This is a review article of a rare group of neoplasms that frequently present as painless preauricular mass in older children. There is a wide differential including first branchial arch abnormalities, inflammatory and granulomatous processes. Those masses that are painless, persistent and firm should be thoroughly investigated as out of all salivary gland lesions approximately 50% will be malignant. Of the benign epithelial tumours by far the commonest is pleomorphic adenoma, with occasional basal cell adenomas and Warthins being extremely rare. Haemangiomas and lymphangiomas also occur. Malignant epithelial tumours are rare but do occur in children and adolescents and in descending order incidence are mucoepidermoid (60%), acinic cell carcinoma (11%), adenocarcinoma (10%) and adenoid cystic carcimoma (9%). Fine needle aspiration may be helpful but is controversial and accuracy is quoted as 33%. The mainstay of management is surgery with total conservative parotidectomy for those who have high-grade tumours or aggressive potential. The presence of enlarged lymph nodes is not uncommon in children, which can be misleading at surgery and neck dissection is only warranted in those with proven metastatic disease. Histopathological findings dictate further management with radiotherapy considered for high-grade malignancies, perineural invasion, soft tissue extension and incomplete resection. The five-year overall survival rate for children with malignancies of major salivary glands is 95%, unlike 59% in adults. 

Disorders and tumours of the salivary glands in children.
Lennon P, Silvera VM, Perez-Atayde A, Cunningham MJ, Rahbar R.
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Charles Giddings

FRCS (ORL-HNS), Monash Health, Melbourne, Australia.

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