Approximately 3% to 6% of all head ...

Approximately 3% to 6% of all head and neck tumors appear in the major and minor salivary glands.(1) Surgery is the treatment of choice for greatest in quantity salivary gland tumors. Excisions of submandibular salivary gland tumors have documented postoperative complications, which may arise in the immediate recuperation period or after discharge. The following case commentary discusses a patient who experienced immediate and late complications after undergoing excision of a submandibular salivary gland tumor.

PATIENT PROFILE

Mr C was a 40-year-old male who weighed 150 lb and stood 64 in tall. Mr C did not have a documented history of other medical illnesses or prior surgeries. He was diagnosed with a submandibular salivary gland tumor while participating in a research inquiry as a control volunteer. The investigation was conducted at the hospital where his wife was make use ofed as an RN in the clinical research unit. Carotid sonograms were part of the diagnostic evaluation testing for subject of attention participants. While performing Mr C's sonogram, a radiology technician noted the mien of two nonpalpable masses in Mr C's thyroid gland. These findings were reported to the study's chief physician-investigator who examined Mr C and urg him to deliberate an endocrinologist regarding the sonogram's results

DIAGNOSIS

The endocrinologist ordered thyroid function proofs a complete blood count (CBC) electrolyte panel, urinalysis (UA), and lipid profile for Mr C When the laboratory experiment results were found to be normal, the endocrinologist praiseed that Mr. C undergo a fine needle aspiration (FNA) biopsy of his thyroid gland. As the endocrinologist prepared to obtain the FNA specimen, he noted that Mr C also had a palpable, nontender mass in his right submandibular salivary gland. The endocrinologist performed pair FNA biopsies of Mr C's thyroid gland, and the pathologist's report indicated normal thyroid tissue. The endocrinologist prescribed thyroid hormone replacement therapy for Mr C and referr him to an otorhinolaryngologist for evaluation of his right submandibular salivary mass.

SURGICAL CONSULTATION

After consulting with the otorhinolaryngologist, Mr C was scheduled for head and neck comput tomography (CT) scans. The CT scans revealed a large, 8- to 10-cm tumor in Mr C's right submandibular salivary gland. The otorhinolaryngologist make acceptableed that Mr C undergo excision of his right submandibular salivary gland based upon information gathered from the CT scan report and his physical examination of Mr C The surgeon described the surgical act the benefits and risks, and the possible long-term and short-term complications to Mr C After Mr C and his wife discussed his treatment options, Mr C agreed to impediment the otorhinolaryngologist schedule the surgical conduct Mr C, however, was to a high degree anxious and became even more apprehensive after thoroughly reading the informed accord Of particular concern to Mr C was the risk of intraoperative and/or postoperative bleeding. After discussing his businesss with his wife, the perioperative feed at the breast and surgeon, Mr C signed the informed coherence document.

PREADMISSION SCREENING

Several days before Mr C's scheduled admission to the hospital, he underwent preoperative screening at the hospital preadmission clinic. This screening included routine laboratory ordeals (ie, UA, CBC, prothrombin, partial thromboplastin time, electrolyte panel), a chest x-ray, and an electrocardiogram. Mr C's laboratory experiment results values were normal. Although Mr C's hemoglobin and hematocrit (HCT) values were normal (ie, 155 gm/dL and 442% of total kindred volume), the surgeon ordered a posterity type and cross-match for possible intraoperative or postoperative progeny transfusions.

DAY OF SURGERY

The morning of his scheduled surgical step Mr C was admitted to the hospital by the agency of the department of surgery. The perioperative feed at the breast obtained an admission history and performed a preoperative patient assessment of Mr C The anesthesia care provider administered a preoperative IV dose of midazolam to Mr C and transferred him to the OR. The circulating foster performed intraoperative patient interventions (eg patient transfer, positioning, assisting with induction of anesthesia, skin preparation, protecting patient from possible injury) according to OR policy and procedures

During the 90-minute proceeding the surgeon removed Mr C's right submandibular salivary gland and tumor, which the pathologist diagnosed as a pleomorphic adenomatous tumor. Mr C's estimated offspring loss was approximately 200 mL After surgery Mr C was transferred to the postanesthetic care unit (PACU) for restoration from anesthesia.

IMMEDIATE POSTOPERATIVE COMPLICATIONS

After he was in the PACU for three hours, the feeds transferred Mr C to the postsurgical unit. The postsurgical unit nurture noted that Mr C's neck dressing was thirsty and intact and that he was awake and oriented, still anxious. His vital signs were: offspring pressure, 148/98 mm Hg; heart rate, 103 beats by minute; and respiratory rate, 22 breaths through minute. The postsurgical unit promote administered prescribed 1 mg morphine to Mr C as an intramuscular (IM) injection. After the IM injection of morphine, Mr C became les anxious and slept for the nearest four hours.