HEALTH:
A 61-year-old woman from Pete village in Unguja South had been successfully operated at the Mnazimmoja after developing a huge and complex parotid tumor. A team of dental surgeons conducted the operation.
She narrates her story
“Two years ago, I found a lump under my right ear, the size of a thumb finger. I ignored it because it was neither neither painful nor itchy and did not affect my normal life.
“When the pimple grew larger saw the village medical doctor for treatment but the tumor did not shrink. But in recent years, the tumor grew larger and larger, and the cheeks on both sides were completely asymmetric.
“I looked strange, and began to be worried. I went to several hospitals, but the doctors said the tumor was too big to be operated on.
“I heard that there were Chinese doctors at Mnazimmoja Referral Hospital where I went to see them”. She said.
According to Dr. Xu Ke, the Chinese Oral Surgeon, when the patient visited the Hospital for treatment, the size of the tumor had not increased. Then, Dr. Xu Ke working in the Department of Oral Surgery diagnosed a huge parotid tumor.
But considering her age, a detailed physical examination and cosmetic incision was specially designed to avoid leaving scars on the front of her face.
Under general anesthesia, Dr. Xu Ke who is maxillofacial surgeon in collaboration with Dr. Mohamed Bakar Machano, a local Dental Surgeon performed right parotid gland tumor resection.
During the operation, it was found that the patient’s tumor was huge and had penetrated into various adjacent tissues. Moreover, part of the facial nerve had been invaded by the tumor. With superb technology, the tumor was removed smoothly, and some nerves were micro surgically anastomosed.
According to Dr. Xu Ke, although most parotid tumors are benign, they will also compress the nerves of the face and neck, and over time, some benign tumors will become malignant and begin to show symptoms of invasion and metastasis.
He said some patients are fearful of surgery; fail to see a doctor in time and delay treatment and resulting to negative physiological and psychological effects to their daily life.
He added that the prevention of the disease include quitting smoking and alcohol, eats a balanced diet, and stop long-time phone calls.
Dr. Xu pointed out that tobacco has a great impact on parotid gland tumors adding that when one makes calls for a long time, the mobile phone would be close to the skin on the surface of the parotid gland. At this time, the parotid gland absorbs phone radiation energy. In the long run, it will greatly increase the probability of gland tissue lesions induced by electromagnetic radiation.
Because the etiology of the disease is not very clear, there are few preventive measures. The most important thing is to find and treat it in time. Generally, the prognosis is good.
What is parotid gland tumor?
It is the most common benign parotid growths accounting for 80% of cases, followed by Warthin’s tumor, covering about 6- 10% of cases.
Parotid malignancies are less common and these include adenocarcinoma, mixed malignant tumors and squamous cell carcinoma. Benign growths typically occurs after age 40 with higher incidence among women, whilst malignancy presents after age 60 with equal distribution in both genders.
Benign tumors particularly pleomorphic adenomas, can transform into malignant mass called carcinoma. The malignant transformation leads to sudden rapid unstable growth of the tumor which is more aggressive with poor prognosis.
Etiology
The exact etiology of parotid tumors remains unknown, however, several contributory factors is established. Genetic predisposition could be related to monosomy and polysomy, structural genetic alterations and allelic loss.
Neck radiation exposure has been associated with parotid and other salivary glands malignancies.
Smoking is significantly related to Warthin’s tumors which increases the risk by eight fold compared to non-smokers. Rampant use of mobile phones remains a controversial risk factor in the development of both benign and malignant neoplasm of the parotid gland.
Signs and symptoms
Parotid Gland Tumor is more common in the distal portion of the gland presenting as a discrete mass. The abnormal growth typically presents as slow-growing, solitary, unfixed neoplasm in the parotid area, although some are multinodular and fixed. Symptoms in most patients occur in duration of less than a year up to several decades.
Pain or discomfort, which is often intermittent and vague, is experienced in malignant as well as benign masses. This results from bleeding or suppuration into a lesion or due to infiltration of nearby tissues.
Clinical presentations suggestive of malignancy upon deep palpation of the parotid tumor include: hard, non-movable tender mass, overlying ulceration and infiltration of adjacent structures like lymph nodes and facial nerve. Facial paralysis indicates malignancy.
Diagnostic evaluation
Ultrasound is the most common early diagnostic procedure indicated to determine superficial lesions. Fine needle aspiration (FNA) guided by ultrasound is performed to obtain samples for cytological examination. CT scan guided biopsy can also be employed as an alternative means for cytology.
After confirmation, CT scan or MRI is indicated to evaluate tumor mass and spread to nearby areas or specific organs. The staging of lesions in malignant parotid cases is based on the commonly used tumor, node and metastasis (TNM) system which correlates with patient’s survival and actual management.
Treatment
Parotid gland tumor is typically initially managed with ablation therapy. Radiation therapy is indicated after surgery especially for high-grade lesions and non-resectable tumors. Radiotherapy improves the overall survival rate of patients as an adjunct management to surgery.
This therapy utilizes high-energy x-rays to kill or control tissue growth. Special radiation types may include fast neutron radiation therapy, which uses invisible neutron particles, and photon-beam radiation therapy which reaches deep tumors with the use of linear accelerator machine.
Polychemotherapy is commonly used for palliative regimen of advanced conditions which are no longer responsive to local therapies of surgery and radiotherapy. Oral mucositis and dryness of the mouth or xerostomia may be experienced after radiation therapy.
Surgery
Benign parotid neoplasms require excision of the gland. Superficial parotidectomy with facial nerve dissection may be indicated for the treatment of parotid growth.
If malignancy is established, more radical procedure will be required with the severance of the facial nerve and complete excisions of the gland.
Complications related to surgical management need to be monitored in the perioperative period.
The facial nerve may be damaged or paralyzed due to infiltration of parotid tumor or surgical procedure. Recurrence of the tumors have also been reported, hence tumors like pleomorphic adenomas need to be completely removed.
