Wang Diancan, Department of Maxillofacial Surgery, Peking University Oral Hospital Many parotid tumors have mild symptoms and are “superficially located”, but they need to be diagnosed and investigated early and treated by a professional doctor! This simple common sense may be so little known that we often hear and see people’s neglect and rashness, irreversible and painful endings and even the cost of life. “The mascot of the 2016 Spring Festival Gala, Kang Kang the Monkey, also happens to be a “cartoon” model of a parotid tumor. This article is written to let the kind-hearted Monkey Sai Lei Kang Kang help spread common sense and hope that the life hardships of parotid tumor patients will not recur. In 2016, I was addicted to “grabbing red packets” on New Year’s Eve, until a few days ago, when I read “Beware of parotid tumors with monkeys” by my good friend Dr. Lu Xuguang, and realized that this year’s Spring Festival Gala had a mascot, Kang Kang, the monkey. The interesting thing is: Kang Kang is not healthy, he has a parotid tumor. It’s not uncommon for people to get parotid tumors like Monkey Rai Kang Kang. However, it is not an easy task for Monkey Sailor Kang Kang to cure the disease and to open his brain twice and escape from three calamities. The first time you open your brain, parotid tumor should be treated in time Parotid tumor, there are many kinds, some are benign and some are malignant. Malignant tumors, commonly known as “cancer”, account for about 20% of parotid tumors. In the initial stage of the disease, the benign and malignant tumors behave in a similar way, neither painful nor itchy, and do not affect the life. It slowly and unknowingly increases in size; “boiling frog in warm water”, and when the tumor grows very large, it is too late to regret. Why would you regret not treating parotid tumor in time? Because, early malignant tumor of parotid gland is treated very well: not only high cure rate, but also less trauma and less cost. If left untreated, the tumor will become larger, spread and metastasize, invade adjacent structures, threaten life and become a deadly disaster. Some people retort: “My tumor has been there for a long time, at least five or six years, it must be benign, it’s fine! I’m not available to recruit friends first in the year of the monkey!” In fact, the parotid tumor hospitalization surgery, five or seven days only, said not to delay the work life recruitment friends. Even if the parotid tumor is benign, if delayed and not treated, the tumor will continue to grow, the scope of surgery will expand, the sequelae of surgery will be highlighted, and the complications of surgery will increase. All these, are minor things. The catastrophic thing is that a benign tumor “grows” into a fatal malignant tumor. It is not alarming that benign tumors of the parotid gland are malignant: pleomorphic adenomas, also known as “mixed tumors”, are the most common benign tumors of the parotid gland, and they have a characteristic – they can become malignant over time. This is why we need to open our minds to the swelling around the earlobe at the back of the face, not to guess that it is “fire”, “inflammation of lymph nodes” or even “cheek capsule”. If it is a parotid tumor, even if it is not painful or itchy and “no feeling”, it should be treated in time. Otherwise, I am afraid that it is like raising a tiger to be a disaster, which is equivalent to a disaster in life. How to detect parotid tumor early? If you can feel a lump or hard node on the body part where the parotid gland is located, it may be a parotid tumor. The location of parotid gland, as shown in the picture, extends above to the front of the ear screen and near the level of the zygomatic arch; the lower pole of the parotid gland covers the angle of the lower jaw and its lower back, reaching the side of the upper neck. The second time to open the brain, parotid gland tumor to look for stomatology With the disease in time to see, as a matter of course; stomatology to see the tumor, baffling! It is the second time that Monkeysbane Kangkang opened his brain to look for parotid tumor in stomatology. The reason is that although the parotid gland is located near the ear and has been given the English name parotid (meaning peri-auricular), its core function is to secrete saliva that flows into the mouth; therefore, it is oral science, and more specifically, oral and maxillofacial surgery, a branch of oral science, that focuses on teaching parotid tumors as a disease. It is logical that the oral surgeon in the hospital should recognize parotid tumors and refer the patient to a specialist in oral and maxillofacial surgery (or head and neck surgery) precisely. For other physicians, parotid tumors seem to be “understood” and not the focus of the exam. They may tell the patient that the mass is “superficial”, asymptomatic, and “will not grow”, so they may tell the patient that it is “fine” and “observe”. “Or they may perform an entry-level “pink tumor” surgery. After the surgery, tragedies may happen: or the tumor may rupture, resulting in implantation recurrence of the tumor requiring multiple surgeries; or the facial nerve may be damaged, resulting in the disability of having difficulty opening and closing the eyes with a crooked mouth. Delayed diagnosis and treatment, tumor implantation recurrence and facial nerve damage are three common clinical problems of parotid tumor and three possible “disasters” for parotid tumor patients. Tumor implantation recurrence is the rupture of tumor during surgery, which is like stabbing an ant’s nest or sowing seeds, and the invisible tumor cells are scattered in the surgical wound. These “seeds” will grow into recurrent tumors, with variable location, number and size; when operated again, the tumor will be broken and the seeds will be sown again. When the tumor is operated again, the seeds will be broken again. It is said that there are those who have done the surgery twelve times. Why are tumors easy to break and nerves easy to hurt? The parotid gland is located deep under the skin and its surface is covered with a very dense sheath, called “parotid occlusal fascia”; these dense sheaths are densely packed and extend to the interior of the parotid gland, forming a dense separation; the dense separation is intertwined with the glandular ducts of varying thickness and drool and the nourishing blood vessels flowing with blood. The facial nerve, which governs the movement of the facial muscles, is a major component of the parotid gland. The facial nerve, which governs the movement of the facial muscles, walks quietly in the mix! Non-specialists may not be familiar with this and are used to surgical methods for tumors in other superficial parts of the body, which can cause tumor rupture and nerve damage when they encounter a tough separation and forcefully remove the tumor. A proper surgery usually involves: let the patient sleep under general anesthesia, open the skin and open the parotid gland; under the bright shadowless lamp, separate the superficial sheath, then in order not to hurt the facial nerve, patiently and carefully identify and avoid the nerve, approach the tumor from all sides, destroy the separation adjacent to the tumor, and finally remove the tumor. After the surgery the patient wakes up and asks, “Doctor, did I damage my facial nerve?” Doctors often reply that they don’t know! The reason is that on the operating table, the partitions, ducts, blood vessels and nerves in the parotid gland are similar and difficult to distinguish with the eagle’s eye; it takes a surgeon “ten years to sharpen his sword” to be able to perform this surgery, and sometimes he is not completely sure whether the nerve was injured during the operation. When will we know if a nerve has been injured? The doctor asks the patient to make a series of facial expressions and says, “The nerve is fine.” The patient was elated: he couldn’t care about the doctor’s back, couldn’t see the smile on the doctor’s face, and didn’t know the doctor’s relief and previous anxiety at this time. Parotid tumor, to be diagnosed and investigated early, should be treated by an oral and maxillofacial surgeon (or head and neck surgeon). Reminder: The negative outcomes of parotid tumor surgery, such as tumor recurrence and nerve damage, salivary fistula, etc., are unsolved problems of modern medicine and occur from time to time. Early consultation and treatment with a specialist can reduce their occurrence – this is the purpose of this article. Written by Wang Tuan-Can, illustrated by Lin Jie, and animated by Zhao Huijun. Welcome to circulate. Please do not reproduce without authorization.