PAROTIDECTOMY – PAROTID GLAND REMOVAL
A parotidectomy is the surgical removal of part or all of the parotid gland. The parotid gland is the largest of the salivary glands, all of which produce saliva. It is located just in front of the ear, and extends behind the ear and into the upper neck. There are two parotid glands, one on each side. The most common indication for parotidectomy is a tumour (lump) in the gland; however most parotid tumours (85-90%) are benign. The most common parotid tumour is a pleomorphic adenoma. Fine needle aspiration biopsy (FNA) can be done preoperatively but rarely changes the decision as to whether to operate or not.
Parotidectomy is performed under general anaesthesia. The operation usually takes about two hours to perform, and the recovery is usually rapid. The operation involves making a cut immediately in front of the ear. This cut is extended either downwards into the neck or behind the ear. Once the gland has been removed the incision is held together again with stitches. These need to be removed around a week after surgery. At the end of the operation a small tube (referred to as a drain) is placed through the skin into the underlying wound to drain any blood which may collect. This is usually removed the following morning. Most patients are ambulatory the day of surgery, and most are discharged from hospital the following morning. Most are able to return to work without restriction within two weeks.
Unfortunately, every operation entails some risk, and parotidectomy is no exception. The parotidectomy incision is very similar to that used for a facelift. This scar will be noticeable immediately after the surgery; however it will usually fade and eventually it should blend into the natural folds of the skin. Since part of the gland is removed it can leave a slight dent under the skin.
Bleeding from beneath the skin can collect and form a haematoma. This occurs in about 5% of patients. This is why a drain is left in for a number of hours after the operation. Infection is uncommon but if you are at an increased risk you may be prescribed a short course of antibiotics.
In one in twenty saliva leaks from the cut surface of the gland. This can collect under the skin. The problem usually settles down on it s own, however, it may be necessary to remove some saliva with a needle.
The removal of the parotid gland will not affect the amount of saliva that you produce as there are many other salivary glands left to keep the mouth moist.
The cheek area will be numb after the surgery, as will the lower half of the earlobe. This numbness improves with time but never resolves completely. The skin of the side of the face will be numb for some weeks after the operation, and often you can expect your ear lobe to be numb permanently.
In addition, when the cheek skin is lifted up to gain access to the parotid gland, tiny nerves that supply the salivary gland and the sweat glands in the skin are unavoidably divided. These nerves grow back, however a nerve that supplied the salivary gland may grow into and supply sweat gland and vice versa. Therefore when the patient smells or tastes food, the nerve fires but stimulates the sweat gland instead of the salivary gland. This facial sweating during meals (Frey’s syndrome) occurs in most patients after parotidectomy to a variable degree. It is rarely a significant problem.
The major risk of parotid surgery is the risk of facial paralysis. There is a very important nerve, the facial nerve, which passes right through the middle of the parotid gland. This nerve makes the muscles of the face, forehead and eyelids move. Most nerve damage occurs as a result of bruising since the facial nerve is protected during surgery. If the facial nerve is damaged during surgery it can lead to a weakness of the face (facial palsy) on that side. In most cases the nerve works normally after the surgery. However in about 1 in five cases, a temporary weakness of the face can occur. This weakness can take several months to recover fully. In 1 in a hundred of cases there is a permanent weakness of the face following this sort of surgery for benign tumours.
As in all surgery it is essential to see a surgeon who will be able to tell you whether your problem can be remedied by surgery, and what the risks are. Thereafter you will be in a position to decide whether you should go ahead or not.