Salivary gland conditions
Chronic parotid swelling can be divided into neoplastic and non-neoplastic causes. The former tend to be well-circumscribed whereas the latter present with diffuse enlargement of the gland.
80% of parotid tumours are benign, most commonly pleomorphic adenoma and Warthin’s tumour (papillary cystadenoma lymphomatosum). Important investigations for diagnostic evaluation include: fine-needle aspiration biopsy (FNAB) +/- US-guidance, and CT/MRI.
Treatment is by parotidectomy (superficial or total) with preservation of the facial nerve. This involves complete removal of the tumour with adequate margin of tissue to avoid recurrences. Simple tumour enucleation is not recommended due to high risk of residual tumour and subsequent recurrences.
There is a risk of malignant change in untreated or recurrent pleomorphic adenoma. Warthin’s tumour is the most common bilateral parotid tumour and is often encountered in individuals with a significant smoking history. It is more common in elderly patients and there is a male preponderance.