Consultant ENT, Head and Neck and Thyroid Surgeon

Parotidectomy

What is Parotidectomy?

Parotidectomy is a surgical operation to remove the parotid which is a large salivary gland located in front of the ear and slightly below it. The most common reasons for removing all or part of this gland are a tumour, chronic infection, or obstruction of the saliva outflow causing chronic enlargement of the gland. Surgeons describe the parotid gland as having two lobes, superficial and deep, separated by the facial nerve that makes the face move and the eye close.

Parotidectomy is usually performed under general anaesthesia. The amount of parotid gland to be removed is often determined at the time of surgery, based on the size and location of the diseased parotid tissue. The extent of surgery may also depend on pathological examination of tissues removed during the surgery.

Most parotid tumors (80%) are benign. The remaining 20% are malignant. The most common tests to determine the nature of a parotid tumour include an ultrasound scan (USS), CT scan (an x-ray test that helps to determine the size and position of the parotid tissues), and MRI scan (an imaging test that uses powerful magnets instead of x-rays). FNA (fine needle aspiration biopsy), may also be helpful. During this procedure, a small amount of fluid is withdrawn from the parotid to see if malignant cells are present,

What happens during surgery?

When the tumour is removed, it is sent for histological evaluation. This means that the pathologist will examine it with various dyes that help in deciding what kind of tumour it is and if it is malignant or benign.

When superficial, benign tumours are treated with excision of the superficial lobe of the parotid gland. Deep tumors may require a total parotidectomy or excision of the portion of the tumour that is deep to the facial nerve. Every effort is made to preserve the facial nerve.

What happens after surgery?

When you wake up from surgery, you will be transported to the recovery room, where would spend about 30 minutes to an hour, until you are fully awake and stable for transportation to your room. You will be asked to move your face, smile or pout to check on the movement of your face.

You will notice a drain tube attached to your clothes. This is usually removed the next day.

For 2 – 3 days after the surgery, it is not unusual to have pain.

When do I go home?

In general, most patients are discharged the day after the operation. By then, they should be able to eat, walk and go to the bathroom.

What are the possible complications?

Possible short term complications include bleeding and infection. Although rare in parotid surgery, some patients may develop a thick scar or keloid. . In some patients, a depression or a "dent" occurs at the site of the removed tumour. Many patients experience numbness of the earlobe and outer edge of the ear after parotid surgery. Sometimes this is permanent if the little nerve that gives senstion to the are has had to be cut to remove the tumour. In a small proportion of patients the face on the side of the parotidectomy sweats while eating ("Frey’s syndrome / gustatory sweating") Most often, this goes essentially unnoticed, however, if it should become bothersome medication and sometimes surgery are available. Very rarely, a salivary fistula may occur, with saliva draining from a small opening in the incision.

Why is the facial nerve important?

The nerve that controls motion to the face (the facial nerve) runs through the parotid gland. This nerve is important in closing the eyes, wrinkling the nose, and moving the lips. Most often the parotid gland can be removed without permanent damage to the nerve, however, the size and position of the diseased tissue may require that the nerve, or small branches of the nerve, be cut to assure complete removal. Even if the nerve is not permanently injured, there may be decreased motion of the facial muscles as the nerve recovers from the surgical procedure. If facial motion does not fully return, there are ways to rehabilitate facial movement.