Salivary gland tumors constitute a broad and heterogeneous group of conditions that may affect the parotid gland, the submandibular gland, and, less frequently, the sublingual gland. These lesions may be benign or malignant and show very diverse biological behavior.
Appropriate treatment of salivary gland tumors requires specialized evaluation, meticulous surgical planning, and thorough anatomical knowledge—particularly in the case of the parotid gland, where the facial nerve is located, a key structure for facial function and expression.
The goal of treatment is always the same: to eradicate the disease effectively while preserving, as much as possible, function, facial aesthetics, and the patient’s quality of life.
Most salivary gland tumors, especially in the parotid gland, are benign. The most common include:
Although these lesions are not cancer, they should not be underestimated. Some benign tumors—particularly pleomorphic adenoma—can grow progressively,
deform facial contour, and if not treated properly, carry a long-term risk of recurrence.
In addition, while uncommon, there is a low but real risk of malignant transformation in certain long-standing or recurrent benign tumors.
This is why timely, well-planned treatment by experienced teams is important.
Malignant salivary gland tumors are less common, but often more complex. Examples include:
These tumors require an integrated oncologic approach, often involving more extensive surgery, evaluation of neck lymph nodes, and in some cases additional treatments such as radiotherapy.
Preoperative evaluation is essential to define the best therapeutic strategy. It typically includes:
FNA is a key tool to guide diagnosis, although it does not always provide a definitive characterization. For this reason, the final diagnosis is obtained from the pathology examination of the surgical specimen.
Surgery is the mainstay of treatment for most salivary gland tumors, both benign and malignant. Each case is evaluated individually, taking into account:
The parotid gland has a crucial anatomical feature: inside it, the facial nerve divides into branches responsible for facial expression. For this reason, parotid surgery is one of the most complex procedures in head and neck surgery and should be performed by surgeons with specific experience in this field.
In benign tumors, the facial nerve is not infiltrated by the lesion. However, the nerve may be in close contact with the tumor,
displaced, thinned, or partially encased by the mass—making surgery technically demanding.
In these cases, surgical technique is essential to achieve complete tumor removal while preserving facial nerve function.
With experienced teams, nerve preservation is the rule, and rates of permanent paralysis are extremely low.
Proper resection is also important to reduce recurrence, especially in pleomorphic adenoma, where recurrences can make future surgeries
significantly more complex and risky.
In malignant tumors, the facial nerve may be involved or infiltrated. When this occurs, the priority is adequate oncologic treatment,
which may require partial or complete removal of the affected facial nerve segment. Preserving an infiltrated nerve could compromise local tumor control.
These decisions are individualized, based on tumor type, aggressiveness, and the balance between oncologic control and functional outcome.
Reconstructive surgery plays an essential role in modern management of salivary gland tumors, especially when facial nerve segments must be resected
or when extensive surgery is required.
Collaboration with reconstructive head and neck specialists allows highly complex procedures aimed at:
Options may include nerve grafts, nerve anastomoses, dynamic or static facial reanimation procedures, and reconstructive techniques using flaps or grafts.
May require superficial parotidectomy, total parotidectomy, or more extensive surgery depending on tumor type, location, and biological behavior.
Submandibular glandIndicated for tumors and certain obstructive conditions, with careful preservation of key nerves such as the lingual and hypoglossal nerves.
Sublingual glandLess common, but with a higher proportion of malignant tumors and particularly delicate anatomy.
Revision surgery of the parotid gland is one of the greatest challenges in head and neck surgery. It is usually indicated for recurrent tumors, especially recurrent pleomorphic adenomas.
These procedures are more complex due to:
Surgical team experience is critical. High-volume teams with specific expertise in revision parotid surgery can minimize risks and provide advanced reconstructive options when needed.
In malignant tumors, depending on histologic type, surgical margins, and lymph node involvement, additional treatments may be recommended, such as:
Long-term follow-up is essential, especially in tumors with risk of late recurrence, such as adenoid cystic carcinoma.
Treating salivary gland tumors requires experience, oncologic judgment, and an integral vision that prioritizes both disease control and preservation of function and aesthetics.
Appropriate management from the beginning—by a specialized team experienced in complex and reconstructive surgery—offers the best outcomes, even in challenging scenarios such as advanced malignant tumors or revision operations.
If you have questions about your diagnosis or treatment options, discuss them openly with your medical team so you can make informed decisions together.