Surgery of Salivary Glands
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The salivary glands usually give rise to histopathologically diverse group of tumors. Consequently, the surgical management of these tumors is also varied. The situation is more complicated due to the surrounding anatomy and the passage of the cranial nerves through these glands. Involvement of these nerves and fixation of the mass to the surrounding muscles and bone indicate the need for sacrifice of the nerves and adjacent structures. For benign tumors or lesions, conservative resection (namely, superficial parotidectomy or submandibular sialoadenectomy) with preservation of vital structures (including nerve) is sufficient. In early malignancy or low-grade malignant tumor (namely, low-grade myoepithelial cell carcinoma) a clean plane of dissection is achieved between the tumor and normal tissues. In more malignant and infiltrative tumors lingual or hypoglossal or facial nerves have to be sacrificed during total submandibular sialoadenectomy or total parotidectomy. The facial nerve is reconstructed with the help of the sural nerve. A neck dissection is also included in the management.