Salivary Gland Tumors: When a ‘Harmless’ Nodule Threatens the Face and Speech

Written by: Igor Čvrljević, M.D.

Unlike the misconception that salivary gland tumors are characteristic of the older population, they frequently occur in young, healthy, working individuals – among whom are many managers. Stress, smoking as a common relaxation mechanism in the business world, as well as prolonged exposure to electromagnetic radiation from mobile phones and chronic lack of sleep and rest, can contribute to the development of tumors, although in most cases the cause cannot be definitively determined.

Good, Bad, Evil

In the latest TNM classification by the World Health Organization, more than forty different histological types of salivary gland tumors are described, making them one of the most heterogeneous groups of neoplasms in the head and neck area. There are large salivary glands (parotid or submandibular, submandibular or submandibular, sublingual or sublingual) and many small ones beneath the mucosa of the oral cavity, sinuses, and nose.

Most tumors of the parotid gland are benign, while tumors of smaller glands, such as those located in the palate, tongue, and buccal mucosa, are significantly more often malignant. This biological complexity means that two tumors of similar location and size can behave completely differently and have different prognoses, further emphasizing the importance of precise and timely diagnosis, which is often accurately determined only after surgery by an experienced pathologist.

A prime example is the most common tumor, pleomorphic adenoma. Although it is a benign change, even such a tumor can metastasize, especially if mismanaged, and it carries the potential for malignant transformation, particularly if not removed in time. Additionally, Warthin’s tumor, the second most common benign tumor of the parotid gland, is associated with smoking. It has the potential for frequent recurrence and can often present multiple simultaneous tumors in both parotid glands.

The Worst Decision – To Wait

For all these reasons, it is important to recognize the first signs of the disease. Any new swelling in front of or below the ear, under the lower jaw, on the neck, or beneath the mucosa of the oral cavity, especially if it lasts longer than a few weeks and does not subside, requires attention. Facial asymmetry, a feeling of pressure, tingling, pain, or weakness of the face may also indicate a salivary gland tumor.

The diagnostic procedure is not complex and primarily includes a clinical examination by a specialist in maxillofacial surgery or otorhinolaryngology, followed by ultrasound examination, cytological puncture, and magnetic resonance imaging or MSCT.

Treatment is primarily surgical and may include so-called parotidectomy, gland extirpation with barely noticeable incisions in the fold or so-called facelift incision, or intraoral resection for tumors of smaller glands with reconstruction. In the case of malignant tumors, a broader surgical approach is taken with possible dissection of the neck lymph nodes, and in some cases, adjuvant radiotherapy is also required.

Unfortunately, it is often at this stage that a critical mistake occurs. Among individuals leading an intense business life, the decision not to operate on a tumor diagnosed as benign becomes common practice. The motivation is clear: the desire not to miss work, fear of surgical complications, the belief that nothing will happen because the finding is benign and there are no symptoms. However, such a decision is not wise.

Namely, even benign tumors can eventually turn malignant over time, and delaying treatment increases the risk of local spread, nerve damage, permanent deformities, and complicates surgical intervention. It is particularly concerning that such tumors grow slowly, quietly, and often painlessly, which further encourages the neglect of symptoms. Nevertheless, their growth can exert pressure on surrounding structures, including the most important facial nerve – the facial nerve (lat. nervus facialis).

Guardian of Facial Expression

This nerve is one of the most important facial nerves, responsible for controlling all the muscles of facial expression. It enables movements such as closing the eyes, smiling, speaking, raising the eyebrows, and many other facial expressions that are crucial not only for communication but also for a person’s social and professional identity. This nerve passes through the parotid gland itself – which means that any tumor of this gland is in direct contact with it.

Postoperatively, transient weakness of a certain branch of the nerve may occur, which completely recovers within a few months after the procedure. In the early stages of the disease, the nerve can be carefully preserved, but the longer the tumor remains, the greater the risk that it will adhere to it or partially encompass it. In such cases, it can cause permanent injury, and sometimes, in the case of malignant tumors, it is necessary to completely remove it.

The consequences of damage to the facial nerve are extremely serious: facial asymmetry, drooping of the corner of the mouth, inability to close the eye, difficulty speaking, problems with swallowing and chewing, and significant psychological consequences due to a distorted self-image. Especially for individuals whose work is related to public performance, communication, and self-presentation, such conditions can result in withdrawal from professional life and a sense of loss of identity.

Although there are many options for nerve reconstruction today, whether through surgical grafting (dynamic reanimation) or static correction methods, none of them can fully replace the natural function of a healthy facial nerve. Furthermore, recovery is prolonged and requires several months of intensive rehabilitation.