1.
Discuss the two main theories on the cellular origins of salivary gland neoplasms.
2.
Give us a table of the incidence of benign vs. malignant tumors in parotid vs. submandibular vs. minor salivary glands in adults. Discuss the commonly cited “Rule of 80’s” as it applies here.
3.
Describe the innervation of the parotid and submandibular glands, including the types of nerve fibers and named nerves that these fibers travel on to reach the respective glands.
4.
What are the most common salivary gland tumors in the pediatric population?
5.
Name the six most common malignant neoplasms of the salivary glands? With respect to the two most common neoplasms, discuss the implications of tumor “grade” and “perineural invasion.”
6.
Describe 5 distinct ways to identify the facial nerve in parotid surgery. What are the external facial anatomic landmarks that are useful when identifying the facial nerve distally for retrograde dissection?
7.
What are some variations of the facial nerve through the parotid gland?
8.
Discuss the indications for pre-operative imaging of a parotid neoplasm? In what situations might ultrasound, CT and/or MRI be indicated?
9.
Discuss the indications for pre-operative fine needle aspiration of a parotid mass?
10.
Is a complete superficial parotidectomy necessary?
Reference(s):
O’Brien, C. J. (2003). Current management of benign parotid tumors–the role of limited superficial parotidectomy. Head & Neck, 25(11), 946–952.
11.
Current management of benign parotid tumors–the role of limited superficial parotidectomy.
12.
Discuss treatment options for patients with deep lobe parotid tumors.
13.
How important to patient’s is preserving the great auricular nerve?
14.
With respect to malignant parotid neoplasms, who should get an elective neck dissection and who should get post-operative radiation therapy?
15.
How would you manage a post-parotidectomy sialocele? Seroma?
16.
What is Frey’s syndrome? How do you diagnose this condition? What are the various treatment options for it?
Reference(s):
de Bree, R., van der Waal, I., & Leemans, C. R. (2007). Management of Frey syndrome. Head & Neck, 29(8), 773–778.
17.
Can you prevent Frey’s syndrome?
Reference(s):
Dai, X.-M., Liu, H., Li, Y.-S., Ji, S.-G., Qin, S.-H., & Liu, L. (2015). Prevention of Frey Syndrome With Temporal Fascia Flap in Parotidectomy. Annals of Plastic Surgery, 75(6), 610–614.
18.
After successful superficial parotidectomy for a suspected benign parotid lesion, the final pathology comes back as “high grade mucoepidermoid carcinoma with negative margins.” Is any further treatment warranted at this time? If so, what?
Reference(s):
Herman, M. P., Werning, J. W., Morris, C. G., Kirwan, J. M., Amdur, R. J., & Mendenhall, W. M. (2013). Elective neck management for high-grade salivary gland carcinoma. American Journal of Otolaryngology, 34(3), 205–208.
19.
Ten years after a superficial parotidectomy for pleomorphic adenoma, your patient develops subcutaneous nodules within the overlying dermis and surgical scar. Fine needle aspiration of the nodules is positive for pleomorphic adenoma. How will you take care of this problem?
Reference(s):
Witt, R. L., Eisele, D. W., Morton, R. P., Nicolai, P., Poorten, V. Vander, & Zbaren, P. (2015). Etiology and management of recurrent parotid pleomorphic adenoma. The Laryngoscope, 125(4), 888–893.
20.
Discuss the management of squamous cell carcinoma of the parotid.
Reference(s):
Chen M.M., Roman, S.A., Sosa J.A., Judson B.L. (2015). Prognostic factors for squamous cell cancer of the parotid gland: an analysis of the 2104 patients. Head and Neck, 37(1), 1-7.