What is Parotidectomy?

Parotidectomy is the removal of the parotid gland, a salivary gland near the ear. The main purpose of parotidectomy is to remove cancerous tumors in the parotid gland. A number of tumors can develop in the parotid gland. Many of these are tumors that have spread from other areas of the body, entering the parotid gland by way of the lymphatic system. Among the tumors seen in the parotid gland are lymphoma, melanoma, and squamous cell carcinoma.

Effects of Parotidectomy

Parotidectomy is done for tumors of the parotid gland and occasionally for recurrent infections of the gland. For benign and low grade malignant tumors (acinic cell or low-grade mucoepidermoid cancers), surgery is usually curative without any need for additional therapy. For other malignant tumors, surgery is usually followed by radiation therapy. Occasionally, benign or low-grade malignant tumors that have recurred are treated with completion parotidectomy and radiation therapy.

If cancer was found, you will have a good chance for cure. If a benign tumor was found, you will avoid the problem of having a visible tumor on your face. You will no longer have pain or swelling around the parotid gland.

Candidates for Parotidectomy

Benign parotid gland growths usually appear after the age of 40. Malignant growths most often affect women over the age of 60, while benign tumors affect both sexes equally. Cancer of the salivary glands accounts for only 1% of all cancers, and 7% of all head and neck cancers.

Reasons for performing this procedure are:

  • The parotid gland may have a lump, which may or may not be cancerous. (20% of lumps are malignant.)
  • A parotid gland lump may be benign (not cancerous), but it may be a type that grows slowly and must be removed to prevent severe cosmetic problems.
  • The duct carrying saliva from the parotid gland may be blocked by a stone, causing infection.

Your Consultation

Follow your health care provider’s instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery. Ask your provider if you need to stop taking any other medicines.

Follow any other instructions your provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

The Parotidectomy Procedure

The procedure is done under general anesthesia. The surgeon will make a cut around the front of your ear and under your jaw. The surgeon will fold the skin back and expose the parotid gland. The surgeon will remove the part of the parotid gland that lies over the facial nerve. Another doctor, called a pathologist, will look at the tumor under a microscope. Depending on the type of tumor, the surgeon may need to remove the remaining part of the parotid gland. The surgeon will try to avoid injuring the nerves that lie inside the gland and control facial muscle movement. If you have cancer around the nerve, the surgeon may remove the tumor and that part of the nerve. The surgeon will place a temporary drain in the wound and close the cut.

This incision heals well with minimal scarring and provides safe access to identify the facial nerve and remove all tumor tissue. Superficial parotidectomy takes 3-4 hours to complete. Total parotidectomy may take 5 hours to complete. The incision is usually closed with nylon sutures that are removed 4-6 days after surgery. A drain is also placed which exits the wound behind the ear. This is removed in clinic 2-4 days after surgery.

Recovery

After surgery, the patient will remain in the hospital for one to three days. The site of incision will be watched closely for signs of infection and heavy bleeding (hemorrhage). The incision site should be kept clean and dry until it is completely healed. The patient should not wash their hair until the stitches have been removed. If the patient has difficulty smiling, winking, or drinking fluids, the physician should be contacted immediately. These are signs of facial nerve damage.

Risks

There are a number of complications that follow parotidectomy. Facial nerve paralysis after minor surgery should be minimal. During surgery, it is possible to repair cut nerves. After major surgery, a graft is attempted to restore nerve function to facial muscles. Salivary fistulas can occur when saliva collects in the incision site or drains through the incision. Reoccurrence of cancer is the single most important consideration for patients who have undergone parotidectomy. Long term survival rates are largely dependent on the tumor types and the stage of tumor development at the time of the operation.

Other risks include blood clots (hematoma) and infection. The most common long-term complication of parotidectomy is redness and sweating in the cheek, known as Frey’s syndrome. Rarely, paralysis may extend throughout all the branches of the facial nervous system.

FAQs

What is the parotid gland?

The parotid gland is the largest of the salivary glands. There are two parotid glands, one on each side of the face. They lie just in front of the ears and a duct runs from each to the inside of the cheek. Each parotid gland has several lobes. Surgery is recommend as part of the treatment for all cancers in the parotid gland.

What is the difference between localized and total paroditectomy?

Superficial or localized parotidectomy is recommended by some authorities, unless a lipoma or Warthin’s tumor is present. One of the advantages to this approach is that nerves to facial muscles are left intact. Many facial nerves run through the same area as the parotid gland and can be damaged during more complete parotidectomies. Most authorities recommend total parotidectomy, especially if cancer is found in both the superficial and deep lobes of the parotid gland. If the tumor has spread to involve the facial nerve, the operation is expanded to include parts of bone behind the ear (mastoid) to remove as much tumor as possible. Some authorities recommend post-surgery radiation as follow-up treatment for cancer.

What happens after the procedure?

You may be in the hospital for a day. The side of your face will be swollen for about 3 weeks and sore for at least a week. If any of the nerves in your cheeks were bruised, the side of your face may be numb and the muscles may be weak. Your face may droop for 3 to 6 weeks. Permanent weakness is common in the lower lip on the side where you had the surgery, but permanent facial weakness or paralysis is rare. While you are recovering, you may feel discomfort when chewing.

Ask your health care provider what steps you should take and when you should come back for a checkup and removal of the drain.

What are the risks involved in this procedure?

There are a number of complications that are associated with parotidectomy. Facial nerve paralysis after minor surgery should be minimal. After major surgery, a graft is attempted to restore nerve function to facial muscles. Salivary fistulas can occur when saliva collects in the incision site or drains through the incision. Recurrence of cancer is the single most important consideration for patients who have undergone parotidectomy. Long-term survival rates are largely dependent on the tumor type and the stage of tumor development at the time of the operation.

Other risks include hematoma (collection of blood under the skin) and infection. The most common long-term complication of parotidectomy is redness and sweating in the cheek, known as Frey’s syndrome. Rarely, paralysis may extend throughout all the branches of the facial nervous system.