Evaluation of the Parotid Gland Mass

History and Physical Exam

• Character of Parotid Mass: onset and duration, rapid (inflammatory) versus slow growing (neoplastic), diffuse versus discrete mass (tumor), unilateral versus bilateral involvement (sialadenosis, mumps), associated pain, association with food ingestion (sialadenitis)

• Contributing Factors: history of smoking or alcohol abuse; exposure to radiation or toxins (lead or mercury); history of sarcoidosis, Sjogren's disease, tuberculosis, gout, amyloidosis; recent facial trauma or surgery

• Associated Symptoms: xerostomia, sialorrhea, weight loss, fever, trismus

• Physical Exam: palpation (mobility, size, consistency), bimanual palpation with duct inspection and saliva expression (or purulence), tenderness (inflammatory process), facial nerve function (malignancy), parapharyngeal space involvement (examine intraorally), cervical lymphadenopathy, complete head and neck history and physical exam

Imaging and Ancillary Tests

• Fine Needle Aspirate (FNA): indicated for discrete nodules of the parotid gland, widely practiced although controversial (may not change management), differentiates cysts, inflammatory processes, lymphoma, and other neoplasms

• CT/MRI: indicated if suspect a tumor or for preoperative evaluation (see Table 2—1), ultrasound (U/S) differentiates cystic lesions

• Superficial Parotidectomy: diagnostically indicated for discrete nodules which require biopsy; incisional biopsy (enucleation) risks tumor seeding, recurrence, facial nerve injury, and violation of tumor margins

• Technetium-99m Isotope Scan: rarely utilized, may differentiate a Warthin's tumor or oncocytoma from other salivary gland neoplasms

• Sialography: visualizes ductal anatomy, indicated for ductal calculi, trauma, fistulas, Sjogren's disease, contraindicated in acute infections

• Lab Work: may consider mumps titers, complete blood count, autoimmune and Sjogren's Profile (SS-A, SS-B, ANA, ESR)

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