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Facial Palsy in Non-Palpable Parotid Tumour

Dr.Vijay. R, D.P.Rajan

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Abstract:

Adenoid cystic carcinoma is a malignant tumour which usually involves the minor salivary glands.When the parotid gland is involved, patients present with facial weakness even before a mass is palpable. We present one such case.

Key Words:

Adenoid cystic carcinoma, cylindroma, perineural invasion, neutron radiotherapy.

Case:

Mrs. V is a thirty two year old lady who presented to us with the complaint of deviation of angle of the mouth to the left for the past one year. It was first noticed following the delivery of her second child. Though some improvement was noticed initially, it gradually worsened.

On examination, Lower motor neuron (LMN) facial paralysis + (Rt)

Slight bulge of the right tonsil medially was noted on inspection of the oral cavity.

Keeping in mind the possibility of a parapharyngeal tumour /tumour arising from the deep lobe of the parotid, we obtained an MRI scan which clinched the diagnosis (Fig.1)

After pre-operative work up, she was taken up for surgery. A total parotidectomy with sacrifice of the facial nerve was done. (Fig.2).

The malignant cells infiltrating the nerve sheath as well as the salivary gland can be made out from figs. 3 & 4.

Her post operative period was uneventful and she was discharged on the seventh day.

Discussion:

Adenoid cystic carcinoma, previously known as cylindroma is the most common malignant tumour of the minor salivary glands.It is relatively rare in the parotid. The peak age of occurrence is the sixth decade and it has an equal sex incidence. It is also known to affect the ear, nose, palate, paranasal sinuses and the tracheobronchial tree.

Salient Features:

Perineural invasion is a characteristic feature – hence, patients usually present with nerve paralysis even before a mass is palpable.

It shows a predilection for pulmonary metastasis. It is known to invade medullary bone and spread over the periosteum for quite some distance before producing significant bone resorption. Lymphatic spread is rare. It is stubbornly recurrent.


Dr.Vijay. R, P.G.Trainee - General Surgery, Room No. B-36, P.G. Annexe, Kozhikode Medical College, Kozhikode - 8.
D.P.Rajan (Associate Professor) Department of General Surgery, Kozhikode Medical College.

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