Accessory parotid gland tumors

Abstract

Tumors of accessory parotid gland are considered in the differential diagnosis of a mid cheek mass. Parotidectomy is the procedure of choice. All pathological types of parotid main gland tumors occur in the accessory parotid gland also. Presenting as a mid cheek or infrazygomatic mass, the tumors of this accessory parotid gland are notorious for recurrences, if adequate margins are not achieved. We describe two such cases of such a tumor. 40-year-old male with a slowly progressive mid cheek mass was operated by a mid cheek incision. Histopathology of the tumor was pleomorphic adenoma. Facial nerve paresis recovered complelety in 6 months. A 52-year-old female with progressive mid cheek mass who underwent parotidectomy and neck dissection by a modified Blair's incision was diagnosed with extranodal marginal zone lymphoma with focal transformation to a diffuse large B-cell lymphoma. Chemotherapy with CHOP regime was initiated. There was no recurrence at 6 months of follow-up. Lymphoma of accessory parotid gland is a very rare tumor. Standard parotidectomy incision is advocated to prevent damage to facial nerve branches.

Adenocarcinoma, NOS of the Accessory Parotid Gland

“…Although we used a standard parotidectomy incision for complete and safe exposure of the mass, the parotid duct, and facial nerve branches, various approaches have been reported for APG tumor excision, including the intraoral, a direct skin incision, a standard parotidectomy incision or facelift, and endoscopic approaches [5]. Of these methods, the standard parotidectomy incision has been recommended for complete tumor excision, avoidance of facial nerve damage, and cosmetic results [1]. In addition, an endoscopic approach was recently found to yield satisfactory results in cases of benign APG tumors [11,12].…”

“…to be malignant. The incidence of malignant tumors in the APG is higher than that of parotid gland tumors [1,5]; therefore, the possibility of malignancy must be considered in cases of APG tumor excision, even if preoperative examinations indicate benign lesions.…”

“…The accessory parotid gland (APG) commonly exists just anterior to the main parotid gland and along the parotid duct, adhering to the masseter muscle. APGs in humans are not uncommon, with a reported incidence of 21-61% [1]. However, tumors of the APG are rare, accounting for only 1-7.7 % of all parotid gland tumors [2,3].…”

The Embryology of the Salivary Glands: An Update

“…52 The most common site for accessory parotid tissue is overlying the masseter muscle, with the ductal system draining into the Stensen duct. 53 The next most common location is in the anterior triangle of the neck, followed by the posterior triangle of the neck. 51,54 As noted above, the major salivary glands begin their normal development and migration between the fourth and sixth embryonic weeks.…”

“…Aplasia of the major salivary glands is rare, and it is usually associated with a syndrome most often involving ectodermal tissue. 53 Most commonly when there is aplasia of a single major salivary gland, it is one of the submandibulare glands.…”