General considerations for treatment

Some points of consideration in the treatment of salivary gland malignancy include:

• tumours in the parotid region should be removed by complete local excision - superficial parotidectomy
• tumours in the submandibular region require that the entire submandibular triangle be cleared
• complete excision is usually sufficient for localised, low-grade malignancy
• post-operative radiotherapy should be administered for high-grade malignancy and for incomplete excision
• clinically involved lymph nodes should be removed by an appropriate neck dissection, but prophylactic neck dissection is unneccessary except possibly for submandibular cancers
• radical surgery is not usually performed when distant metastases are present, except for adenoid cystic carcinoma
• the facial nerve should be preserved unless it is paralysed or found to be invaded by tumour. If it must be divided, it can be reconstructed using a nerve graft, e.g. sural nerve. Such grafts are effective in about 60% of cases but complete recovery may take up to 2 years.