Tumours of salivary glands in the stomatology and maxillo-facial surgery unit at the university hospital centre —Yalgado Ouédraogo

doi:10.4236/ojst.2013.39077

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Open Journal of Stomatology, 2013, 3, 465-470 OJST

http://dx.doi.org/10.4236/ojst.2013.39077 Published Online December 2013 (http://www.scirp.org/journal/ojst/)

Tumours of salivary glands in the stomatology and

maxillo-facial surgery unit at the university hospital centre

—Yalgado Ouédraogo

Mathieu Millogo1*, Tarcissus Konsem1, Haréfétéguéna Bissa2, Rasm a né Béogo 3,

Dieudonné Ouédraogo1

1Service of Stomatology and Maxillo-Facial Surgery of the University Hospital Yalgado Ouédraogo, Ouagadougou, Burkina Faso

2Service of Stomatology and Maxillo-Facial Surgery of the University Hospital of Tokoin, Lomé, Togo

3Service of Stomatology and Maxillo-Facial Surgery of the University Hospital Souro SANOU, Bobo-Dioulasso, Burkina Faso

Email: *[email protected]

Received 20 September 2013; revised 1 November 2013; accepted 19 November 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The aim of this study was to contribute to strengthen-

ing the efficiency in the treatment of the salivary

gland tumours in the Stomatology and Maxillo-facial

surgery service at the University Hospital Centre/Yal-

gado OUEDRAOGO of Ouagadougou. It has been a

retrospective and descriptive study covering seven (7)

years [January 2006-December 2012] on epidemiol-

ogy and the treatment of 54 cases of the salivary

glands tumours histologically confirmed. Benign tu-

mours (non-mal ignant tu mour s were pr eval ent (61.11 %

of cases). The annual incidences were 4.71 cases for

non malignant tumours and 3 cases for malignant

tumours. The average age was 34 - 45 years for non

malignant tumours and 44 - 33 years for malignant

ones. In both groups, the tumour was discovered

lately with an average 32 - 48 months before consult-

ing in case of non malignant tumours and 18 - 29 mo n-

ths for malignant tumours. The location of non ma-

lignant tumours was very often the parotid (42.42%),

under mandible gland (27.28%). Malignant tumours

very often concerned the parotid (76.18%) and the

under mandible gland (14.29%). The histology has

revealed that pleomorphic adenoma was the leading

type of non-malignant tumours (93.94% of cases)

whereas carcinoma was predominant in malignant

tumours (80.95% of cases). Long term track keeping

was difficult and it has been complicated by the loss

of contact with some patients. The low living stand-

ard, the time wasted before consulting, limited human

resources and therapeutic means constitute handicaps

to the treatment in our African context.

Keywords: Tumours; Salivary Glands; Epide miolo gy;

Histology; Treatment

1. INTRODUCTION

The tumours developed at the expense of the main sali-

vary glands (parotid, under-mandible, sub-lingual) and

accessory salivary glands are relatively frequent in every-

day medical practice. Indeed, according to Ansari [1], in

the Republic of Iran and Boko [2] in Togo, they represent

respectively 3% to 6% of all tumours of the head and

neck and 17.19% of Oto-Rhino-laryngology sphere.

Salivary gland tumours have a diverse histology, but

the non-malignant forms are prevalent with pleomorphic

adenoma as the leading type [3-5]. However, tumours are

not rare and they remain the haunting memory for any

doctor. Only anatomo-phatologic study enables to diag-

nose these tumours efficiently and therefore to suggest

the appropriate therapeu tic attitude [6].

The earlier diagnose of salivary gland tumours is the

guaranty for an optimal treatment. In our under-devel-

oped African context, many difficulties are met impeding

seriously diagnostic and therapeutic procedure. As a

matter of fact, most patients come to consult at a very

advanced stage of the disease, with very developed tu-

mours called historic ones. Incidentally, their precari-

ousness limits seriously diagnostic investigations and

therapeutic responds. The aim of this study is to do the

inventory of salivary gland tumours in our context in or-

der to strengthen the efficiency of their treatment.

2. PATIENTS AND METHOD

It was a retrospective study concerning medical files of

patients’ suffering from tumours of salivary glands in the

*Corresponding a uthor.

OPEN ACCESS

M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470

466

Stomatology and MaxillO-facial surgery unit at the Uni-

versity Hospital Centre—Yalgado OUEDRAOGO from

2006 to 2012 representing 7 years.

Our population of study was a non probabilistic and

exhaustive type. The study has taken into consideration

all the salivary glands tumours cases treated in the hos-

pital service and which histology was confirmed during

the period of study. We have examined patients coming

for consultation and completed the sample with data

from hospitalization’s registers. We have also used data

from surgery reports and patients’ medical reports. The

variables studied were epidemiologic (age, sex, profes-

sion), clinical, histological and therapeutic. Data have

been analyzed with EPI INFO 3.5.1 software/French

version August 2008. Statistic calculations have been

done with Chi 2 of Pearson to compare different vari-

ables with an Alpha risk equal to 0.05. The test is con-

sidered as conclusive if the value of P is less than 0.05.

Due to our context, it was not possible to practice im-

muno-histochemistry investigation.

3. RESULTS

3.1. Epidemiological Aspects

During the period of study, 77 files have been recorded

and 54 have been kept on the basis of inclusion criteria.

This serial counted 33 non-malignant tumours and 21

malignant tumours of salivary glands. The annual inci-

dence was 4.71 cases for non-malignant tumours and 3

cases for malignant tumours. The breaking down of pa-

tients by sex has been reported in Table 1.

Chi2-corrected = 4.4728, P = 0.03444. The relation

between the sex and the type of tumours has been statis-

tically significant (P < 0.05).

The sex ratio of all the salivary glands tumours was at

0.86. It was at 0.5 in non-malignant series and at 2 in

malignant tumours.

The patients’ average age was 39.28 with extremes of

2 and 70 years old. In the cases of non-malignant tu-

mours, the age group of (15 - 30) was the modal class.

The average patients’ age carriers of a non-malignant

tumour of saliva glands were 34.45 with some extremes

of 2 and 60 years. For malignant tumours, the modal

class was the age group of (45 - 60).

The patients’ averages age was 44.33 with extremes of

6 and 70 years old.

Table 1. Breaking down of patients by sex.

Sex Non-malignant

tumours Malignant

tumour Total

Female 22 (66.67%) 7 (33.33%) 29 (53.70%)

Male 11 (33.33%) 14 (66.67%) 25 (46.30%)

Total 33 (100%) 21 (100%) 54 (100%)

3.2. Clinical Aspects

In the non-malignant tumours serial, the average con-

sulting time was 32.48 months with extremes of 1 to 120

months. In malignant tumours cases, 18.29 months were

the average time before consulting with extremes of 1 to

72 months.

Non-malignant tumours were located at the parotid

(42.42%), at under mandible gland (27.28%), at sub lin-

gual gland (12.12%) at palatal gland (9.09%) and at lips

gland (9.09%) (Figures 1 and 2). Malignant tumours

were also located at salivary glands, but with a great pre-

dilection for the parotid: parotid (76.19%) under mandi-

ble gland (14.19%) and palate gland (9.52%). Tissue

covering the tumefaction was apparently healthy in

84.85% of non-malignant tumours, and ulcerous in

42.86% of malignant tumours The value of Chi2 = 21.26

and P = 0.002 (Figures 3 and 4).

Figure 1. Pleomorphic adonoma

of the parotid gland.

Figure 2. Under mandible gland

tumour.

Figure 3. Carcinoma of the pa-

rotid gland on burn scars.

M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470 467

Figure 4. Parotidian sarcoma.

3.3. Histological Aspects

Histological types encountered have been summed up in

Table 2.

The non-malignant tumours predominated with 61.11%.

Pleomorphic adenoma was the most frequent non-ma-

lignant tumour (93.94% of cases).

The malignant tumours (38.89% of cases) were domi-

nated by carcinomas (80.95% of cases).

Two types of carcinoma were frequently met: the epi-

dermoid carcinoma and the cystic adenoid carcinoma,

23.53% of cases each. Sarcomas, 19.05% of malignant

tumours were as follow: 1 case of fibro-sarcoma, 1 case

of lipo-sarcoma and 2 cases of non differentiated sar-

coma (Figures 5-8).

The histological breaking down by age group has been

represented in the Table 3.

A great proportion of patients suffering from pleo-

morphic adenoma (3 2.26%) were found in the age group

of (15 - 30). Patients suffering from carcinoma belonged

to the age group of (45 - 60) re presenting 47. 06% of cases.

3.4. Therapeutic A spects

The therapeutic means were surgery and medicinal treat-

ment. A surgical treatment has been done with all pa-

tients suffering from non-malignant tumour. It has been a

tumourous extraction taking out the entire or part of the

gland.

In cases of malignant tumours, the tumourous extrac-

tion required taking out the entire gland and in addition

to this a lymphe node groove was associated.

Anti-cancerous chemotherapy used as adjuvant treat-

ment to surgery has been necessary for only 3 patients.

The evolution has been characterized by the transforma-

tion of pleomorphic adenoma into malignant histo-

cystoma of the parotid with a six years step back. More-

over, 5 cases of recurrences of pleomorphic adenoma and

2 cases of recurrences of malignant tumours were no-

ticed with a step back of 2 years. Howe ver, in 41 patients

(75.93%) were no longer in touc h with medical staff with

a step back of 6 years.

Figure 5. Microscopical aspect of oncocy-

tary carcinoma of saliva glands.

Figure 6. Microscopy of a cystic adenoid

carcinoma.

Figure 7. Microscopical aspect of epider-

moid carcinoma moderately differenciated of

the parotid.

Figure 8. Microscopical aspect of a sarcoma

of the parotid.

M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470

468

Tab le 2 . Breaking down of tumours according to the histologi-

cal type.

Histological types Value Percentage

Pleomorphic adenoma 31 57.41

Non-malignant

tumours Oncosis [o nc oc ytom a] 2 3.70

Carcinoma 17 31.48

Malignant tumours Sarcoma 4 7.41

TOTAL 54 100

Table 3. Distribution of histological types according to age

group.

Pleomorphic

adenoma N° (%) Oncocytoma

N° (%) Carcinoma

(%) Sarcoma

N° (%)

(0 - 15) 3 (9.68) 0 (0) 1 (5.88) 0 (0)

(15 - 30) 10 (32.26) 2 (100) 1 (5.88) 2 (50)

(30 - 45)9 (29.03) 0 (0) 4 (23.53) 0 (0)

(45 - 60)8 (25.81) 0 (0) 8 (47.06) 1 (25)

>60 1 (3.22) 0 (0) 3 (17.65) 1 (25)

TOTAL 31 (100) 2 (100) 17 (100) 4 (100)

4. DISCUSSION

4.1. Epidemiological Aspects

Tumourous pathology of salivary glands is relatively

frequent [2,5]. In a period of seven years, we have re-

corded 54 cases confirmed by the histology. We think

however that these figures are far from the reality due to

the under notification of cases. In our context character-

ized by poverty and ignorance of the population, a great

number of patients don’t do anatomo-pathologic check

and another important number do not go to hospital,

having preference for traditional medicine. In fact after

surgery, many patients could not afford to do the ana-

tomo-pathologic checking of the operated part. The his-

tological extempore per operative checking was not

available. In addition to this, cancers register in Burkina

is not functional and it does not permit to record all the

malignant tumours cases. The 54 salivary glands tumours

were composed of 21 malignant tumours (38.89% of

cases) and 33 non-malignant cases (61.11% of cases).

The prevalence of non-malignant salivary glands tu-

mours in comparison to malignant tumours is reported by

most of the authors: Ehsen [5] in Tunisia (88% of non-

malignant tumours and 12% of malignant tumours),

Ochida [7] in Nigeria (56.5% of non-malignant tumours

and 43.6% of malignant tumours). We have noticed a

prevalence of female patients 53.70% suffering from

non-malignant tumours of salivary gland. The sex-ratio

was 0.86. Similar results have been observed by most of

the authors [2,8-11].

In the malignant tumours serial, there was a preva-

lence of male patients with a sex ratio of 2. There was a

significant statistic relation between the sex and the na-

ture of the tumour (the Chi2-corrected = 4.4728, P =

0.03444). The male prevalence being noticed in malig-

nant tumours and female predominance in non-malignant

tumours salivary glands. In our society in fact, men are

more active and seem more exposed to different risk

factors (alcohol, tobacco, irradiations, etc.) responsible

for malignant tumours. Besides, men tended less to visit

doctors in absence of evident symptoms, also because of

socio professional constraints and ignorance.

As far as women are concerned, their esthetical pre-

occupation obliged them to go earlier to consultation

than men as soon as they notice a facial and cervical tu-

mefaction.

In the non-malignant tumours series, the age group of

(15 - 30) was the modal class. The average year of the

appearance of non-malignant tumours of salivary glands

was 44, 33. Non malignant tumours would appear at any

age, but with high frequency as far as young persons are

concerned [4,11]. In the malignant tumors serial, the

modal class was the age group (45 - 60) years. The aver-

age of appearance of malignant tumours of saliva glands

was 44.33 years. Classically malignant tumors are fre-

quent with aged subject, wit h risk f actor s su ch a s tobacco,

alcohol and the absence of month and dental hygiene

[4,5,11].

4.2. Clinical Aspects

The time before consulting was relatively long in these

series and most of the patients have often come with tu-

mours already in evolution. Indeed socio-cultural beliefs

and the difficulties to afford hospital cures, in addition to

the geographical distance of most hospital centers oblige

patients to resort to traditional medicine before coming

in a modern one. We also have the lack of qualified med-

ical staff.

All salivary glands can be the location of a tumour

(non-malignant or malignant) but with prevalence at pa-

rotid. The prevalence of non malignant and malignant

tumors of salivary gland at the parotid can be explained

by the fact that this it is the biggest one and the most

functional of salivary glands [12-15].

4.3. Anatomo-Pathologic Aspects

Non-malignant tumors represent 61.11% of all tumors of

our series.

The pleomorphic adenoma was the most frequent tu-

mour (93.94% of non malignant tumours). This preva-

lence of pleomorphic adenoma has been found by all the

authors who dealt with the qu estion. Ehsen B.B. in Tuni-

sia [5] and Edda A.M.V. in Ouganda [4] have respec-

tively reported among tumors of th eir series 81.9%, 88%

and 74.8% of pleomorphic adenoma. The frequency of

M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470 469

the pleomorphic adenoma among non malignant tumors

of salivary glands could be explained by the cellular di-

versity of salivary glandular tissue. The pleomorphic

adenoma is indeed a mixed tumor. Its microscopy shows

epithelial and myoepithelial cells in an abundant stroma

with some chondroma or myxoid areas [2,5,16,17]. Ma-

lignant tumours represented 38.89% of all the tumours

(80.95% of carcinomas and 19.05% of sarcomas). The

epithelial nature predominating in salivary glands cells

could explain the predominance of carcinoma [18,19].

We have noticed in our series 9 different types of car-

cinomas dominated by the epidermoid carcinoma (23%,

53%) and adenoid cystic carcinoma (23.53%).

This histological diversity among malignant tumours

of salivary glands could be explained by the diversified

characteristic of salivary glands cells (epithelial interme-

diaries, acinous, oncosis, malpighian). There seems to be

a general agreement on the prevalence of carcinomas

among malignant tumours of salivary glands and on the

histological diversity of carcinomas. However, no histo-

logical form among carcinomas of salivary glands has

been considered as leading type of the file [5,7,18 - 20].

Sarcomas were less frequent (19.05% of malignant

tumours), but with also varied histolog ic types. This con-

cerns rare nesenchymatous tumours appearing at all age

and representing nearly 1% of all cancers [8,12,15,17,

20].

4.4. Therapeutic A spects

The treatment of non malignant tumours of salivary

glands is exclusively surgical [6].

The treatment of malignant tumours of salivary glands

is multidisciplinary. It combines oncology, surgery, ra-

diotherapy and psychology. It takes into consideration

the histopathology of the tumour, its state of evolution,

its location, the availability of medical platform and the

patient. Chemotherapy and radiotherapy are often used to

complete surgery in the therapeutic protocol. The radio-

therapy was not availab le in our context. In addition, th e

immuno-histochemistry could not be done, which has

certainly limited the choice of the drugs in the chemo-

therapy. The particular case is the one of parotid gland.

As a matter of fact, therapeutic indication depends on the

location, the volu me of the tumour, the age of the patient,

but also the results of the histological examination ex-

tempore and the infiltration of adjacent structures by the

tumour [6,10,18]. An evoluated malignant tumour will

require a surgical extraction of the gland (partial or en-

tire), extended to adjacent structures (facial nerves, mus-

cular plan). The histological type and grade of malignant

tumour as well as its clinical stage will necessitate a

lymph node groove. Radiotherapy in association with

surgery improves the prognostic of treated tumours and

decreases the rate of local and regional recurrence [18].

The evolution of salivary glands tumours in our con-

text has been characterized by recurrences (5 cases of

pleomorphic adenomas and 25 cases of malignant tu-

mours) and a malignant transformation of plesiomorphic

adonema. We think however that there is an under noti-

fication of recurrent cases in our study due to the diffi-

culty to follow patients in long term. The great number

of patients who did not keep in touch with medical staff

can be a justification. Recurrences are often linked to an

incomplete resection of the initial tumour, especially in

case of exo facial parotidectomy. Generally, the pleomor-

phic adenoma has a high tendency to recurrence [3,8].

5. CONCLUSION

The pathology of salivary glands tumours is relatively

frequent but less known by our population. An accurate

diagnosis rests upon the histological examination. The

very concern with salivary gland tumours in our context

is their treatment. As a matter of fact, most patients con-

sult lately or wander about because of ignorance or

socio-cultural beliefs. The difficulties at the therapeutic

level are particularly due to an insufficiency of qualified

human resources, but also because of the medical plat-

form under acceptable standard. All these situations do

not permit an adequate treatment. In addition to this, we

have the ignorance of the population and the precarious-

ness.

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