodeficiency virus (HIV)-associated
    2. Non-inflammatory enlargement
      1. Acute: neoplasm, pneumoparotitis, trauma
      2. Chronic: sialadenosis (endocrine, nutritional, medication-related, idiopathic), amyloidosis
  2. Neoplasms
    1. Theories of tumor histogenesis: multicellular, reserve cell theory
    2. Etiologic factors: ionizing radiation, I131, hardwood dust, Epstein-Barr virus, genetic, smoking for Warthin’s tumor
    3. Risk of malignant conversion of a benign tumor (carcinoma ex-pleomorphic)
    4. Recognize the risk of skin cancer metastasis to intraparotid lymph nodes
References 
  1. Batsakis JG. Non-neoplastic diseases of the salivary glands. In: Batsakis JG, editor. Tumors of the head and neck. 2nd ed. Baltimore: Williams & Wilkins; 1999:100-19.
  2. Peel RL. Diseases of the salivary glands. In: Barnes L, editor. Surgical pathology of the head and neck. 2nd ed. New York: Marcel Dekker; 2001:633-757.
  3. Spitz, M.R., et al., Incidence of salivary gland cancer in the United States relative to ultraviolet radiation exposure. Head Neck Surg. 1988 May-Jun;10(5):305-8.
  4. Andreasen, S., et al., Pleomorphic adenoma of the parotid gland 1985-2010: A Danish nationwide study of incidence, recurrence rate, and malignant transformation. Head Neck, 2016:38 Suppl 1:E1364-9.
  5. Spiro, RH, et al., Salivary gland tumors. Current opinion in oncology, 2.3 (1990): 589-595.

Incidence

Learning Objectives 
  1. Understand the frequency of occurrence of salivary gland neoplasms.
    1. Salivary gland neoplasms are uncommon. Malignancies occur with an incidence of approximately 1 to 2 per 100,000 population per year in the United States.
  2. Know the tumor frequencies per specific gland.
    1. Parotid gland: most are benign (pleomorphic adenoma most common).
    2. Submandibular gland, sublingual gland: the proportion of malignant tumors increases with decreased gland size.
    3. Minor salivary glands: highest percentage of malignant tumors (adenoid cystic carcinoma most common).
References 
  1. Del Signore, A.G. and U.C. Megwalu. The rising incidence of major salivary gland cancer in the United States. Ear Nose Throat J. 2017;96(3): E13-E16.
  2. Bradley, P.J. and M. McGurk. Incidence of salivary gland neoplasms in a defined UK population. Br J Oral Maxillofac Surg. 2013;51(5):399-403.
  3. W Ehab YH, Suen JY. Neoplasms of the salivary gland. In: Cummings CW, et al., editors. Otolaryngology - head and neck surgery. 3rd ed. St. Louis: Mosby; 1998:1255-302.
  4. Eisele DW, Johns ME. Salivary gland neoplasms. In: Bailey JB, et al., editors. Head and neck surgery - otolaryngology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:1279-97.
  5. Weber, R.S., et al., Submandibular gland tumors. Adverse histologic factors and therapeutic implications. Arch Otolaryngol Head Neck Surg. 1990;116(9):1055-60.

Genetics

Learning Objectives 

Describe the current state of knowledge of molecular testing in salivary neoplasms and the potential role of targeted therapy.

References 
  1. Douglas JG, Koh WJ, Austin-Seymour M, Laramore GE. Treatment of salivary gland neoplasms with fast neutron radiotherapy. Arch Otolaryngol Head Neck Surg. 2003 Sep;129(9):944-8.
  2. Linton OR, Moore MG, Brigance JS, Summerlin DJ, McDonald MW. Proton therapy for head and neck adenoid cystic carcinoma: initial clinical outcomes. Head Neck. 2015 Jan;37(1):117-24.
  3. Garden AS, Weber RS, Morrison WH, Ang KK, Peters LJ. The influence of positive margins and nerve invasion in adenoid cystic carcinoma of the head and neck treated with surgery and radiation. Int J Radiat Oncol Biol Phys. 1995;32:619–626.
  4. Tanvetyanon T, Qin D, Padhya T, et al. Outcomes of postoperative concurrent chemoradiotherapy for locally advanced major salivary gland carcinoma. Arch Otolaryngol Head Neck Surg. 2009;135:687–692.

Patient Evaluation

Learning Objectives 
  1. Know that a thorough history and physical examination with directed diagnostic investigations are the key components of the evaluation of diffuse salivary gland enlargement.
    1. History: age, gender, character and duration of symptoms, other head and neck symptoms, systemic review of systems, medications, prior illnesses, substance abuse, family history
    2. Physical examination: complete head and neck examination, including bimanual gland palpation, ductal and salivary inspection
    3. Sialendoscopy
    4. Imaging studies: magnetic resonance imaging (MRI), computed tomography (CT) scan, sialography, chest radiography
    5. Laboratory studies: order on basis of clinical judgment and information gleaned from history, physical examination, and imaging studies
    6. Fine needle aspiration biopsy
    7. Diagnostic gland biopsy: lower lip minor salivary gland, parotid gland
  2. Understand the diagnostic workup of a patient with a suspected salivary gland neoplasm.
    1. History: symptoms related to mass and associated structures, risk factors, history of skin or scalp cancers 
    2. Physical examination: complete head and neck examination, tumor size and mobility, cranial nerve function, associated cervicofacial lymphadenopathy
    3. Fine needle aspiration biopsy: accurate for diagnosis of neoplasms
    4. Imaging studies: MRI, CT scan for select tumors (malignant, large, decreased mobility, deep extension), chest radiography for malignant tumors

Measurement of Functional Status

Learning Objectives 
  1. Know that to study salivary composition, laboratory testing is needed.
  2. Evaluate salivary flow.

Imaging

Learning Objectives 

Understand the role of various imaging modalities of the salivary glands.

  1. Ultrasound: simple, inexpensive.  Recognize limitations in deep lobe tumors
  2. Sialography: evaluates salivary ductal system; painful
  3. MRI: superior soft tissue imaging capabilities
  4. CT scan: mandibular and temporal bone assessment, rapid, well-tolerated
  5. Positron emission tomography (PET) scan: no benefit over MRI or CT scan at present

Pathology

Learning Objectives 

Understand the diverse pathology of salivary gland diseases and benign and malignant salivary gland neoplasms.

References 
  1. Becker TS. Salivary gland imaging. In: Bailey JF, et al., editors. Head and neck surgery - otolaryngology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:437-51.
  2. Silvers AR, Som PM. Salivary glands. Radiol Clin North Am. 1998;36:941-5. 
  3. Prasad RS.  Parotid Gland Imaging.  Otolaryngol Clin N Am. 2016 Apr;49(2):285-312.
  4. Marchal F, Becker M, Dulguerov P, Lehmann W. Interventional sialendoscopy. Laryngoscope. 2000;110(2):318-318. 
  5. Kuan EC, Mallen-St Clair J, St John MA.  Evaluation of Parotid Lesions.  Otolaryngol Clin N Am.  2016 Apr;49(2):313-25.
  6. Liu, Y., et al., Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(2):238-245 e2.
  7. Howlett, D.C. High resolution ultrasound assessment of the parotid gland. Br J Radiol. 2003:76(904):271-7.
  8. Eversole L. Salivary gland pathology. In: Fu YS, et al., editors. Head and neck pathology with clinical correlations. New York: Churchill Livingstone; 2001:242-92.

Treatment

Learning Objectives 
  1. Outline the treatment of the various non-neoplastic disorders of the salivary glands.
    1. Infections
      1. Bacterial
      2. Viral
    2. Chronic inflammatory disorders
    3. Obstructive processes: Sialolithiasis, Ductal stenosis, Ductal kinks
    4. Non-inflammatory, non-neoplastic disorders
    5. Trauma

Medical Therapies

Learning Objectives 
  1. Describe the role of massage, warm compresses, and oral hydration for infectious and inflammatory sialadenitis.
  2. Identify the typical presentation of a parotid abscess and outline the approach to further evaluation and management of such a patient.
References 
  1. Haller JR. Trauma to the salivary glands. Otolaryngol Clin North Am. 1999;32:907-18. 
  2. McQuone SJ. Acute viral and bacterial infections of the salivary glands. Otolaryngol Clin North Am. 1999;32:793-811. 
  3. Rice DH. Nonneoplastic diseases of the salivary glands. In: Bailey JF, et al., editors. Head and neck surgery - otolaryngology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:453-69.
  4. Williams MF. Sialolithiasis. Otolaryngol Clin North Am. 1999;32:819-34. 
  5. Hernandez S, Busso C, Walvekar RR.  Parotitis and Sialendoscopy of the Parotid Gland. Otolaryngol Clin N Am Apr. 2016;49(2):381-93.
  6. Aubin-Pouliot A, Delagnes EA, Chang JL, Ryan WR. Sialendoscopy-assisted surgery and the chronic obstructive sialadenitis symptoms questionnaire: A prospective study.  Laryngoscope. 2015;126(6):1343-8.
  7. Atienza G, López-Cedrún JL. Management of obstructive salivary disorders by sialendoscopy: a systematic review. B J Oral Maxillofac Surg. 2015;53(6):507-19.

Pharmacology

Learning Objectives 
  1. Outline the typical bacteria implicated in acute and chronic sialadenitis.  What glands are typically affected? How to confirm on examination? 
  2. Recognize when a resistant bacterial infection should be considered and describe how this would change your management.

Surgical Therapies

Learning Objectives 

Be able to describe the surgical approach to the following procedures used to manage benign and malignant salivary gland diseases.

  1. Parotid gland
    • Surgical approach: extracapsular dissection vs superficial parotidectomy vs total parotidectomy with nerve preservation vs radical parotidectomy with facial nerve sacrifice
    • Recognize when additional services may need to be involved (neurotology for patients with involvement of the temporal bone, EAC and/or proximal facial nerve, reconstructive surgery)
    • Adjuvant radiation or chemoradiation therapy for select malignant tumors
    • Outline the appropriate management of cervical lymph nodes in patients with salivary cancer
      • How do you manage a patient with resectable N+ disease?
      • What are indications for neck dissections in cN0 patients with salivary cancer?
    • Facial nerve management and rejuvenation 
    • Outline different ways to find the facial nerve
      1. Anterograde dissection with identification of the main trunk using the traigal pointer, posterior digastric, stylomastoid suture line and/or base of the styloid process
      2. Retrograde through the identification of distal facial nerve branch(es)
    • Preserve a functional facial nerve if oncologically possible
    • Describe the utility of facial nerve monitoring during parotidectomy and how to set up the system
    • Recurrent pleomorphic adenoma management
  2. Submandibular gland/sublingual gland
    • Submandibular gland excision
    • Sublingual gland excision
    • Adjuvant radiation therapy for select malignant tumors
  3. Minor salivary glands
    • Complete surgical resection, site and tumor extent dependent
    • Adjuvant radiation therapy for select malignant tumors
References 
  1. W Ehab YH, Suen JY. Neoplasms of the salivary gland. In: Cummings CW, et al., editors. Otolaryngology - head and neck surgery. 3rd ed. St. Louis: Mosby; 1998:1255-302.
  2. Eisele DW, Johns ME. Salivary gland neoplasms. In: Bailey JB, et al., editors. Head and neck surgery - otolaryngology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:1279-97.
  3. Weber, R.S., et al. Submandibular gland tumors. Adverse histologic factors and therapeutic implications. Arch Otolaryngol Head Neck Surg. 1990;116(9):1055-60.
  4. Xiao, C.C., et al. Predictors of Nodal Metastasis in Parotid Malignancies: A National Cancer Data Base Study of 22,653 Patients. Otolaryngol Head Neck Surg. 2016;154(1):121-30.
  5. Armstrong, J.G., et al. The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer. 1992;69(3):615-9.
  6. Wang, Y.L., et al. Predictive index for lymph node management of major salivary gland cancer. Laryngoscope. 2012. 122(7):1497-506.
  7. Chisholm, E.J., et al. Anatomic distribution of cervical lymph node spread in parotid carcinoma. Head Neck. 2011. 33(4):513-5.
  8. Klussmann, J.P., et al. Patterns of lymph node spread and its influence on outcome in resectable parotid cancer. Eur J Surg Oncol. 2008;34(8):932-7.
  9. im, C.M., et al. Is level V neck dissection necessary in primary parotid cancer. Laryngoscope. 2015;125(1):118-21.
  10. Silver, N.L., et al. Surgery for Malignant Submandibular Gland Neoplasms. Adv Otorhinolaryngol. 2016;78:104-12.
  11. Stenner, M., et al. Occurrence of lymph node metastasis in early-stage parotid gland cancer. Eur Arch Otorhinolaryngol. 2012;269(2):643-8.
  12. Deschler DG, Eisele DW. Surgery for Primary Malignant Parotid Neoplasms.  Adv Otorhinolaryngol.  2016;78:83-94.
  13. Mehta V, Nathan CA.  Extracapsular Dissection Versus Superficial Parotidectomy for Benign Parotid Tumors. The Laryngoscope. 2015;125:1039-1040.
  14. Yoo SH, Roh JL, Kim SO, Cho KJ, Choi SH, Nam SY, Kim SY. Patterns and treatment of neck metastases in patients with salivary gland cancers. J Surg Oncol. 2015;111(8):1000-6. 

Staging

Learning Objectives 

Know that malignant parotid gland and submandibular gland neoplasms are staged by the 8th Edition of the American Joint Committee on Cancer (AJCC) staging system.

  1. Tumor node metastasis (TNM) staging
    1. Primary tumor (T)
      • TX    Primary tumor cannot be assessed
      • T0    No evidence of primary tumor
      • T1    Tumor 2 cm or less in greatest dimension without extraparenchymal extension*
      • T2    Tumor more than 2 cm but not more than 4 cm in greatest dimension without extraparenchymal extension*
      • T3    Tumor more than 4 cm and/or tumor having extraparenchymal extension*
      • T4a    Tumor invades skin, mandible, ear canal, and/or facial nerve
      • T4b    Tumor invades skull base and/or pterygoid plates and/or encases carotid artery
      • *Note: Extraparenchymal extension is clinical or macroscopic evidence of invasion of soft tissues. Microscopic evidence alone does not constitute extraparenchymal extension for classification purposes.
    2. Regional lymph nodes (N)
      • NX    Regional lymph nodes cannot be assessed
      • N0    No regional lymph node metastasis
      • N1    Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
      • N2    Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
      • N2a    Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
      • N2b    Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
      • N2c    Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
      • N3    Metastasis in a lymph node, more than 6 cm in greatest dimension
    3. Distant metastasis (M)
      • MX    Distant metastasis cannot be assessed
      • M0    No distant metastasis
      • M1    Distant metastasis
      • Stage Grouping
      • Stage I    T1    N0    M0
      • Stage II    T2    N0    M0
      • Stage III    T3    N0    M0
      •     T1    N1    M0
      •     T2    N1    M0
      •     T3    N1    M0
      • Stage IVA    T4a    N0    M0
      •     T4a    N1    M0
      •     T1    N2    M0
      •     T2    N2    M0
      •     T3    N2    M0
      •     T4a    N2    M0
      • Stage IVB    T4b    Any N    M0
      •     Any T    N3    M0
      • Stage IVC    Any T    Any N    M1
References 
  1. American Joint Committee on Cancer. AJCC cancer staging manual. 8th ed. New York: Springer-Verlag: 2017.

Case Studies

  1. Bilateral diffuse parotid enlargement: a teenage girl with bulimia complains of bilateral nonpainful parotid enlargement. The glands are diffusely enlarged and nontender to palpations.
    1. Probably bulimia-related sialadenosis.
    2. Cessation of bulimia usually results in resolution.
  2. Bilateral multicystic parotid enlargement: a young woman with HIV notes bilateral intermittently painful parotid enlargement. Physical examination and imaging reveal multiple parotid cysts.
    1. Probably HIV-associated parotid cysts.
    2. Treatment options include sclerotherapy and radiation therapy.
  3. Acute unilateral submandibular enlargement: a middle-age male with a history of episodic right submandibular swelling after meals notes painful right submandibular swelling. Physical examination reveals purulent discharge from the right Wharton’s duct with a sialolith near the orifice.
    1. Probably acute submandibular sialadenitis resulting from sialolithiasis.
    2. Treatment includes transoral removal of the sialolith, antibiotics, hydration, and glandular massage.
    3. Additional sialoliths should be excluded clinically, radiographically, or with sialendoscopy.
    4. Select stones can be managed by sialendoscopy with basket removal or laser lithotripsy
  4. 62 year-old male with a slowly enlarging right parotid mass.
    1. Outline what to ask in the history of the lesion (associated symptoms, prior surgeries or work up for the lesion, prior skin/scalp skin cancer removal).
    2. Outline an appropriate work-up for this lesions, if any.
    3. What would be the options for management?
    4. What would be the risks if a parotidectomy is planned?
  5. A 54 year-old female presents with progressive snoring.  
    1. On physical exam is noted to have a bulge of the right soft palate
    2. MRI is performed showing a well-circumscribed lesion of the deep lobe of the right parotid gland with extension into the right parapharyngeal space
    3. Describe differential diagnosis for this lesion
    4. What would be the most appropriate surgical approach if excision is planned.
    5. Outline the risks of the surgery as part of the informed consent process.
  6. Hard palate mass. A middle-age woman is noted to have a mass of the hard palate. The patient is asymptomatic. A 1-cm submucosal hard palate mass is evident on physical examination.
    1. Probable minor salivary gland neoplasm.
    2. Complete surgical resection is the recommended treatment.
    3. Select cases of malignancy may benefit from adjuvant radiation therapy.

Complications

Learning Objectives 

Understand avoidance, identification, and management of complications of salivary gland excision and of radiation therapy to these areas.

  1. Parotidectomy complications:
    1. Facial nerve injury
    2. Hemorrhage
    3. Infection
    4. Skin flap necrosis
    5. Salivary fistula or sialocele
    6. Frey’s syndrome
    7. Cosmetic alterations
  2. Submandibular gland excision complications:
    1. Nerve injury: marginal mandibular branch of facial nerve, hypoglossal nerve, lingual nerve
    2. Hemorrhage
    3. Infection
    4. Seroma
  3. Radiation-therapy complications:
    1. Mucositis
    2. Xerostomia
    3. Hair loss
    4. Skin ulceration
    5. Osteoradionecrosis of mandible
    6. Tissue fibrosis
    7. Neural injury: optic, brainstem
References 
  1. Eisele, DW, Johns ME. Complications of surgery of the salivary glands. In: Eisele DW, editor. Complications in head and neck surgery. St Louis: Mosby; 1993:183-200.
  2. Eisele DW, Kleinberg LR, O’Malley BB. Management of malignant salivary gland tumors. In: Harrison LB, et al., editors. Head and neck cancer - a multidisciplinary approach. Philadelphia: Lippincott Rankin; 1999:721-40.

Review

Review Questions 
  1. Discuss the composition of saliva and its role in maintaining oral health and in digestion.
  2. Describe the anatomy of the parotid gland and its relationship to the facial nerve and other surrounding structures.
  3. What is the workup and differential diagnosis for a patient with diffuse salivary gland enlargement?
  4. What is the role of sialendoscopy in the management of salivary gland disorders?
  5. Describe the tumor staging system and prognostic factors for parotid malignancies.
  6. Outline a management plan for both benign and malignant salivary neoplasms.
  7. Determine the appropriate management of cervical lymph nodes in a patient with salivary gland cancer based on their histopathology.
  8. What is the role of radiation therapy in the treatment of parotid malignancies?
  9. Discuss the treatment of recurrent pleomorphic adenoma of the parotid gland.
  10. What are the potential complications of parotidectomy and how are they managed?
Resources 

Learner must Sign In to access AAO-HNSF education activities.

Annual Meeting Webcasts (AMW):