The parotid gland is located on either side of the face, in front of the ear over the upper portion of the jaw, with a small part extending below the earlobe. Its primary function is the production of saliva in your mouth. The gland is divided into superficial and deep lobes, with the plane of division being the facial nerve, a nerve that controls the movement of muscles on that side of the face. Both benign and malignant (cancerous) tumors can affect the gland.
Other inflammatory or autoimmune diseases, such as chronic sialoadenitis or Sjogren's Syndrome, can also affect the gland. Often your surgeon will have performed a needle biopsy of a suspected tumor in the gland. If the biopsy shows a malignant lesion, an aggressive benign lesion, or a lesion highly suspicious for malignancy, the removal of the portion of the gland containing the tumor or suspicious lesion (parotidectomy) may be needed. Suspicious- looking areas on pre-operative imaging studies such as MRI or CT may also necessitate the removal of the portion of the gland containing the tumor or suspicious lesion. Tumors affecting the superficial lobe require removal of only the superficial lobe, whereas tumors of the deep lobe require removal of both the superficial and deep lobes.
The procedure to remove the parotid gland takes place under general anesthesia and takes approximately two to three hours. An incision is made just in front of the ear, extending around the earlobe and then down a small distance on the neck. This incision is typically very well masked within an existing skin crease, and the resulting scar usually heals to the point of being imperceptible to the naked eye. The portion of the gland containing the tumor is carefully dissected away from the branches of the facial nerve, and once removed, the deeper layers of the wound and the skin are then sutured closed. Occasionally a small drain is placed in the wound- this drain is typically removed in one to two days after surgery.
After spending several hours in the recovery area, you will be discharged home. Pain associated with the procedure is typically mild. Most patients often state the worst sensation after surgery is a sore throat, which is caused by the breathing tube placed in the airway during surgery. This sensation usually resolves after several days.
The skin over the earlobe and parotid area may be numb after surgery. This typically resolves over a period of several months. You may also have some mild facial weakness on the side of the surgery. This is usually temporary and typically resolves over a period of several days to several weeks. If a drain has been placed during surgery, you will return to the office the next day to have it removed. Approximately one week after surgery, the skin sutures are removed.
Risks of Surgery
There are several risks with parotid surgery. One of the important structures traversing within the gland is the facial nerve. The branches of this nerve control the muscles of the face. Damage to any of these branches can lead to muscle weakness throughout the face. The risk of facial nerve injury leading to permanent paralysis of one or more areas of the face is less than 1-2%. Permanent weakness or paralysis may require further adjunctive procedures. Some temporary weakness of the face can occur after surgery due to manipulation of the nerve while dissecting the tumor away from it. This weakness typically resolves over the span of a few weeks. Another risk of surgery is numbness to the earlobe and part of the skin around the ear. This occurs because some of the sensory nerves to this area must be cut to gain access to the parotid gland. This numbness typically resolves after a few months, but occasionally can be permanent.
Gustatory sweating aka Frey's Syndrome, which is sweating from the skin overlying the parotid gland while eating, is another risk of surgery. This occurs when the nerves responsible for the production of saliva in the parotid gland reinnervate the sweat glands of the skin after removal of the gland. Steps are taken during surgery to minimize this complication, including the use if muscle flaps to cover the exposed parotid tissue. Another risk is recurrence of the tumor. Though every necessary step is taken during surgery to remove the entirety of the tumor, certain tumor types have a predisposition for recurrence and may require additional surgery.
After surgery, an area of depression is often noted in the space that the parotid gland previously occupied. This depression gradually fills in with soft tissue over time, minimizing any asymmetry. The risk of bleeding after surgery is very low, typically less than 1%. If any sudden swelling associated with pain is noted, immediate evaluation is required. This risk is minimized by the avoidance of any heavy lifting, strenuous activity, straining, or the use of blood-thinning products such as aspirin or NSAIDS for two weeks after surgery. Infection after surgery is a rare complication and is managed by oral antibiotics. Scarring from the surgery is very minimal; often the scar is so well hidden in skin creases that they are virtually unnoticeable. If you have prior history of keloids or hypertrophic scars, however, you may be at risk for larger-than-normal scar formation.