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.
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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.
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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.
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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.
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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.
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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.
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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.
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Frequently Asked
Questions
Q: What is the parotid gland?
A:
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.
Q: What is the difference between localized
and total paroditectomy?
A:
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.
Q: What happens after the procedure?
A:
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.
Q: What are the risks involved in this
procedure?
A:
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.
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