Salivary Gland Malignancies: Diagnosis and Treatment of a Rare and Challenging Cancer

There have also been some advances in dealing with facial paralysis. Neuromuscular retraining has been gaining recognition as an effective modality for optimal recovery from facial nerve paresis.13,14 The retraining includes the use of surface electromyographic facial nerve monitoring and sensory feedback (practicing exercises in front of a mirror) to increase activity in weak muscles, improve coordination of muscle groups, and decrease activity in hyperactive muscles. Although there are not many physical therapists specializing in nonsurgical facial nerve rehabilitation, there are some centers in the Midwest-most notably, the Neuromuscular Retraining Clinic at the University of Wisconsin Hospital and Clinics, run by H. Jacqueline Diels, OTR-to which patients can be referred. Advances in this area have the potential to immeasurably improve patients’ quality of life. A person with facial paralysis loses not just his or her self-image (which can engender social prejudice) but also the ability to convey the normal social signals of interpersonal communication. Restoring function and expression to the highest possible level results in patients’ improved health, self-esteem, acceptance by others, and quality of life.

Support for the Patient

Most patients with malignant salivary gland tumors have two major issues, said Dr. Schaitkin. Not only do these patients face a potentially life-threatening diagnosis, but the very real possibility that they will have some facial paralysis. Dr. Schaitkin, who runs a facial paralysis center, is often amazed at how close the psychosocial aspects of facial paralysis equal those of the diagnosis of cancer. Some patients with terminal prognoses still get tremendous benefit from minor facial reanimation procedures.

Physicians can help provide psychosocial support for these major issues in some of the following ways.

At diagnosis: Careful attention should be paid to conducting a candid, truthful, and gentle discussion of patients’ situations, said Dr. Medina. At his tertiary center, patients may be intimidated by initial discussions that can include up to three physicians (surgeons and radiologists) as well as trainees. Dr. Medina has found that patients at the University of Oklahoma often open up to a dedicated oncology nurse who is part of the multidisciplinary team. The multidisciplinary team at UCSF includes oncology social workers and psychologists who can provide counseling, said Dr. Eisele. This [facial paralysis as the result of surgical treatment] is a daunting thing for someone to contemplate. His team at UCSF also links newly diagnosed patients with those who have already successfully completed treatment and rehabilitation. This can be a powerful support to a patient in the early period after diagnosis and during treatment.