PAROTID LUMPS IN THE UPPER NECK
It may go undetected for years but caution is called for once found.
The swelling of the upper part of the neck is a common problem and the common diagnosis in the region includes a cervical lymph node, parotid tumour or a parapharyngeal tumour.
In Asia, a mass in this area, in particular among the Chinese community, is commonly associated with a spread from the cancer of the nose (also called Nasopharyngeal Cancer). The lymph nodes are the portal of cancer spread; they become enlarged usually over a period of months before the patient is aware of the swelling. There can also be accompanying symptoms in this group of patients, such as bleeding from the nose or mouth, hearing loss, ear block, ear ringing or nose discharge.
Unfortunately, 60% of all patients who present upper neck lumps for the first time are found to have nose cancer. Thus, having a neck lump can be the first sign of cancer.

One common diagnosis of an upper neck lump is that of a parotid tumour. The parotid gland is one of two large salivary glands in the head and neck (the other is the submandibular gland). It is sited at the angle of the jaw in front of the ear. Lumps can grow inside the gland and present as enlargement of the parotid gland. There is no known cause for parotid enlargement. This is the same gland that enlarges during a mumps infection.

Fortunately, 80% of the tumours in the parotid gland are benign and the rest being malignant (or cancerous). Typically, the patients would have known about the mass for several months or even years. Parotid lumps present without any symptoms in the majority of cases.

The presence of pain in and rapid growth of a parotid mass make one suspect a cancer. A fine needle test can be done but the final diagnosis can only be ascertained on removal of the lump. The risk of cancer includes rapid enlargement, invasion of the tumour to the surrounding tissues, and spread to the lymph nodes of the neck.
PAROTID SURGERY
The mainstay of treatment for parotid tumours is the removal of such a mass. The common benign tumours of the parotid are pleomorphic adenoma and Warthins tumour (adenolymphoma), and the malignant tumour being adenoidcystic carcinoma, mucoepidermoid carcinoma and acinic cell carcinoma.
In general, no medication is recommended if a parotid mass is suspected.
Inside the middle of the parotid gland is a nerve, called the facial nerve that controls the facial muscles. As the facial nerve passes through the parotid gland, extreme care must be taken during surgery if the tumour has grown over the nerve fibre.
There are several important issues related to patients going for parotid surgery. Firstly, the incision used for the surgery needs to be carefully considered. The parotid mass has to be pinpointed so that incision can be as small as possible. Secondly, there is risk of post surgery numbness of the ear due to a nerve that runs near the incision. Thirdly, there is the risk of skin sweating over the operation area when eating, a complication called Frey's Syndrome. Finally, the most important risk is that to the facial nerve injury during surgery which would result in weakness. This facial weakness would usually be temporary due to the surgery on the nerve. However, in a small percentage this can be permanent.
Because the surgery requires both highly technical micro-dissection as well as facial nerve monitoring and as such, it is not just simply cutting the skin and removing the mass without regard to surrounding structures. The doctor's competence and experience are extremely important factors in ensuring a successful parotid tumour surgery.
A/PROF LUKE K S TAN
Ear Nose & Throat Surgeon

MBBS FRCS (England) MMEDS ci FAMS (ORL)
Head & Neck Surgery (Texas, USA)
Luke Tan ENT - Head & Neck Cancer and
Thyroid Surgery Centre
3 Mount Elizabeth #14-17 Mount Elizabeth Medical Centre. Tel: 6474 6116
www.thyroidsurgery.com.sg