Presented by ; Supervised by ; Shahad Samir Khaleel. Dr.Khalaf Rasheed

Transcription

1 Parotid mass

2 Presented by ; Shahad Samir Khaleel Supervised by ; Dr.Khalaf Rasheed

3 Case sheet كامل دمحم عبيد Name: Age: 37 years Sex: male Occupation : manual worker Residence : D.O.A. :31\10\2011 موصل / قضاء شرقاط Religion : muslim

4 D.O.E.: 31\10\2011 D.O.I.: 1\11\2011 Chief complaint : Small painless swelling in the left cheek for 2 years before admission.

5 History of present illness The condition started as small painless swelling in the left cheek which was first noticed by the patient when he was washing his face before 2 years ago. There was no other swelling in other site in the body, and the patient didn t have any constitutional symptoms like rise in temperature, sweating,malaise or weight loss.

6 The swelling didn t interfere with speaking or swallowing and didn t cause any harm to the patient,so he neglected it. Over the next months the swelling increased in size gradually and slowly without any other changes. After 1 year the patient consulted doctor because he thought that he might have sebaceous cyst.

7 The doctor examined him and he underwent investigation of biopsy from the site of swelling.the doctor told him that he had benign parotid tumor and decided to do surgical intervention but the patient refused because he was afraid of post operative complications. After that the swelling continued to increase in size only with no other symptoms.

8 5 days before admission the patient went to doctor to undergo intervention because he thought that the swelling might increase more in size and cause facial disfiguring. At admission he underwent investigations of blood test and CXR. The operation was done on the next day. It last for 3/4hr.

9 Postoperatively the patient regained his consciousness nearly after 1/4hr.without any complications.he was discharged on the next day at morning.

10 General examination: Examination 37 years old male, conscious, alert,good built, looking well,no anemia,no jaundice,no dyspnea,no cyanosis. There was no cervical L.N. enlargement. No swelling in front of the neck.

11 Regional examination: By inspection,there was swelling in the left parotid area anterior to the ear. No scar,normal colour of overlying skin and hair distribution,no elevation or deviation of ear lobe. By palpation,the swelling was oval,its size was4 3cm,rubbery firm in consistency with lobulated surface and well defined edge,

12 slightly movable within parotid area, not tender,normal temperature, not attached to overlying skin, deep tissue or to the ear. It was not translucent,not flactuant,not compressible and not pulsatile. Examination of oral cavity was normal. Facial nerve examination was normal.

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14 What are the differential diagnosis??????? Parotid conditions: Benign parotid tumor Low grade malignant tumor(acinic cell carcinoma). Tumor-like lesions(lymphoepithelial & adenomatoid hyperplasia). Pre auricular L.N. enlargement Lipoma Sebaceous cyst

15 What are the most useful investigations????? FNAC Core needle biopsy Ultrasound CT-scan MRI Sialography

16 Salivary glands

17 Pleomorphic adenoma mixed tumor(sialoma) Incidence:most common neoplasm,4 th -6 th decade,m:f=4:1 Clinically: slow-growing painless parotid mass,90% in the superficial lobe,most in tail of gland.no FN palsy. The tumor rarely after 10years turns to carcinoma. Pathology: Gross pathology:smooth,well demarcated,solid and cystic changes with myxoid stroma. Histology:mixture of epithelial,myoepithelial and stromal components. No true capsule,tumor pseudopods.

18 Treatment: Superficial parotidectomy.

19 What is the most important structure should be preserved during this operation?????? Facial nerve.

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22 What are the post op. complications?????? Early: Complications of anesthesia Hematoma formation. Infection Temporary facial nerve weakness Late: Transection of facial nerve causing permanent facial weakness

23 Sialocele and salivary fistula. Transection of great auricular nerve causing permanent numbness of ear lobe. Frey s syndrome?????? Recurrence Cosmotic complications Thank you for your kind lestining