Parotid Gland Removal
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 (Stensen’s Duct / Parotid Duct).
The Parotid Gland is most commonly operated on to remove a “lump”.
What does the operation involve?
The treatment involves a general anæsthetic, 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?
The medico-legal landscape of consent has been shaped by a number of cases, such as Chester v Afshar [2004] [https://exodontia.info/chester-vs-afshar-2004/], Montgomery v Lanarkshire Health Board [2015], Duce v Worcestershire Acute Hospitals NHS Trust [2018] amongst others, so that it is more patient-centred.
Many of the legal claims in surgical (& medical) cases occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent.
A pre-requisite for obtaining consent for a surgical (medical / dental) procedure from a patient, is a full exchange of information regarding any risks, drawbacks and limitations of the proposed treatment and any alternatives to it (even non-treatment).
The clinician should provide the patient with as much information as is appropriate and relevant, that it should be in terms the patient understands & the risks should be personalised for that individual patient.
Also, there should be enough time for the patient to understand the information given and get a second opinion if needs be.
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 [link to Salivary Fistula / Sialocœle webpage].
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 [link to Frey’s Syndrome / Gustatory Sweating webpage].
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 Articles & Websites
BJOMS 2011. Letters to the Editor. An Unusual Complication of a Parotidectomy