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Thyroiditis

Introduction Thyroiditis consists of a varied assortment of disorders and is fairly commonly encountered in clinical practice. The term thyroiditis implies an inflammatory response, and although inflammation of the thyroid may be present in some forms of thyroiditis, in reality some etiologies of thyroiditis are not actually an inflammatory response per se. Forms of thyroiditis may share some features but may have distinct underlying etiologies (…

Thyroid Physiology and Thyroid Function Testing

Thyroid physiology Thyroid Hormone Synthesis and Regulation The basic functional unit of the thyroid gland is the thyroid follicle. The thyroid follicle contains a single layer of thyroid follicular cells that form a sphere with a follicular lumen, which is filled with a colloid protein aggregate. Thyroid follicular cells are polar; the apical membrane is adjacent to the follicular lumen, and the basolateral membrane is the…

Applied Embryology of the Thyroid and Parathyroid Glands

Acknowledgment The authors would like to acknowledge and thank Dr. Anand K. Mishra for contributions to the previous edition of this chapter. The modern thyroid or endocrine surgeon should have a complete understanding of the embryonic development of the thyroid and parathyroid glands as well as knowledge of the possible congenital abnormalities associated with these glands, because they may affect the completeness of surgery and cause…

History of Thyroid and Parathyroid Surgery

The history of thyroid surgery closely parallels the evolution of modern surgical techniques and the synthesis of our understanding of anatomy, physiology, endocrinology, and pathology. The evolution of thyroid surgical techniques has been convoluted. Even when thyroid and parathyroid disorders were first recognized as discrete entities, they were misunderstood. Initially, Graves’ disease was considered to represent a cardiac illness; hypothyroidism, a neurologic and dermatologic disorder; and…

European Salivary Gland Society and the Evolution to a World Salivary Gland Society

Introduction The late 1990s were active in the Department of Otorhinolaryngology – Head & Neck Surgery (ORL-HNS) at the Geneva University Hospital. Dr. Francis Marchal was involved in exploring a completely new field by developing instruments for sialendoscopy and Dr. Pavel Dulguerov had embarked on a Privat Docent thesis on parotidectomy complications. The publications related to these lines of work illustrated that, around the turn of…

Malpractice in Salivary Gland Surgery

Overview – The Legal Requirements for a Malpractice Claim In the United States, medical malpractice laws vary from state to state. Generally speaking, the laws require a plaintiff (the person filing the lawsuit, typically the patient) to establish four things: (1) that the clinician owed the patient a duty of care; (2) that the physician breached the standard of care; (3) that the breach was a…

Quality of Life

Introduction Quality of Life (QoL) can be defined as the “perceived discrepancy between the reality of what a person has and the concept of what the person wants, needs, or expects.” QoL is multidimensional, incorporating physical, psychological, social, emotional, and functional domains. It is subjective and must be based on self-reporting according to a patient's own experiences. Thus, data from QoL questionnaires are becoming an important…

Salivary Gland Surgery in Developing Countries

Introduction Most of the world's people live in developing countries, and 85% will reside in developing countries by 2030; the world has witnessed a mass migration of refugees from developing countries to Western Europe in recent years; and many surgeons are engaged in surgical outreach programs to developing countries. For all these reasons, a textbook about salivary disease would be incomplete without providing a developing world…

Chemotherapy and Molecular Targeted Therapy

Introduction Salivary gland carcinomas represent a rare group of malignancies, accounting for 6–8% of all head and neck cancers, and can involve the major or minor salivary glands. According to the World Health Organization (WHO) classification, there are 24 subtypes of salivary gland carcinomas, whose behavior and clinical course vary based on site of origin and histology. The two major categories of salivary gland carcinomas include…

Salivary Gland Tissue Engineering to Relieve Xerostomia

Introduction Xerostomia, or dry mouth, is a product of reduced quality and quantity of saliva. Common causes include physiologic mouth breathing, polypharmacy, autoimmune disease, including Sjogren disease, and radiation. Drug-induced xerostomia can occur in the elderly population treated with medications that include anticholinergics, antidepressants, or sympathomimetics. Radiation-induced xerostomia occurs in 63–93% of head and neck cancer patients who undergo radiotherapy. The resulting alterations in the rate…

Radiation Therapy for Malignant Salivary Gland Tumors

Introduction Primary cancers arising from the parotid gland represent a diverse biologic spectrum. Surgery remains the primary local curative modality with high rates of local regional control (LRC) for the majority of early stage parotid contained neoplasms. For more advanced, aggressive neoplasms, or in the setting of resectable recurrent cancers, adjuvant radiotherapy (RT) reduces the risk of local regional failure. Radiation sterilizes areas of residual microscopic…

Lymphoma

Epidemiology Approximately 75% of lymphomas present as adenopathy and 25% present extranodally. The gastrointestinal (GI) tract is the most common site of extranodal lymphoma, followed by the head and neck region. The salivary glands serve as the site for nearly 12% of extranodal lymphoma of the head and neck region, which accounts for 2–5% of salivary gland neoplasms. About 80% of salivary gland lymphomas occur in…

Facial Paralysis Rehabilitation

Introduction Facial paralysis is a debilitating disease process that poses significant physical and psychosocial impacts to patients. Facial paralysis resulting from salivary gland tumors can be due to the direct invasion of a malignant tumor, injury, or transection of the facial nerve during tumor removal. Sunderland classified nerve injury into five degrees : 1st degree injury is the temporary interruption of conduction at the site of…

Surgery for Metastasis to the Parotid Gland and Tumor Infiltration of the Parotid Gland

Introduction Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) are the most common forms of nonmelanoma skin cancers. Some 70–90% of cSCCs are located in the head and neck region, and 5% of cutaneous skin malignancies metastasize into the parotid or periparotid lymph nodes. Patients with primary lesions >2 cm in diameter, tumor thickness >4 mm, tumor on or around the ear, recurrent lesions, high-grade lesions,…

Surgery of the Neck for Malignant Salivary Gland Tumors

Management of the Clinically Negative Neck The current consensus involves treatment of the neck for selected patients with tumors that display poor prognostic features for metastasis, although some do advocate elective treatment of the neck for all salivary gland malignancies. Reported rates of occult metastasis in the literature range from 12% to 48%, likely due to varying proportions of the diverse histologic types of salivary malignancy…

Malignant Tumors: Surgery

47.1 Parotid Gland A complete surgical resection with negative margins is the primary goal when treating malignant tumors of the parotid gland. Preparation for surgery includes clinical evaluation of the patient, physical examination, including testing facial nerve function, cytologic evaluation for diagnosis, and detailed radiologic imaging evaluation for extent of disease. Imaging evaluation of parotid tumors is important, not only to document the extent of disease…

Prognostic Scoring for Salivary Gland Malignancy

Overview Prognostic Research for Salivary Gland Cancer Prognostic research for patients with salivary gland carcinoma relates specific prognostic factors to specific oncologic outcomes. Outcomes generally studied are “overall survival” (death from any cause as the central event); “disease specific survival” (death due to tumor – reflects the best obtainable treatment result of all possible treatment given); and “disease control” (freedom of tumor recurrence: local, regional, at…

Malignant Tumors

Overview Malignant salivary gland tumors are rare, accounting for <1% of all cancers and 3–5% of head and neck cancers. It encompasses a diverse group of disease entities with heterogeneous histologies and clinical behaviors. Advances in genomic and molecular pathology techniques have improved tumor characterization and expanded our understanding of tumor biology. In addition, classification of salivary gland tumors has recently been updated. In the 4th…

Vascular Lesions of the Salivary Glands

Introduction Vascular lesions may involve both major and minor salivary glands, simultaneously with other neck spaces. Most cases are present in pediatric patients. This chapter reviews the differential diagnosis and treatment of hemangiomas and vascular malformations ( Table 44.1 ). TABLE 44.1 Comparison Between Hemangioma and Vascular Malformation Hemangiomas Vascular Malformations Present at birth May or may not Always present but may not be evident Involution…

Buccal Space Tumors

Introduction Buccal space tumors may arise from salivary tissue, facial artery and vein, mandibular and facial nerves, adipose tissue, muscular, and lymphoid tissue. Additionally, the buccal space can be involved by direct invasion or metastasis from regional or distant cancer. Tumors in the buccal space tend to overlap in their clinical presentations and radiologic findings often are nonspecific. Definitive diagnosis commonly requires a biopsy by fine…