- DR VIKRAM BHARDWAJ
Pleomorphic adenoma (PA) is the most common tumor of the salivary glands, and the most common gland to be involved is the parotid gland. Its occurrence in the submandibular gland is uncommon. PA are benign slow growing tumour. It is estimated that up to 25% of untreated PAs undergo malignant transformation 1. Therefore, early definitive treatment is strongly recommended.
It presents as slow growing painless lump under the jaw which may produce functional and cosmetic problems.
CT scan or magnetic resonance imaging (MRI) are the gold standard radiological tests for swellings arising from the major or minor salivary glands. Adjunctive procedures like ultrasound guided needle aspiration or fine needle aspiration are non-confirmatory. Hence a biospy is mandatory.
The recommended surgical approach is with a direct submandibular incision which provides an easy access. The excision of the tumor should also be accompanied by the removal of the submandibular gland in toto. Incomplete removal of the glandular tissue paves the way for a definitive recurrence.
The important structures during surgery are Lingual Nerve ( which carries the taste sensation), Hypoglossal nerve ( which moves the tongue) , Marginal Mandibular Nerve ( for Smile) and Facial Vessels (artery and vein).
A young lady came to us with a slowly enlarging mass below the jaw bone for 4-5 months duration with heaviness and vague sensation. On Radiology ie Contrast Enhanced MRI , a homogenous mass noted in left side submandibular region not separate from the submandibular gland.FNAC from the mass suggested an adematous lesion(PIC 1,2).
The patient was detailed regarding treatment options and risk and benefits of surgical removal including nerve palsies.
After Anesthesia clearance, patient was admitted on morning of surgery. Surgery went uneventfully and all important structures/nerves were positively identified following standard surgical practice ( PIC 3,4).
Patient was discharged next day with subcutaneous self absorbing sutures. Patient was very happy with the whole hassle free procedure.
Histopathology report came in after a week which reported the mass to be Pleomorphic Adenoma.
LiVolsi VA, Perzin KH. Malignant mixed tumors arising in salivary glands. I. Carcinomas arising in benign mixed tumors: A clinicopathological study. Cancer. 1977;39:2209–30.)