Tumeurs malignes des glandes salivaires chez l’enfant

Salivary gland carcinoma in children and adolescents: The EXPeRT/PARTNER diagnosis and treatment recommendations

“…As the majority of SGCs usually present as a slowly growing asymptomatic mass, diagnosis is often delayed by up to 12-24 months. 2,6,30,35,36 Nevertheless, metastases at diagnosis (mainly to the lungs, followed by the liver and bone) remain rare. 1 Less frequently, recent-onset pain or swelling without infectious or inflammatory symptoms, regional lymph node involvement, and rarely facial nerve palsy can be observed, as well as nasal symptoms, vision impairment or trismus.…”

“…1 Less frequently, recent-onset pain or swelling without infectious or inflammatory symptoms, regional lymph node involvement, and rarely facial nerve palsy can be observed, as well as nasal symptoms, vision impairment or trismus. 1,2,21,30,36,37 Skin tethering and/or ulceration are more likely associated with malignant tumors. Discussion by a multidisciplinary team (MDT) is highly recommended early in the assessment process, and before any invasive procedure (Level V; Grade A).…”

“…Appropriate clinical and imaging studies at diagnosis are useful to assess disease stage and extent of locoregional and metastatic spread. 2,30,37 Clinical evaluation should include full cervical lymph node and neurological examination (Level V; Grade A). Cervical ultrasound is a useful, easily accessible, well-tolerated, noninvasive, and nonirradiating imaging method, which can provide valuable information about tumor characteristics.…”

“…Based on the above considerations, total parotidectomy with complete tumor resection and facial nerve preservation is the treatment of choice for malignant parotid tumors whenever feasible (Level IV; Grade A). Partial superficial parotidectomy (resection of the latero-facial portion of the gland) can be considered for tumors arising in the superficial lobe, depending on the intraoperative findings (it may be difficult to achieve clear margins with this procedure in most cases) 1,2,30,32,36,75,76 (Level IV; Grade B). Transient or permanent postoperative facial nerve injury is one of the main risks of parotid surgery, particularly in children, in whom the smaller caliber of the facial nerve branches makes its dissection difficult, requiring extra care and dedicated surgical tools to avoid excessive traction.…”

“…In addition to facial nerve paralysis, Frey syndrome, scar complications, sialocele, bleeding, hematoma, fistula, and first bite syndrome have also been reported. 21,30,77 Regional dissection of the submandibular triangle bounded by the mandible superiorly, the anterior belly of the digastric muscle anteroin-feriorly, and the posterior belly of the digastric muscle posteroinferiorly is recommended for submandibular tumors (Level IV; Grade A).…”