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6.4.3: 3. Evaluation of Submandibular Salivary Gland Mass- Key Points

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    • 50% are malignant
    • Adenoid cystic carcinoma is the most common malignancy
    • Clinical evaluation, cytology and imaging do not conclusively exclude malignancy….hence complete resection of the tumour and histological examination are required, or if surgery is not to be done, a core needle biopsy
    • Objectives of preoperative evaluation
      • Distinguish between a submandibular lymph node and salivary mass
      • Avoid unnecessary surgery
      • Do appropriate surgery
      • Avoid embarking on surgery that is beyond the scope of a surgeon e.g. tumour requiring neck dissection
    • History and examination are important means to identify non-neoplastic causes e.g. sialadenitis, sialolithiasis, and benign and malignant primary tumours, although 2/3 of malignant tumours are clinically benign
    • FNAC is helpful in selected cases
    • Ultrasound may distinguish a lymph node from a salivary mass, and identify cervical nodal metastases
    • Histological classification of primary salivary gland neoplasms is difficult and complex. Cytological and histological diagnoses should always be treated with caution and viewed in a clinical context, especially if not reported from centers of excellence