Diagnosis and management of salivary lesions of the neck.

The diagnosis and management of masses of the neck require strict attention to obtaining a history and performing a physical examination so as to establish a differential diagnosis for the mass under consideration. The development of a differential diagnosis of a neck mass frequently includes neoplastic and nonneoplastic salivary lesions that are considered as a function of the age of the patient, the patient’s history, and the clinician’s physical examination of the patient. This exercise is particularly important because the surgeon must consider the role of fine-needle aspiration biopsy and imaging studies of the neck before providing definitive surgical therapy for the mass. The anatomic region of the mass of the neck also permits the surgeon to include or discard certain diagnoses. For example, most salivary lesions of the neck occur in the lateral upper neck region, and specifically in level IB (submandibular gland) and level IIA (parotid tail). While placing salivary lesions on the differential diagnosis of a neck mass, it is important to understand that incisional biopsies of such neck masses have no role to play in their management. It is therefore essential that surgeons rely on available preoperative measures, including the development of a comprehensive and orderly differential diagnosis, obtaining structural imaging studies, and performing a fine-needle aspiration biopsy as indicated so as to execute the proper surgical treatment plan. This article reviews salient features and the surgical management of the most commonly encountered salivary lesions of the neck, including the plunging ranula and submandibular gland mucocele, the parotid tail tumor, the submandibular gland tumor, and sialadenitis/sialolithiasis of the submandibular gland.