Salivary Gland Program

Head & Neck Surgery

 

 

Davud Sirjani, MD
Clinical Associate Professor of Otolaryngology — Head & Neck Surgery (OHNS)
Director of the Salivary Gland Surgery Program

Appointments

(650) 498-6000

Press Option 2, then Option 3

There are 3 sets of major salivary glands which can cause disease that may be benign tumors, cancers or inflammatory/infectious glands. These glands are around important nerves that harbor functions which are essential to speaking, swallowing and facial expressions.  At Stanford our goal is to provide the most effective treatment, while preserving function and restoring cosmesis including innovative approaches.  We have a team of innovative and experienced surgeons who super-specialize in this area to provide our patients with the most modern and cutting-edge techniques to improve their quality of life.

Conditions treated:

  • All parotid, submandibular and sublingual gland benign masses
  • Malignant cancers
  • Obstructions from stones or strictures

Some of our Specialized treatments include:  

  • Advanced minimally invasive parotidectomy for pleomorphic adenomas, including recurrent disease in patients who have had surgery previously.  This includes extracapsular and retrograde partial parotidectomies
  • We reconstruct all our surgical defects to restore cosmetic balance
  • We discuss all of our cancer patients including non-cancer pleomorphic adenomas at our multidisciplinary tumor board (a panel of 20 doctors to prove a consensus for surgical plans).
  • Advanced salivary cancers are treated with surgery, radiation therapy and sometimes chemotherapy.  We offer the latest in facial nerve reconstruction in patients who require facial nerve sacrifice
  • We offer endoscopic assisted surgery and robotic surgery in the rare scenarios which provide the surgeon with an advantage to get access to the tumor
  • We provide sialendoscopy for patients with salivary stones and strictures from radioactive iodine
  • Interventional radiology sclerotherapy of benign cystic lesions of the salivary gland in select cases
  • Intraoperative nerve monitoring on all relevant operations

 

 

Conditions We Manage

Benign Tumors

   

The parotid glands are the largest salivary glands and located on either side of the cheek in front part of the ear to the mid cheek and from the cheekbone to the lower edge of the jaw.  Critical in surgery is preservation of the facial nerve that exits the skull below the ear and passes into and through the parotid gland as it divides into about five branches that go onto and innervate the muscles of facial expression (forehead wrinkle, eye closure, moving nose, and smile).  The facial nerve separates the parotid gland into deep and superficial components (sometimes referred to loosely as “lobes” though the gland is one gland and not separated into components). The majority of pleomorphic adenomas are a single mass in the superficial part of the parotid, although a larger tumor may push nerve branches aside without invading the nerve.

The submandibular gland and sublingual glands have similar masses. 

Pleomorphic adenoma

Pleomorphic adenoma (a.k.a benign mixed tumors) is the most common BENIGN tumor of the saliva (parotid) glands in your cheek and sometime under the jaw in the submandibular gland.  Your tumor is NOT a cancer and will not spread to other parts of the body.  As a benign growth it will grow at 1-3mm per year and over decades it can be large enough to cause a cosmetic deformity especially if you get this tumor in your middle ages.  There is a very small chance that your tumor will change into a cancer (1%) but this process takes several decades.  The recommendations to treat are surgery vs. clinical monitoring (living with the tumor and having the doctor keep an eye on it). 

Why did this happen?
The underlying cause for this tumor is not very well understood.  We do know that you did not get this from your parents, and you will not be getting this to your kids.

   

Warthin's tumor

This is a tumor seen in patients over the age of 60 years old and the only salivary tumor associated with smoking. It can occur in multiple spots and on both sides of the parotid.  The treatment is the same as pleomorphic adenoma with surgery being the main treatment.  These tumors can be painful and do have a small risk of malignant transformation. 

 

 

Your Care Team

Davud Sirjani, MD
Clinical Associate Professor of Otolaryngology — Head & Neck Surgery (OHNS)
Director of the Salivary Gland Surgery Program

Uchechukwu Megwalu, MD, MPH
Associate Professor of Otolaryngology — Head & Neck Surgery (OHNS)
Chief of Comprehensive Otolaryngology

Jennifer Christy Alyono, MD, MS
Clinical Assistant Professor of Otolaryngology — Head & Neck Surgery (OHNS)
Residency Program Associate Director

Jon-Paul Pepper, MD
Associate Professor of Otolaryngology — Head & Neck Surgery (OHNS)

 

Radiation Oncology

Quynh Thu Le, MD
Katharine Dexter McCormick and Stanley McCormick Memorial Professor, Professor and Chair of Department of Radiation Oncology

Michael Gensheimer, MD
Clinical Assoiate Professor, Radiation Oncology

 

Clinical Team

Monika Kurzymski, RN
Nurse Coordinator



Medical Oncology

Speech Therapy

 

 

If you are interested in any of our current trials, please let us know or directly email the study coordinator:

Study of Atezolizumab in Patients With Stage II to IV Cutaneous Squamous Cell Carcinoma

ClinicalTrials.gov Identifier: NCT04710498

Now accepting new patients.

The primary objective of the study is to evaluate the efficacy of Atezolizumab as measured by Pathologic complete response (pCR) rate per independent central pathology review. 

The secondary objectives of the study are: 

  • To evaluate the efficacy of Atezolizumab on measures of disease response, including: 
  • Major pathologic response (mPR) rate per independent central pathology review
  • pCR rate and mPR rate per local pathology review
  • ORR prior to surgery, according to local assessment using RECIST 1.1 
  • To evaluate the efficacy of Atezolizumab on event free survival (EFS), disease free survival (DFS), and overall survival (OS) 
  • To evaluate the safety profile of Atezolizumab 
  • To assess change in surgical plan (ablative and reconstructive procedures) from the screening period to definitive surgery, both according to investigator review and independent surgical expert review 
  • To assess change in post-surgical management plan (radiation, chemoradiation, or observation) from the screening period to post-surgery pathology review, both according to investigator review and independent surgical expert review

 

 

Head & Neck Surgery