Management of nasopharyngeal salivary gland malignancy

Objective. The objective of this study was to evaluate the oncological outc ome and complication rate following surgical treatment of nasopharyngeal sa livary gland malignancy. Study Design: Retrospective case review at tertiar y care skull base center. Methods. Pertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therap y were studied. Survival and recurrence data were analyzed using the Kaplan -Meier and Cox proportional hazards methods. Results. Histological types in cluded 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cas es of adenocarcinoma not otherwise specified. All patients underwent primar y surgical resection, and the lateral infratemporal middle fossa approach w as used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remainin g 17 patients underwent planned postoperative radiation therapy. Elective n eck dissection was undertaken in 15 patients, and occult neck disease was p resent in 47%. Disease specific survival was 67% at 5 years and 48% at 10 y ears. High-grade tumors had a significantly poorer outcome (P = .035) with a relative risk of 4.6 compared with low-grade disease. Local control was s een to be 77% at 5 years. Conclusions. Planned combined surgery and radiati on therapy achieves survival outcomes and recurrence rates in nasopharyngea l salivary gland malignancy comparable to results reported using the same t reatment for minor salivary gland tumors cancer originating elsewhere in th e head and neck. Because of the high rate of occult neck metastases, we rec ommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides s afe and adequate access to resect the vast majority of these tumors with ac ceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we curren tly prefer the gastro-omental free flap.