Management of clinically benign lumps

At least 50% of submandibular lumps prove to be malignant and the only logical treatment is therefore submandibular excision if suspicious. In the parotid, about 50% prove to be benign pleomorphic adenomas, but potentially malignant tumours may present with identical clinical features.

Investigations must provide reliable information on the relationship of a lump to the facial nerve and its branches, and of the histological diagnosis. Sialography is often performed but provides no such useful information. Ultrasound examination of salivary lumps is also misleading because both benign adenomas and carcinomas may have cystic areas. CT, in combination with tissue-density assessment studies, may be informative, but cannot provide an accurate diagnosis. However, CT or MRI scanning do help determine the extent of deep invasion.

Pre-operative histological diagnosis could refine management, but biopsy by incision or with a Tru-cut needle carries risks of tumour seeding. Fine-needle aspiration (FNA) cytology is probably risk-free but is not always helpful. Some 90% of FNA specimens are adequate and of these, the precise histological nature of a tumour cannot be determined in 10%. Thus FNA will provide a reliable diagnosis in about 80% of cases.

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