Our patients have found it really useful when we send out information about their upcoming surgery. It puts their minds at ease and keeps them fully informed about their condition and what to expect from the operation itself. We also provide useful information about aftercare and recovery. This is the information we send out about a Parotidectomy:
The parotid gland is the largest salivary gland which is located in front of the ear and extends down into the top of the neck. The most common parotid lump is called a pleomorphic adenoma which is non-cancerous. Very occasionally, a pleomorphic adenoma can undergo cancerous change and therefore, it is usually recommended that these are removed. The next most common tumour is an adenolymphoma or Warthin’s tumour. These can be left or removed depending on their size and your preference. Cancerous tumours are rare and there are several different types. Treatment plans for parotid (salivary gland) cancer will be tailored to the individual patient.
Following investigations and the subsequent type and size of the parotid tumour will determine the type of surgery you have.
Risks of parotid surgery:
- The main risk of a parotid procedure is the risk of damage to the facial nerve. The facial nerve controls the muscles of facial expression and damage to the nerve can cause weakness of some or all of the facial muscles. The risk of this is low and if it occurs, is usually temporary, with about 75% of weakness recovering. However there is a very low risk of permanent weakness.
- A scar which will become less pronounced with time. The incision is often hidden in a skin crease so it is not obvious.
- Numbness to the ear lobe and part of the cheek is common and occurs in at least 50% of patients, it usually improves a little with time but may not go back to normal. However, usually numbness to the ear lobe settles.
- Like all operations there is a small risk of a wound infection, bleeding, or a collection of liquid called seroma.
- Other risks include Frey’s syndrome which is redness and sweating of the skin on the cheek over the gland when eating but this is usually mild and resolves after about a year.
- A salivary fistula is temporary leaking of saliva into the neck and again this usually settles quickly but may need to be drained with a needle if it becomes uncomfortable.
- There is always a risk that the lump may return after it’s been removed but this is uncommon.
- Lastly there is a risk of seeing a minor change in facial contouring if a large amount of the parotid gland is removed.
This procedure should be performed for lumps that are thought to be non-cancerous. It is a smaller operation than a superficial/total parotidectomy and involves only removing the lump from the parotid gland. The benefits of this procedure are a lower risk of developing Frey’s syndrome or salivary fistula and there is no need to identify the main parts of the facial nerve. It is a faster operation meaning less anaesthetic time and it usually does not require a drain (a small plastic tube to collect fluid) and this is therefore usually a day case procedure. Occasionally, lumps we believe are non-cancerous subsequently turn out to be a cancer and this may result in a further procedure with a formal superficial or total parotidectomy and/or oncology treatment .
This procedure is performed for larger benign tumours where it is thought to be in close proximity of the facial nerve, possible cancers or definite cancers. This procedure involves removing the parotid lump with some, or all of the parotid gland above the facial nerve. Nearly all (90%) of the gland is above the nerve and only a small proportion (about 10%) underneath the nerve. This procedure will usually require a drain left in place after the operation and has a slightly higher chance of Frey’s syndrome or a salivary fistula. You usually need to stay in hospital for one night and occasionally two.
This procedure is required for cancers or if the tumour is located in the deep part of the gland under the facial nerve. Usually, the superficial part of the gland is removed or dissected first and subsequently the deep part underneath the nerve is removed. It is unusual to require this procedure.
Fig 1: A Modified Blair Incision
After the operation
The patient may have a drain in place which can be removed when there is only a small amount of fluid going into the drain, usually the same or next day. The skin stitches are not dissolvable and need to be removed after 5 to 7 days at your GP surgery and the wound needs to stay dry until 24 hours after the stitches are removed. If the area becomes swollen, red, hot, painful or tense, this may indicate an infection or salivary fistula and I would recommend getting in touch with us or seeing your GP.
Following the procedure, I will arrange a follow up appointment between two and six weeks later to discuss the findings of the operation. If in the meantime, there are any questions or concerns, please get in touch with my Practice Manager Rebecca Semmens via the website, by email (firstname.lastname@example.org) or by phone on 07450852096.