Open Journal of Stomatology, 2013, 3, 465-470 OJST Published Online December 2013 (
Tumours of salivary glands in the stomatology and
maxillo-facial surgery unit at the university hospital centre
—Yalgado Ouédraogo
Mathieu Millogo1*, Tarcissus Konsem1, Haréfétéguéna Bissa2, Rasm a né Béogo 3,
Dieudonné Ouédraogo1
1Service of Stomatology and Maxillo-Facial Surgery of the University Hospital Yalgado Ouédraogo, Ouagadougou, Burkina Faso
2Service of Stomatology and Maxillo-Facial Surgery of the University Hospital of Tokoin, Lomé, Togo
3Service of Stomatology and Maxillo-Facial Surgery of the University Hospital Souro SANOU, Bobo-Dioulasso, Burkina Faso
Email: *
Received 20 September 2013; revised 1 November 2013; accepted 19 November 2013
Copyright © 2013 Mathieu Millogo et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The aim of this study was to contribute to strengthen-
ing the efficiency in the treatment of the salivary
gland tumours in the Stomatology and Maxillo-facial
surgery service at the University Hospital Centre/Yal-
gado OUEDRAOGO of Ouagadougou. It has been a
retrospective and descriptive study covering seven (7)
years [January 2006-December 2012] on epidemiol-
ogy and the treatment of 54 cases of the salivary
glands tumours histologically confirmed. Benign tu-
mours (non-mal ignant tu mour s were pr eval ent (61.11 %
of cases). The annual incidences were 4.71 cases for
non malignant tumours and 3 cases for malignant
tumours. The average age was 34 - 45 years for non
malignant tumours and 44 - 33 years for malignant
ones. In both groups, the tumour was discovered
lately with an average 32 - 48 months before consult-
ing in case of non malignant tumours and 18 - 29 mo n-
ths for malignant tumours. The location of non ma-
lignant tumours was very often the parotid (42.42%),
under mandible gland (27.28%). Malignant tumours
very often concerned the parotid (76.18%) and the
under mandible gland (14.29%). The histology has
revealed that pleomorphic adenoma was the leading
type of non-malignant tumours (93.94% of cases)
whereas carcinoma was predominant in malignant
tumours (80.95% of cases). Long term track keeping
was difficult and it has been complicated by the loss
of contact with some patients. The low living stand-
ard, the time wasted before consulting, limited human
resources and therapeutic means constitute handicaps
to the treatment in our African context.
Keywords: Tumours; Salivary Glands; Epide miolo gy;
Histology; Treatment
The tumours developed at the expense of the main sali-
vary glands (parotid, under-mandible, sub-lingual) and
accessory salivary glands are relatively frequent in every-
day medical practice. Indeed, according to Ansari [1], in
the Republic of Iran and Boko [2] in Togo, they represent
respectively 3% to 6% of all tumours of the head and
neck and 17.19% of Oto-Rhino-laryngology sphere.
Salivary gland tumours have a diverse histology, but
the non-malignant forms are prevalent with pleomorphic
adenoma as the leading type [3-5]. However, tumours are
not rare and they remain the haunting memory for any
doctor. Only anatomo-phatologic study enables to diag-
nose these tumours efficiently and therefore to suggest
the appropriate therapeu tic attitude [6].
The earlier diagnose of salivary gland tumours is the
guaranty for an optimal treatment. In our under-devel-
oped African context, many difficulties are met impeding
seriously diagnostic and therapeutic procedure. As a
matter of fact, most patients come to consult at a very
advanced stage of the disease, with very developed tu-
mours called historic ones. Incidentally, their precari-
ousness limits seriously diagnostic investigations and
therapeutic responds. The aim of this study is to do the
inventory of salivary gland tumours in our context in or-
der to strengthen the efficiency of their treatment.
It was a retrospective study concerning medical files of
patients’ suffering from tumours of salivary glands in the
*Corresponding a uthor.
M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470
Stomatology and MaxillO-facial surgery unit at the Uni-
versity Hospital Centre—Yalgado OUEDRAOGO from
2006 to 2012 representing 7 years.
Our population of study was a non probabilistic and
exhaustive type. The study has taken into consideration
all the salivary glands tumours cases treated in the hos-
pital service and which histology was confirmed during
the period of study. We have examined patients coming
for consultation and completed the sample with data
from hospitalization’s registers. We have also used data
from surgery reports and patients’ medical reports. The
variables studied were epidemiologic (age, sex, profes-
sion), clinical, histological and therapeutic. Data have
been analyzed with EPI INFO 3.5.1 software/French
version August 2008. Statistic calculations have been
done with Chi 2 of Pearson to compare different vari-
ables with an Alpha risk equal to 0.05. The test is con-
sidered as conclusive if the value of P is less than 0.05.
Due to our context, it was not possible to practice im-
muno-histochemistry investigation.
3.1. Epidemiological Aspects
During the period of study, 77 files have been recorded
and 54 have been kept on the basis of inclusion criteria.
This serial counted 33 non-malignant tumours and 21
malignant tumours of salivary glands. The annual inci-
dence was 4.71 cases for non-malignant tumours and 3
cases for malignant tumours. The breaking down of pa-
tients by sex has been reported in Table 1.
Chi2-corrected = 4.4728, P = 0.03444. The relation
between the sex and the type of tumours has been statis-
tically significant (P < 0.05).
The sex ratio of all the salivary glands tumours was at
0.86. It was at 0.5 in non-malignant series and at 2 in
malignant tumours.
The patients’ average age was 39.28 with extremes of
2 and 70 years old. In the cases of non-malignant tu-
mours, the age group of (15 - 30) was the modal class.
The average patients’ age carriers of a non-malignant
tumour of saliva glands were 34.45 with some extremes
of 2 and 60 years. For malignant tumours, the modal
class was the age group of (45 - 60).
The patients’ averages age was 44.33 with extremes of
6 and 70 years old.
Table 1. Breaking down of patients by sex.
Sex Non-malignant
tumours Malignant
tumour Total
Female 22 (66.67%) 7 (33.33%) 29 (53.70%)
Male 11 (33.33%) 14 (66.67%) 25 (46.30%)
Total 33 (100%) 21 (100%) 54 (100%)
3.2. Clinical Aspects
In the non-malignant tumours serial, the average con-
sulting time was 32.48 months with extremes of 1 to 120
months. In malignant tumours cases, 18.29 months were
the average time before consulting with extremes of 1 to
72 months.
Non-malignant tumours were located at the parotid
(42.42%), at under mandible gland (27.28%), at sub lin-
gual gland (12.12%) at palatal gland (9.09%) and at lips
gland (9.09%) (Figures 1 and 2). Malignant tumours
were also located at salivary glands, but with a great pre-
dilection for the parotid: parotid (76.19%) under mandi-
ble gland (14.19%) and palate gland (9.52%). Tissue
covering the tumefaction was apparently healthy in
84.85% of non-malignant tumours, and ulcerous in
42.86% of malignant tumours The value of Chi2 = 21.26
and P = 0.002 (Figures 3 and 4).
Figure 1. Pleomorphic adonoma
of the parotid gland.
Figure 2. Under mandible gland
Figure 3. Carcinoma of the pa-
rotid gland on burn scars.
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M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470 467
Figure 4. Parotidian sarcoma.
3.3. Histological Aspects
Histological types encountered have been summed up in
Table 2.
The non-malignant tumours predominated with 61.11%.
Pleomorphic adenoma was the most frequent non-ma-
lignant tumour (93.94% of cases).
The malignant tumours (38.89% of cases) were domi-
nated by carcinomas (80.95% of cases).
Two types of carcinoma were frequently met: the epi-
dermoid carcinoma and the cystic adenoid carcinoma,
23.53% of cases each. Sarcomas, 19.05% of malignant
tumours were as follow: 1 case of fibro-sarcoma, 1 case
of lipo-sarcoma and 2 cases of non differentiated sar-
coma (Figures 5-8).
The histological breaking down by age group has been
represented in the Table 3.
A great proportion of patients suffering from pleo-
morphic adenoma (3 2.26%) were found in the age group
of (15 - 30). Patients suffering from carcinoma belonged
to the age group of (45 - 60) re presenting 47. 06% of cases.
3.4. Therapeutic A spects
The therapeutic means were surgery and medicinal treat-
ment. A surgical treatment has been done with all pa-
tients suffering from non-malignant tumour. It has been a
tumourous extraction taking out the entire or part of the
In cases of malignant tumours, the tumourous extrac-
tion required taking out the entire gland and in addition
to this a lymphe node groove was associated.
Anti-cancerous chemotherapy used as adjuvant treat-
ment to surgery has been necessary for only 3 patients.
The evolution has been characterized by the transforma-
tion of pleomorphic adenoma into malignant histo-
cystoma of the parotid with a six years step back. More-
over, 5 cases of recurrences of pleomorphic adenoma and
2 cases of recurrences of malignant tumours were no-
ticed with a step back of 2 years. Howe ver, in 41 patients
(75.93%) were no longer in touc h with medical staff with
a step back of 6 years.
Figure 5. Microscopical aspect of oncocy-
tary carcinoma of saliva glands.
Figure 6. Microscopy of a cystic adenoid
Figure 7. Microscopical aspect of epider-
moid carcinoma moderately differenciated of
the parotid.
Figure 8. Microscopical aspect of a sarcoma
of the parotid.
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M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470
Tab le 2 . Breaking down of tumours according to the histologi-
cal type.
Histological types Value Percentage
Pleomorphic adenoma 31 57.41
tumours Oncosis [o nc oc ytom a] 2 3.70
Carcinoma 17 31.48
Malignant tumours Sarcoma 4 7.41
TOTAL 54 100
Table 3. Distribution of histological types according to age
adenoma N° (%) Oncocytoma
N° (%) Carcinoma
(%) Sarcoma
N° (%)
(0 - 15) 3 (9.68) 0 (0) 1 (5.88) 0 (0)
(15 - 30) 10 (32.26) 2 (100) 1 (5.88) 2 (50)
(30 - 45)9 (29.03) 0 (0) 4 (23.53) 0 (0)
(45 - 60)8 (25.81) 0 (0) 8 (47.06) 1 (25)
>60 1 (3.22) 0 (0) 3 (17.65) 1 (25)
TOTAL 31 (100) 2 (100) 17 (100) 4 (100)
4.1. Epidemiological Aspects
Tumourous pathology of salivary glands is relatively
frequent [2,5]. In a period of seven years, we have re-
corded 54 cases confirmed by the histology. We think
however that these figures are far from the reality due to
the under notification of cases. In our context character-
ized by poverty and ignorance of the population, a great
number of patients don’t do anatomo-pathologic check
and another important number do not go to hospital,
having preference for traditional medicine. In fact after
surgery, many patients could not afford to do the ana-
tomo-pathologic checking of the operated part. The his-
tological extempore per operative checking was not
available. In addition to this, cancers register in Burkina
is not functional and it does not permit to record all the
malignant tumours cases. The 54 salivary glands tumours
were composed of 21 malignant tumours (38.89% of
cases) and 33 non-malignant cases (61.11% of cases).
The prevalence of non-malignant salivary glands tu-
mours in comparison to malignant tumours is reported by
most of the authors: Ehsen [5] in Tunisia (88% of non-
malignant tumours and 12% of malignant tumours),
Ochida [7] in Nigeria (56.5% of non-malignant tumours
and 43.6% of malignant tumours). We have noticed a
prevalence of female patients 53.70% suffering from
non-malignant tumours of salivary gland. The sex-ratio
was 0.86. Similar results have been observed by most of
the authors [2,8-11].
In the malignant tumours serial, there was a preva-
lence of male patients with a sex ratio of 2. There was a
significant statistic relation between the sex and the na-
ture of the tumour (the Chi2-corrected = 4.4728, P =
0.03444). The male prevalence being noticed in malig-
nant tumours and female predominance in non-malignant
tumours salivary glands. In our society in fact, men are
more active and seem more exposed to different risk
factors (alcohol, tobacco, irradiations, etc.) responsible
for malignant tumours. Besides, men tended less to visit
doctors in absence of evident symptoms, also because of
socio professional constraints and ignorance.
As far as women are concerned, their esthetical pre-
occupation obliged them to go earlier to consultation
than men as soon as they notice a facial and cervical tu-
In the non-malignant tumours series, the age group of
(15 - 30) was the modal class. The average year of the
appearance of non-malignant tumours of salivary glands
was 44, 33. Non malignant tumours would appear at any
age, but with high frequency as far as young persons are
concerned [4,11]. In the malignant tumors serial, the
modal class was the age group (45 - 60) years. The aver-
age of appearance of malignant tumours of saliva glands
was 44.33 years. Classically malignant tumors are fre-
quent with aged subject, wit h risk f actor s su ch a s tobacco,
alcohol and the absence of month and dental hygiene
4.2. Clinical Aspects
The time before consulting was relatively long in these
series and most of the patients have often come with tu-
mours already in evolution. Indeed socio-cultural beliefs
and the difficulties to afford hospital cures, in addition to
the geographical distance of most hospital centers oblige
patients to resort to traditional medicine before coming
in a modern one. We also have the lack of qualified med-
ical staff.
All salivary glands can be the location of a tumour
(non-malignant or malignant) but with prevalence at pa-
rotid. The prevalence of non malignant and malignant
tumors of salivary gland at the parotid can be explained
by the fact that this it is the biggest one and the most
functional of salivary glands [12-15].
4.3. Anatomo-Pathologic Aspects
Non-malignant tumors represent 61.11% of all tumors of
our series.
The pleomorphic adenoma was the most frequent tu-
mour (93.94% of non malignant tumours). This preva-
lence of pleomorphic adenoma has been found by all the
authors who dealt with the qu estion. Ehsen B.B. in Tuni-
sia [5] and Edda A.M.V. in Ouganda [4] have respec-
tively reported among tumors of th eir series 81.9%, 88%
and 74.8% of pleomorphic adenoma. The frequency of
Copyright © 2013 SciRes. OPEN ACCESS
M. Millogo et al. / Open Journal of Stomatology 3 (2013) 465-470 469
the pleomorphic adenoma among non malignant tumors
of salivary glands could be explained by the cellular di-
versity of salivary glandular tissue. The pleomorphic
adenoma is indeed a mixed tumor. Its microscopy shows
epithelial and myoepithelial cells in an abundant stroma
with some chondroma or myxoid areas [2,5,16,17]. Ma-
lignant tumours represented 38.89% of all the tumours
(80.95% of carcinomas and 19.05% of sarcomas). The
epithelial nature predominating in salivary glands cells
could explain the predominance of carcinoma [18,19].
We have noticed in our series 9 different types of car-
cinomas dominated by the epidermoid carcinoma (23%,
53%) and adenoid cystic carcinoma (23.53%).
This histological diversity among malignant tumours
of salivary glands could be explained by the diversified
characteristic of salivary glands cells (epithelial interme-
diaries, acinous, oncosis, malpighian). There seems to be
a general agreement on the prevalence of carcinomas
among malignant tumours of salivary glands and on the
histological diversity of carcinomas. However, no histo-
logical form among carcinomas of salivary glands has
been considered as leading type of the file [5,7,18 - 20].
Sarcomas were less frequent (19.05% of malignant
tumours), but with also varied histolog ic types. This con-
cerns rare nesenchymatous tumours appearing at all age
and representing nearly 1% of all cancers [8,12,15,17,
4.4. Therapeutic A spects
The treatment of non malignant tumours of salivary
glands is exclusively surgical [6].
The treatment of malignant tumours of salivary glands
is multidisciplinary. It combines oncology, surgery, ra-
diotherapy and psychology. It takes into consideration
the histopathology of the tumour, its state of evolution,
its location, the availability of medical platform and the
patient. Chemotherapy and radiotherapy are often used to
complete surgery in the therapeutic protocol. The radio-
therapy was not availab le in our context. In addition, th e
immuno-histochemistry could not be done, which has
certainly limited the choice of the drugs in the chemo-
therapy. The particular case is the one of parotid gland.
As a matter of fact, therapeutic indication depends on the
location, the volu me of the tumour, the age of the patient,
but also the results of the histological examination ex-
tempore and the infiltration of adjacent structures by the
tumour [6,10,18]. An evoluated malignant tumour will
require a surgical extraction of the gland (partial or en-
tire), extended to adjacent structures (facial nerves, mus-
cular plan). The histological type and grade of malignant
tumour as well as its clinical stage will necessitate a
lymph node groove. Radiotherapy in association with
surgery improves the prognostic of treated tumours and
decreases the rate of local and regional recurrence [18].
The evolution of salivary glands tumours in our con-
text has been characterized by recurrences (5 cases of
pleomorphic adenomas and 25 cases of malignant tu-
mours) and a malignant transformation of plesiomorphic
adonema. We think however that there is an under noti-
fication of recurrent cases in our study due to the diffi-
culty to follow patients in long term. The great number
of patients who did not keep in touch with medical staff
can be a justification. Recurrences are often linked to an
incomplete resection of the initial tumour, especially in
case of exo facial parotidectomy. Generally, the pleomor-
phic adenoma has a high tendency to recurrence [3,8].
The pathology of salivary glands tumours is relatively
frequent but less known by our population. An accurate
diagnosis rests upon the histological examination. The
very concern with salivary gland tumours in our context
is their treatment. As a matter of fact, most patients con-
sult lately or wander about because of ignorance or
socio-cultural beliefs. The difficulties at the therapeutic
level are particularly due to an insufficiency of qualified
human resources, but also because of the medical plat-
form under acceptable standard. All these situations do
not permit an adequate treatment. In addition to this, we
have the ignorance of the population and the precarious-
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