Exodontia.Info
Parotid Gland Removal /
Superficial Parotidectomy
This leaflet has been designed to improve your
understanding of your forthcoming treatment and contains
answers to many of the common questions.

If you have any other questions that the leaflet does not
answer or would like further explanation please ask a
member of the medical or nursing staff
.
What is the Parotid Gland?

The parotid gland is a salivary
gland
that lies immediately in
front of the ear.  Saliva drains
from it through a tube that
opens on the inside of the
cheek next to the first upper
molar.  The
parotid gland is
most commonly operated on to
remove a lump.
What does the operation involve?

The treatment involves a general anaesthetic, which means you are going to be put
to sleep completely.

An incision (cut) will be made which runs from in front of your ear and down into
your neck.  This incision heals very well indeed; the incision is nearly the same as
the one used in “face lift” surgery, and in time the scar is likely to be minimal.

Once the gland has been removed the incision is held together again with stitches.  
These need to be removed around a week after surgery.

At the end of the operation the surgeon will place a drain (plastic tube) through the
skin in order to prevent any blood clot collecting under the skin.  Most patients will
require 24 - 48 hours in hospital after the operation before the drain can be
removed and they can go home.

If your gland is being removed because of infection that is caused by a stone, it
may also be necessary to make a cut inside the mouth to remove that stone.

How long will the operation take?

Removal of all or part of the parotid gland is a complicated operation which can
take up to approximately two hours.

What can I expect after the operation?

You usually need a night in hospital following the surgery.  It is unlikely to be very
sore but regular painkillers will be arranged for you.  There is relatively little swelling
following
parotid gland removal.

The removal of one
parotid gland will not have an impact on the amount of saliva
that you produce.  There are many other salivary glands left in and around the
mouth that will still keep it moist.

Do I need any time off work?

It is usually advisable to take 1 - 2 weeks off from work to recover from the
surgery.  During this time you should avoid strenuous activity.

Is there anything that I need to do when I get home?

It is important to keep the wound dry for the first week following surgery.  This
obviously means you need to take care when washing or shaving.

Will I have a scar?

All cuts made through the skin leave a scar but the majority of these fade with time
and are difficult to see when they are fully healed.  It may take several months for
your scar to fade but eventually it should blend into the natural folds and contours of
your face.

What are the possible problems?

This list of warnings might seem excessive to some however the legal ruling in the
case of
Chester vs Afshar (2004) would suggest that it is quite prudent / necessary
to list them.  Others might say that there isn't enough information but where do you
stop?

The following list of warnings regarding parotidectomy is neither exhaustive nor is
it predictive.  The most pertinent warnings have been included here.

Infections.  Infection is uncommon because of the antibiotics that are used during
and after surgery.  You may also be prescribed a short course of antibiotics to take
home.

Bleeding.  Bleeding is unlikely to be a problem.  If it occurs, it usually does so within
the first 12 hours of surgery which is why you need to stay in hospital overnight.

Facial Weakness / Facial Nerve Palsy.  The Facial Nerve runs directly through the
centre of the
parotid gland.  It is the nerve that makes the muscles of the face work.

Damage to some or all of the
Facial Nerve can result in weakness of the muscles
on one side of your face (
Facial Nerve Palsy).  Most nerve damage occurs as a
result of bruising since the
Facial Nerve is held out of the way and protected during
surgery.

In most cases the nerve works normally after the surgery.  However sometimes (in
about 15 - 20% of cases), where the lump has been very close to the nerve, a
temporary weakness of the face can occur that can last for a few weeks - months.  
In 1% of cases, there is a permanent weakness of the face following this sort of
surgery.

Numbness of the Earlobe.  The nerve that supplies feeling to your ear lobe
(
Greater Auricular Nerve) sometimes requires mobilisation / removal to gain better
access to the
parotid gland and as a result you may end up with a numb or tingling
feeling in your ear lobe.  Often you can expect your ear lobe to be numb
permanently.

Hæmatoma.  A blood clot can collect beneath the skin (hæmatoma).  This occurs in
about 5% of patients and it is sometimes necessary to return to the operating
theatre and remove the clot and replace the drain.

Salivary Fistula / Sialocœle.  In 2 - 5% of patients, the cut surface of the parotid
gland leaks a little saliva on the skin (
salivary fistula), in which case this can also
collect under the skin (
sialocœle).  This problem usually settles down on its own but
can take several weeks to get better.  If the saliva collects under the skin, it is
necessary to remove the saliva, usually just with a needle, like a blood test,
although it may need to be repeated several times.

Frey’s Syndrome / Gustatory Sweating.  Some patients find that after this surgery
their cheek can become red, flushed and sweaty whilst eating. This is because the
nerve supply to the gland can re-grow to supply the sweat glands of the overlying
skin, instead of the
parotid gland. This can usually be treated easily by the
application of a roll-on antiperspirant or other simple non-surgical treatments.

Scar / Keloid.  Although rare in parotid surgery, some patients (those with darker
skin) may develop a thick scar (
hypertrophic scar) or keloid.

Depression in front of the ear where the gland was.  In some patients, a
depression / "dent" occurs at the site of the removed lump.

Recurrence.  Dependent on what was removed, there is always a small chance of
recurrence.  Hence, the need for regular reviews over several years.

Amputation / Traumatic Neuroma.  After healing, there is a chance that one of the
nerves in the area may have been cut and on healing, be scarred.  They are often
sensitive or painful on pressure.  If particularly painful, these have to be surgically
removed.

Will I need further appointments?

A review appointment will be arranged before you leave hospital.  We will keep a
close eye on you for several months following treatment to make sure that nothing
recurs and your symptoms settle.


Useful Websites & Article:

British Association of Oral & Maxillofacial Surgeons

Ear, Nose & Throat UK


BJOMS 2011.  Letters to the Editor.  An Unusual Complication of a Parotidectomy
Please click here to send any comments via email.
Last Updated 30th December 2011