What are the other Names for this Condition? (Also known as/Synonyms)
- Intraoral MSGT
- Minor Salivary Gland Tumors of the Mouth
What is Intraoral Minor Salivary Gland Tumors? (Definition/Background Information)
- Intraoral Minor Salivary Gland Tumors constitute both benign and malignant tumors of the minor salivary glands. These are commonly seen in the cheek, palate, and lips. The minor salivary gland tumors (MSGTs) may be present in individuals of a wide age range (including children and adults)
- The cause of formation of these tumors are generally unknown, but they may form due to certain genetic abnormalities and gene mutations. Smoking, exposure to industrial pollutants, and a history of radiation therapy to the head and neck region may contribute towards Intraoral Minor Salivary Gland Tumor development
- The signs and symptoms of the tumors depend upon whether they are benign or malignant. Most benign tumors are slow-growing and painless; while malignant tumors are generally fast-growing and painful
- The diagnosis of Intraoral Minor Salivary Gland Tumor can be confirmed through a tissue biopsy. In most cases, the treatment is a complete surgical removal of the tumor with adequate margins. In case of a malignancy, additional therapies (chemotherapy and radiation therapy) may be necessary to treat the tumor
- The prognosis of benign Intraoral Minor Salivary Gland Tumor is generally excellent with appropriate treatment (complete removal through surgery). However, the prognosis of malignant tumors may depend upon a set of several factors including tumor stage and overall health of the patient
Who gets Intraoral Minor Salivary Gland Tumors? (Age and Sex Distribution)
- Between 10-20% of all benign and malignant salivary gland tumors arise from the minor salivary glands
- Intraoral Minor Salivary Gland Tumors can be present in individuals of a wide age range. It may be observed in infants, children, and young and old adults
- Generally, most benign MSGTs are seen at a peak age of 30-40 years, while malignant ones are seen in the 40-50 years’ age range
- Both males and females and all racial and ethnic groups may be affected
What are the Risk Factors for Intraoral Minor Salivary Gland Tumors? (Predisposing Factors)
A variety of factors may contribute towards Intraoral Minor Salivary Gland Tumor formation. Specific risk factors depend upon the type of the tumor. Some of the risk factors for Intraoral MSGT include:
- Smoking and chewing of tobacco are strong risk factors for these oral cavity tumor types
- History of radiation therapy to the head and neck region
- Exposure to pollutants (industrial, agriculture, other occupational-related)
- A positive family history of the tumor: A majority of the tumors may be caused by genetic factors; in such cases, a familial background may play a contributory role
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Intraoral Minor Salivary Gland Tumors? (Etiology)
Currently, the exact cause of formation of Intraoral Minor Salivary Gland Tumors is unknown.
- However, genetic mutations have been detected in many tumors, which are currently being characterized
- Smoking or chewing of tobacco have been indicated as strong risk factors for oral cancers
What are the Signs and Symptoms of Intraoral Minor Salivary Gland Tumors?
The signs and symptoms of Intraoral Minor Salivary Gland Tumor may include:
- Presence of a tumor mass in the mouth; the tumors occur within the minor salivary gland of the oral mucosa
- Most the benign tumors are present on the upper lip, palate (hard and soft), and cheek inner lining
- Malignant minor salivary gland tumors prefer the floor of the mouth, area behind the jaw (near the tonsil or the retromolar trigone) and the tongue. Many are also found on the lower lip
- Tumors are typically solitary, but multiple lesions that arise from the same gland or from other salivary glands may be noted
- Most tumors are small, while some can grow to very large sizes
- Usually benign tumors are slow-growing and well-circumscribed, while malignant tumors show a rapid increase in size and are poorly-circumscribed
- Small tumors usually do not cause any symptoms. Pain is generally not felt, unless the surrounding structures are compressed
- Malignant tumors may present systemic signs and symptoms including weight loss, fatigue, anemia, etc.
Large tumors may cause the following signs and symptoms:
- Difficulty in opening one’s mouth; pain while eating (pain may be felt in the mouth and face)
- Dryness of mouth
- Numbness of part of the face
- Inability to move one side of the face due to damage to the facial nerve, known as facial nerve palsy
- Facial pain
How is Intraoral Minor Salivary Gland Tumors Diagnosed?
The following exams and procedures may be used in the diagnosis of Intraoral Minor Salivary Gland Tumors:
- Evaluation of the individual’s medical history and a through physical examination
- Plain X-ray of the head and neck region
- Ultrasound scan of the affected salivary gland
- CT or CAT scan with contrast of the head and neck may show a tumor mass. This radiological procedure creates detailed 3-dimensional images of structures inside the scanned region
- MRI scans of head and neck region: A magnetic field is used to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include:
- Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy may be recommended.
- Salivary gland core biopsy of the tumor
- Salivary gland open biopsy of the tumor
Tissue biopsy:
- A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
- Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
- Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis
Note: A differential diagnosis, to eliminate other tumor types are often considered, before arriving at a definitive diagnosis.
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Intraoral Minor Salivary Gland Tumors?
The complications of Intraoral Minor Salivary Gland Tumors depend upon whether the tumors are benign are malignant. Generally, malignant tumors exhibit more significant complications than benign tumors.
The complications of Intraoral MSGT may include:
- Emotional stress and cosmetic concerns (facial disfigurement)
- Surgery to remove the tumor mass may result in facial nerve palsy (surgical complication)
- Post-surgical wound infection
- Both benign and malignant tumors are known to recur following surgery to remove them
- Some benign tumors may undergo malignant transformation, can become aggressive, and spread to local and distant sites
- Malignant tumors may metastasize to other organs and severely affect their functioning
- Complications that arise from cancer therapy (such as due to chemotherapy or radiation therapy)
How is Intraoral Minor Salivary Gland Tumors Treated?
- A complete surgical excision with clear margins is the preferred mode of treatment for both benign and malignant Intraoral Minor Salivary Gland Tumors
- Surgery may be followed by radiation therapy and/or chemotherapy for malignant tumors
- If the tumor has metastasized to other body regions, then a combination of chemotherapy, radiation therapy, and other invasive procedures may be needed
- Reconstructive surgery may be necessary after therapy
- Post-operative care is important, until the surgical wound heals
- Long-term follow-up is required, because recurrence at the site of surgery have been reported many years (even decades) after surgery
How can Intraoral Minor Salivary Gland Tumors be Prevented?
Current medical research has not established a method of preventing the formation of Intraoral Minor Salivary Gland Tumors. However, some of the risk factors may be avoided by considering the following points:
- Maintain proper oral hygiene
- Avoid chewing tobacco and smoking
- Avoiding exposure to industrial and other pollutants by using suitable protective devices, masks, etc.
Regular medical screening at periodic intervals with blood tests, radiological scans, and physical examinations, for those who have already endured the tumor, are helpful.
What is the Prognosis of Intraoral Minor Salivary Gland Tumors? (Outcomes/Resolutions)
- The prognosis of benign Intraoral Minor Salivary Gland Tumor is generally excellent with surgical intervention and complete removal, since it is a benign tumor
- With respect to benign tumors, besides recurrence, malignant transformations have been infrequently noted. In such cases, the prognosis is based on several factors, including on the stage of the tumor
- Malignant tumors in their early stage with complete excisional (surgical) treatment, typically have good prognosis
- Nevertheless, the prognosis of malignant Intraoral Minor Salivary Gland Tumor may depend upon a set of several factors including:
- Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
- The surgical resectability of the tumor (meaning, if the tumor can be removed completely)
- Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health
- Age of the individual: Older individuals generally have poorer prognosis than younger individuals
- Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have worse prognosis compared to tumors that do not recur
- Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment
Additional and Relevant Useful Information for Intraoral Minor Salivary Gland Tumors:
There are 3 major types of salivary glands and these include the following:
- Parotid glands, found on the sides of the face
- Submandibular glands located at the back of mouth, on both sides of the jaw
- Sublingual glands that are seen under the floor of the mouth
The salivary glands produce saliva that helps in:
- Lubricating the mouth
- Swallowing
- Protects the teeth against bacteria
- Digestion of food
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