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Salivary Gland Pathology


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transpired over the past seven years to warrant a new edition of a text concerning salivary gland dysfunction only first published in 2008. The prevalence of salivary gland neoplasia in comparison to other oral tumors is very small, and to whole body cancer even smaller; significant trauma to the glands ranks low in incidence compared to the rest of maxillofacial injuries; no one dies from inflammatory or immune disease of the glands; don't these facts mitigate against the need for a new textbook on the salivary glands every few years?

      Quite the contrary! Because the 2008 Carlson‐Ord volume was one of the very few works – and certainly the most comprehensive – dedicated solely to their topic, it is almost mandatory that it be reviewed and up‐dated on a regular basis to provide clinicians and educators an authoritative repository of new information in this specialized field of interest.

      And, indeed, there is new information! The complexity, variety, and heterogeneity in the origins of salivary gland tumors (as discussed in the new Chapter 8) makes these lesions an ideal study group for the development of all malignant neoplasia; they give credence to the notion that all disease, particularly malignant, is ultimately individualized and not to be boxed into currently recognized classifications. Senior readers will well remember the teaching axiom that salivary gland malignancies are impervious to radiation therapy; this new edition's Chapter 12 effectively disassembles that contention. Concurrently with the burgeoning understanding of cellular pathology at the subcellular and molecular levels, the concept of systemic chemotherapy, even targeted therapy, for salivary gland cancers has demanded re‐evaluation over the past decade; this is illuminated in the new Chapter 13. Further, the authors have combined their first‐hand knowledge with a compilation of all pertinent literature to offer a unique assembly of pediatric salivary gland pathology in Chapter 15, another addition.

      While new knowledge – most excitingly provided in Chapters 8, 12, and 13 – and updated bibliographies, sketches, highlighted algorithms, and investigational studies are features of the new text, the focus of these elements and the overall emphasis of the work remains the surgical treatment of patients. Illustrative surgeries from the first edition have been retained, and new cases added to demonstrate principles and additional techniques. Management of the more common salivary tumors, injuries, and infections is well exhibited, but room is provided for illustration of rarer entities (Primary desmoid melanoma of the parotid?! Central (osseous) mucoepidermoid carcinoma of the mandibular ramus?!). Mundane or rare, the range of these maladies, plus the scope and depth of their demonstrated knowledge, attest to the broad experiences of Carlson and Ord in the field of salivary gland abnormality, and deservedly position them in the upper echelons of American salivary gland surgeons.

      One could anticipate in 2008 that Carlson‐Ord would recognize the abiding need for pertinence and currency in their text; indeed, they have and have delivered again.

      Robert Bruce MacIntosh, DDS

      Department of Oral and Maxillofacial Surgery, University of Detroit Mercy School of Dentistry, Detroit, MI, USA

      Foreword Third Edition

      What defines dedication if not the willing contribution of countless hours, huge blocks of energy, and outpouring of intellect and meaningful experience to construct a landmark scientific text? Indeed, these were the elements that Eric Carlson and Robert Ord mobilized in 2008 in introducing to the surgical world their first – now landmark – textbook on salivary gland pathology and treatment. Their dedication to the topic was intense – they had elevated it to the level of subspecialty – and the volume’s success prompted an updated second edition in 2016. Now, with Carlson‐Ord‐III, they have answered the continuing demand and – because of progress within the discipline – the need, for integration of previous writing with new information in the field.

      To be a good scientific writer, an author must first be a good teacher, ready to anticipate uncertainties, confusion, or missed emphasis in the minds of his less‐initiated readers, but also ready to anticipate the worthy critique of an experienced colleague. Both Carlson and Ord have easily answered this requirement, not only in their decades‐long responsibilities in the resident education milieu but in countless lecture engagements, conferences, and surgical activities worldwide. Their word on the topic of salivary gland maladies is authority, and it is effectively transmitted both in the operating room and from the podium.

      Some say today that a textbook is passé, that what is important in the literature can be much more efficiently harvested through one’s fingertips on a computer. The good textbook is bifocal, however: It must be a lightning rod for all that is new and exciting at the time of printing, but also an entombed repository of everything pertinent that has been recorded up to that date. To honor the functions, the authors have labored diligently to review and update the bibliographies of the texted materials, including pertinent meta‐analyses of earlier literature, and inserting more descriptive visuals of earlier material where appropriate. New features of this Third Edition include greater than 100 new full‐color images, illustrated case presentations to demonstrate important clinical situations, and new chapters on minimally invasive surgery and the complications of surgery in the field. The roster of contributing faculty now numbers 14. With this detailed review and revision, the new edition provides an edited compilation of salivary gland pathology not readily recoverable through journal review, regardless how efficient.

      From the perspective of 50+ years of navigation in the ablative and reconstructive precincts of oral and maxillofacial surgery, one can safely relate today’s circumstances to those of “back when”. In the earlier decades of the last half‐century, imaging diagnosis of salivary gland disease depended chiefly on plain radiography and contrast sialography; microscopic diagnosis was dependent on the accommodation of a tumor to one of perhaps a dozen epithelial variants; chemotherapy protocols were essentially adaptions of those used for management of squamous cell carcinoma; salivary carcinoma was thought impervious to radiation therapy; surgical management of salivary malignancy fell almost exclusively to those few otolaryngologists, general surgeons, or, more infrequently, oral and maxillofacial surgeons, with special interests in treating these relatively uncommon lesions.

      Immense progress in understanding the pathophysiology of salivary gland disease in later years has delivered incredibly complicated microscopic classifications and more precisely directed chemical treatment protocols, and over the past two decades, the earlier assumption that salivary gland disease was impervious to radiation therapy has been demolished. This improved understanding of salivary gland biology has brought in train the need for increasingly well‐founded and sophisticated care within all interested surgical groups; Dr. Carlson in Knoxville, and Dr. Ord in Baltimore have answered this call with their surgical expertise and recognized educational efforts in oral and maxillofacial surgical training.

      With this Third Edition, the authors have ensured their volume’s position in the lexicon of surgical texts, a metric against which all future efforts will be scaled.

      Robert Bruce MacIntosh, DDS

      Department of Oral and Maxillofacial Surgery, University of Detroit Mercy School of Dentistry, Detroit, MI, USA

      Preface First Edition

      The concept of this book devoted to the diagnosis and management of salivary gland pathology arose from our longstanding friendship and professional relationship where we first collaborated in the early 1990s. This led to a trip to India with the Health Volunteers Overseas in 1996, where we operated numerous