Salivary Gland, Intraoperative

The purpose of intraoperative examination of salivary gland tumors is primarily to differentiate LOW grade tumors (both benign and low grade malignant) from HIGH grade malignant tumors. Carcinomas of HIGH histologic grade require neck dissection, which can be performed during the same surgery if high grade can be confirmed on frozen.

  1. Review pathology and imaging histories.
  2. Weigh and measure specimen in 3D.
  3. Take note of specimen integrity.
  4. Take note of orienting sutures if present, and Ink accordingly.
  5. Cut the specimen along the longest axis (parallel to long axis).
  6. Photograph the cut surface(s).
  7. Measure tumor in 3D.
  8. Describe tumor: one or multiple nodules, color, consistency, circumscription/relationship to adjacent salivary gland.
  9. Measure distance to nearest margins.
  10. Take note of intra/peri-glandular lymph nodes, dilated ducts, pus, or calculi.
  11. Discuss with the frozen section attending on service and select appropriate tissue(s) for frozen section:
    1. Consider a section parallel to the cut surface, leaving specimen as intact as possible.
    2. Consider performing a smear to better evaluate the nuclear features.
  12. When complete, pin halves to wax for fixation, cut surface down.
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