Examqo › Examqo library › Otolaryngology – Head and Neck Surgery › Salivary glands and neck · IMLE

Salivary gland tumours

The smaller the salivary gland, the more likely a tumour in it is malignant: most parotid tumours are benign (mainly pleomorphic adenoma), while in the sublingual and minor glands most tumours are malignant; work-up is ultrasound and fine-needle aspiration (FNA), and treatment is excision with facial nerve preservation.

לקריאה בעברית

Why it matters in the exam

The "rule of 80" helps in questions: about 80% of salivary tumours are in the parotid, about 80% of parotid tumours are benign, and about 80% of the benign ones are pleomorphic adenoma. Pleomorphic adenoma grows slowly and has small extensions outside its capsule, so enucleation causes recurrence; over the years there is a risk of malignant change (carcinoma ex pleomorphic adenoma). Warthin tumour appears in older male smokers, in the parotid tail, sometimes bilateral, and takes up technetium on scanning.

The commonest malignant parotid tumour (in adults and children) is mucoepidermoid carcinoma. Adenoid cystic carcinoma is common in the submandibular and minor glands, spreads along nerves (perineural spread) and gives late lung metastases — so MRI is done before surgery to assess spread along the nerves. Warning signs of malignancy: facial nerve palsy, pain, a hard fixed lump, neck nodes and rapid growth. Work-up: ultrasound and FNA (Milan system), MRI for the deep lobe or suspected malignancy; open biopsy is not recommended.

Treatment of a parotid tumour is partial or superficial parotidectomy with identification and preservation of the facial nerve (landmarks: the tragal pointer, the tympanomastoid suture and the posterior belly of digastric). A functioning nerve is kept unless the tumour invades it. Neck dissection is done for suspicious nodes or a high-grade tumour. Adjuvant radiotherapy is advised for high grade, T3 to T4, close or positive margins, perineural or lymphovascular invasion, and nodal metastases. Complications: Frey syndrome (facial sweating while eating, from aberrant regeneration of the auriculotemporal nerve; treated with botulinum toxin), ear numbness from the great auricular nerve, and first bite syndrome — parotid pain at the first bite, after surgery in the parapharyngeal space.

Key points

• 80% in the parotid, 80% of those benign.
• Commonest benign: pleomorphic adenoma.
• Commonest malignant: mucoepidermoid carcinoma.
• Work-up: ultrasound and FNA.
• Parotidectomy with facial nerve preservation.

Summary table

A free exam question

In the full version for subscribers

• A simple algorithm
• Memory aid
• Exam traps
• 5 review cards
• Enough for IMLE

The full version is open to subscribers of: ENT and head and neck surgery, Medical licensing exam (IMLE), Oncology, General surgery, Diagnostic pathology.

Subscriber? Read the full topic Plans and prices 25 free questions

Sources

• NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers — Salivary Gland Tumors, 2025 — Surgery and adjuvant radiotherapy
• The Milan System for Reporting Salivary Gland Cytopathology, 2nd edition (2023) — Diagnostic categories and risk of malignancy
• Cummings Otolaryngology: Head and Neck Surgery, 7th edition (2021) — Benign and malignant neoplasms of the salivary glands

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.