Parotid gland

What is the parotid gland?

The parotids are a pair of salivary glands on the face. There is a parotid on each part of the face in front of the ears. Lumps or tumours form in the parotid as a result of abnormal development of part of the gland. Those tumours are usually benign. Malignant tumours (cancer) of the parotid are rare. Fine needle aspiration (FNA) in clinic might help elucidate the nature of the lump.

 

Why have the lump removed?

Even though 80% of the tumours in the parotid are benign, an operation to have them removed is recommended. The reason for that is because they carry on growing and with the passage of time there is a possibility of them turning malignant. Also, the exact nature of the lump can only be established once it is removed and send for histology.

Parotidectomy is the surgical removal of part or the whole of the gland including the tumour.

 

What does the operation involve?

The operation is done under a general anaesthetic. The incision begins from in front of the ear and extends down to the side of the neck. Even though it is quite long, it usually heals very well and is similar to the one used for a face lift. At the end of the operation a plastic drain is placed through the skin and the wound is closed with suitable sutures or staples. Hospital stay is usually for 24-48 hours after the operation. It is recommended that you keep off work for at least  two weeks.

 

What are the possible complications?

Facial nerve weakness:

The facial nerve runs with its branches through the middle of the parotid gland. The nerve serves to move the muscles of the face (one on each side). If it is damaged during the operation then weakness or even paralysis part or all of the one side of the face can occur. The use of a special nerve monitor can help reduce the chances of such a complication occurring.

Even if there is some weakness of the face after the operation this is usually temporary. In benign tumours the possibility of causing permanent weakness to the face due to facial nerve damage is around 1%.

Ear lobe numbness:

The skin around the wound but mainly the earlobe might feel numb for a period of time after the operation..

Haematoma:

Clotted blood under the skin around the wound can form in around 5% of the cases. Sometimes this might need surgical drainage.

Salivary fistula:

Occasionally, a salivary leak might be observed. This is due to normal function of parotid remaining tissue and can find a way out of the wound or collect under the skin forming a cyst around the scar in about 2-5% of the cases. This is usually treated successfully with needle aspiration in clinic.

Frey’s syndrome:

Some patients experience inappropriate excessive sweating and redness of the face over the operation site during eating. This can occur because the salivary nerves that used to supply the parotid before the operation and have been cut during the operation, now supply the sweat glands under the skin. This can be treated conservatively.