Overview
The parotid glands make saliva and are found on each side of the face, in front of the ears. They are not the only salivary glands. The parotid gland is special because the nerve that controls the muscles of the face, the facial nerve, runs through the gland. This nerve controls the muscles that raise the eyebrows, close the eyes, smile and frown, and stop food from leaking out of the mouth.
A parotidectomy is most often done to remove a tumour from the parotid gland. Most parotid tumours are benign, but cancers also grow in the parotid and are more likely to affect the facial nerve. The tumour, together with an area of normal-appearing tissue, is removed to reduce the chance of any tumour cells being left behind. If the tumour is a cancer, the lymph nodes in the neck may also be removed at the same time (a neck dissection).
Who It Helps
Parotid tumours usually present with
- Swelling in the face and jaw, usually painless and by far the most common
- Loss of facial movement, which can indicate a serious diagnosis
- Difficulty swallowing, which is very rare
What Happens
Parotid tumours are diagnosed following an ultrasound-guided fine needle aspiration (FNA), in which cells are removed for testing. Imaging such as an MRI or CT scan may be used to check the size of the tumour and whether it has spread. Most parotid tumours are benign, such as pleomorphic adenoma, Warthin’s tumour and oncocytoma. Malignant tumours include metastasis from skin cancers and several types of salivary carcinoma.
Superficial Parotidectomy
Used when the tumour is limited to the superficial lobe of the parotid gland. All or part of the affected superficial lobe is removed, along with some surrounding tissue.
Total Parotidectomy
For tumours in the deep lobe, a total parotidectomy may be recommended to remove the deep lobe and, if necessary, part of the superficial lobe for access.
Protecting The Facial Nerve
In both types of surgery, protection of the facial nerve is critical. During surgery Dr Kelly uses nerve integrity monitoring (NIM), a device that monitors the function of the facial nerve. This helps protect the nerve and minimises the risk of weakness in the facial muscles. In exceptional circumstances this is impossible due to the location or size of the tumour.
Recovery Information
Immediate Recovery
A hospital stay of 1 to 2 days is typical. A small surgical drain may be placed in the wound, which is usually removed within 1 to 2 days.
Diet And Activity
Normal diet. Strenuous exercise and heavy lifting are restricted for about two weeks.
Timeline
You can usually return to work or driving within 1 to 2 weeks, provided you are no longer taking prescription pain medication. Full sensation in the face and ear can take several months, and occasionally up to a year, to return.
Possible Side Effects
Nausea: general anaesthetic may cause nausea, which settles soon after the operation and can be treated.
Sore throat: from the breathing tube placed during the operation.
Numbness near the ear: the skin in front of the ear will be numb for some time. This gradually improves over months, but the ear lobe usually stays numb.
Bleeding or bruising: occasionally an operation may be needed to remove a blood clot.
Pain when eating: rarely, first bite syndrome, which usually improves over time.
Gustatory sweating: sweating on the operated side of the face.
Facial weakness: rare.
Post-Operative Care Instructions
Detailed aftercare guidance for your surgery, to keep and refer back to.
Frequently Asked Questions
Are most parotid tumours cancerous?
No. Most parotid tumours are benign (non-cancerous), with pleomorphic adenoma being the most common.
How is the facial nerve protected during surgery?
Dr Kelly uses nerve integrity monitoring (NIM) to monitor the facial nerve throughout surgery, minimising the risk of facial weakness.
How long will I stay in hospital?
A hospital stay of 1 to 2 days is typical, and a small drain is usually removed within 1 to 2 days.
When can I return to work?
Usually within 1 to 2 weeks, provided you are no longer taking prescription pain medication.