Surgery MCQ 223

A 55-year-old patient presents with a painless swelling in the preauricular region. Upon imaging and further evaluation, the lesion is identified to be a tumor of the parotid gland. The surgeon is preparing to excise the tumor and is considering the anatomical features of the gland. Which of the following statements about the parotid gland is true?

A. Most tumors arise in the superficial lobe
B. Deep lobe of the gland is larger than the superficial lobe
C. Superficial temporal artery divides the gland into two lobes
D. Gland is enclosed in superficial fascia
E. Stone formation is more common in parotid gland


Correct Answer:

A. Most tumors arise in the superficial lobe


Explanation:

The parotid gland is the largest of the salivary glands and is located in front of the ear, extending into the preauricular region. It has two major lobes: the superficial lobe and the deep lobe, which are separated by the facial nerve. Understanding the anatomy and pathology of the parotid gland is crucial for the management of conditions such as salivary gland tumors and inflammatory conditions.

Why “A. Most tumors arise in the superficial lobe” is the Correct Answer:

  1. Tumor Distribution:
    • The superficial lobe of the parotid gland is where most tumors occur. About 80-85% of parotid tumors are found in the superficial lobe, while the deep lobe is less commonly involved in neoplastic processes.
    • Tumors of the superficial lobe are generally more accessible for surgical excision, making them easier to manage compared to deep lobe tumors.
  2. Types of Tumors:
    • The most common type of tumor in the parotid gland is the pleomorphic adenoma, which typically arises in the superficial lobe.
    • Malignant tumors, such as mucoepidermoid carcinoma or adenoid cystic carcinoma, can also occur in the parotid gland, often in the superficial lobe.
  3. Clinical Implication:
    • Superficial lobe tumors tend to present as a painless swelling in the preauricular region, which is often the first sign that prompts medical evaluation.

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Analysis of Other Options:

B. Deep lobe of the gland is larger than the superficial lobe:

  • This statement is incorrect. The superficial lobe of the parotid gland is larger and more visible than the deep lobe. The deep lobe is located behind the mandible and extends towards the pharynx and styloid process, making it less accessible and harder to visualize than the superficial lobe.

C. Superficial temporal artery divides the gland into two lobes:

  • This statement is incorrect. The superficial temporal artery is a branch of the external carotid artery that supplies the scalp and does not divide the parotid gland. The gland is actually divided into two lobes, the superficial and deep lobes, by the facial nerve, which runs through the gland. The superficial temporal artery runs above the gland, outside its structure.

D. Gland is enclosed in superficial fascia:

  • This statement is partly correct but not entirely. The parotid gland is enclosed by a capsule, which is derived from the deep cervical fascia, not just the superficial fascia. The superficial fascia is a layer of connective tissue that lies beneath the skin and is not responsible for the main encapsulation of the gland. Therefore, this option is not the best answer.

E. Stone formation is more common in the parotid gland:

  • This statement is incorrect. Stone formation (or sialolithiasis) is much more common in the submandibular gland (about 80% of cases) due to the gland’s duct being longer and having a more difficult drainage path. The parotid gland is less prone to stone formation, as it has a relatively straight duct and higher flow of saliva.

Key Points to Remember:

  1. Most parotid gland tumors arise in the superficial lobe of the gland.
  2. The parotid gland has two lobes: the superficial lobe (larger and more visible) and the deep lobe (located behind the mandible).
  3. The facial nerve divides the parotid gland into two lobes, not the superficial temporal artery.
  4. The parotid gland is encased in a capsule derived from the deep cervical fascia.
  5. Sialolithiasis (stone formation) is more common in the submandibular gland than in the parotid gland.

Clinical Management:

  • Parotid Tumors: Most benign parotid tumors (e.g., pleomorphic adenomas) are located in the superficial lobe and can be managed surgically with superficial parotidectomy.
  • Malignant Tumors: Malignant tumors may require more extensive surgery and nerve preservation techniques due to the proximity of the facial nerve.
  • Sialography or Ultrasound: Diagnostic imaging, such as sialography, ultrasound, or CT scan, is used to locate tumors or stones within the parotid gland.

Summary:

The parotid gland, the largest salivary gland, has two lobes: the superficial lobe and the deep lobe. Most tumors arise in the superficial lobe, which makes up the bulk of the gland’s mass and is more accessible for surgical removal. The gland is divided into lobes by the facial nerve, and is encapsulated by deep cervical fascia. Stone formation is more commonly seen in the submandibular gland rather than in the parotid. Understanding the anatomy and pathology of the parotid gland is essential for diagnosing and managing conditions like salivary gland tumors and sialolithiasis.

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