Parotidectomy

Overview

Parotidectomy involves the surgical removal of all or part of the parotid gland, which is a major salivary gland situated in the cheeks, in front of and below the ears. Tumors can develop in the parotid glands, leading to the need for a parotidectomy to excise the affected portions of the gland.

The facial nerve, a crucial nerve, traverses each parotid gland, dividing it into two lobes: the superficial lobe and the deep lobe. There are two types of parotidectomy, chosen based on the location of the tumor:

• Superficial parotidectomy: This procedure involves removing a tumor situated superficially to the facial nerve.
• Total parotidectomy: This surgery is performed to eliminate a tumor located in the deep lobe or in both the deep and superficial lobes.

Reasons for undergoing the procedure

A parotidectomy may be necessary if a tumor forms in your parotid gland. While these tumors are typically benign (noncancerous), malignant (cancerous) tumors can also develop, requiring removal in both cases.

Benign tumors may necessitate removal due to their potential for growth, which can cause damage to surrounding tissue. Certain types of benign tumors may even undergo transformation into salivary gland cancer.

Malignant tumors pose a threat by damaging surrounding tissue and having the potential to spread (metastasize). In cases of metastasis, cancer cells break away from the original tumor and travel to other parts of the body through the bloodstream or lymphatic system. Cancer originating in the parotid gland may extend to nearby lymph nodes in the neck, migrate to other areas of your body.

Additionally, a parotidectomy might be recommended for individuals with infections in their parotid glands or those experiencing salivary gland stones. These stones, comprised of calcium deposits, can accumulate in the parotid glands, obstructing saliva flow and leading to recurrent gland swelling and infections.

Risks

Parotidectomy is generally not regarded as a high-risk procedure,
but if complications do arise, they may include:

• Numbness in the ear, face, or jaw: Most individuals regain sensation within three to four months, although complete recovery may take up to a year. Temporary facial weakness, lasting from a few weeks to a few months, may occur, especially with extensive dissection around the facial nerve. While rare, long-term facial paralysis can be a potential complication of parotidectomy. Persistent facial and jaw numbness is exceptionally rare and typically only associated with highly complex parotidectomies. Ear numbness, however, is relatively common.
• Frey’s syndrome: Characterized by excessive sweating on the side of the face while eating, Frey’s syndrome typically emerges several months after surgery. Antiperspirants and botulinum toxin injections are potential treatments for this condition.
• First bite syndrome: This involves severe pain with the initial bite of food, diminishing with subsequent bites. Botox injections can be employed to alleviate pain caused by the involved nerve.

Other general surgical risks applicable to parotidectomy include:

• Allergic reactions to pain medication.
• Damage to nearby organs during surgery.
• Fluid collection at the surgery site (seroma or sialocele).
• Accumulation of blood at the surgery site (hematoma).
• Infection, bleeding, or scarring.

Scarring after a parotidectomy is typically minimal, as incisions are strategically made to align with neck creases, making them inconspicuous as scars develop.

Before the procedure

Your doctor will collect essential medical information to strategize your surgery and ensure your understanding of the parotidectomy process, facilitating proper preparation for your recovery.

In preparation, your doctor may:

• Review your medical history and medications: Conducting a physical examination, your doctor will assess your past and current medical conditions. They will inquire about all medications you are taking, encompassing prescriptions, over-the-counter drugs, herbs, and supplements.
• Perform imaging procedures: Utilizing a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI), your doctor may capture images of your parotid gland to plan the surgery, especially if a tumor is near your facial nerve. This aids in determining the optimal approach for gland removal while safeguarding the facial nerve.
• Perform a biopsy: Your doctor might conduct a biopsy by extracting a tumor sample for cancer cell testing. The most common biopsy type for a parotidectomy is Fine-Needle Aspiration (FNA), involving a thin needle to collect a small cell sample. Your healthcare provider can plan surgery and provide prognosis guidance upon determining whether a tumor is cancerous.
• Provide instructions for preparing for the parotidectomy, including details on medications to take or discontinue, fasting before surgery, and other guidelines. Smoking cessation advice may also be given, as smoking heightens the risk of breathing issues during surgery and can impede healing afterward.

Your doctor will provide the necessary information for your preparation toward a parotidectomy. However, it is crucial to ensure that all your queries are addressed beforehand.

To prepare:

• Arrange for someone to drive you home and provide care for at least 24 hours post-surgery.
• Adhere to your provider’s recommendations regarding the safe usage of medications and supplements.
• Comply with your provider’s instructions on when to cease eating or drinking before the surgery.
• Follow your provider’s guidance on smoking cessation.
• Inquire with your provider about the recommended duration for your recovery. Depending on your circumstances, you may require assistance from a friend or family member for a period extending beyond 24 hours.

During the procedure

Parotidectomy, a major surgical procedure, typically spans from three to four hours in duration. Otolaryngologists, specialized in head and neck conditions, are the surgeons who perform parotidectomies. Your surgery for a parotidectomy will take place in a hospital or surgery center, typically requiring an overnight stay of one to two nights. Throughout the procedure:

• You will be positioned on a table and administered anesthesia through an IV to ensure you are asleep during surgery.
• Your doctor will make an incision starting in front of your ear, extending back and downward into the natural crease in the upper part of your neck. This incision pattern is designed to minimize visibility once it heals.
• The skin flap will be pulled back to expose the parotid gland. Your doctor will carefully identify the facial nerve, taking precautions to avoid any damage during the surgery. The use of a facial nerve monitoring device may be employed to ensure the correct functioning of the facial nerve throughout the procedure.
• All or part of the gland will be removed by your provider, and if cancer cells have spread to nearby lymph nodes in your neck, they will also be removed.
• The incision will be sutured back together.
• A small tube, known as a drain, may be inserted by your doctor to capture any blood or fluid that could accumulate at the surgery site.

After the procedure

After the parotidectomy, you will regain consciousness in a recovery room, where a doctor will closely monitor vital signs such as blood pressure, heart rate, and breathing to ensure your well-being. Pain medication will be administered as needed.

Once fully awake, your provider will assess your facial nerve function. This may involve tasks like smiling, closing your eyes, or making other facial movements to confirm the proper functioning of the facial nerve.

Before discharge from the hospital, you will receive instructions on caring for your wound and drain. The timeline for follow-up care varies among individuals but typically includes:

• One to two days post-surgery: Removal of the drain.
• Five to seven days post-surgery: Removal of sutures.
• Four to six weeks post-surgery: A follow-up appointment to ensure proper healing.

Outcome

Common recovery symptoms include:

• Pain and swelling at the surgery site, generally subsiding over approximately three weeks.
• Discomfort in the jaw while eating, which may persist for two to four weeks.
• Numbness in the ear or near the incision site, with noticeable improvement typically within three to four months.

The duration of your recovery hinges on the complexity of your surgery. Generally, the recovery period spans a few weeks, with most individuals resuming normal activities within a month. Full recovery from numbness and facial weakness may extend from a few months to a year.

Consult your doctor for personalized insights into how your tumor and surgery will influence your specific recovery timeline.