Parotidectomy is the removal of the parotid gland, a salivary gland near the ear.
The parotid gland is the largest of the salivary glands. There are two parotid glands, one on each side of the face, just below and to the front of the ear. A duct through which saliva is secreted runs from each gland to the inside of the cheek.
The main purpose of parotidectomy is to remove abnormal growths (neoplasms) that occur in the parotid gland. Parotid gland neoplasms may be benign (approximately 80%) or malignant. Tumors may spread from other areas of the body, entering the parotid gland by way of the lymphatic system.
Benign parotid gland growths usually appear after the age of 40. Malignant growths most often affect women over the age of 60, while benign tumors affect both sexes equally. Cancer of the salivary glands accounts for only 1% of all cancers, and 7% of all head and neck cancers.
During surgery, two different areas of the parotid gland are identified: the superficial lobe and the deep lobe. Superficial parotidectomy removes just the superficial lobe, while total parotidectomy removes both lobes.
The patient is first placed under general anesthesia to ensure that no pain is experienced and that all muscles remain relaxed. An incision is made directly to the front or back of the ear and down the jaw line. The skin is folded back to expose the parotid gland. The various facial nerves are identified and protected during the surgery so as to avoid permanent facial paralysis or numbness. A superficial or total parotidectomy is then performed, depending on the type and location of the tumor. If the tumor has spread to involve the facial nerve, the operation is expanded to include parts of the bone behind the ear (mastoid) to remove as much tumor as possible. Before the incision is closed, a drain is inserted into the area to collect any leaking saliva, if a superficial parotidectomy was performed. The procedure typically takes from two to five hours to complete, depending on the extent of surgery and the skill of the surgeon.
A complete physical examination and medical history is performed, as are diagnostic tests to help the surgeon better plan for the surgery. Some tests that may be performed include computed tomography (CT) scan, magnetic resonance imaging (MRI), and fine-needle aspiration biopsy (using a thin needle to withdraw fluid and cells from the growth).
After surgery, the patient will remain in the hospital for one to three days. The incision site will be watched closely for signs of infection and heavy bleeding (hemorrhage). The incision site should be kept clean and dry until it is completely healed. If the patient has difficulty smiling, winking, or drinking fluids, the physician should be contacted immediately. These are signs of facial nerve damage.
There are a number of complications that are associated with parotidectomy. Facial nerve paralysis after minor surgery should be minimal. After major surgery, a graft is attempted to restore nerve function to facial muscles. Salivary fistulas can occur when saliva collects in the incision site or drains through the incision. Recurrence of cancer is the single most important consideration for patients who have undergone parotidectomy. Long-term survival rates are largely dependent on the tumor type and the stage of tumor development at the time of the operation.
Other risks include hematoma (collection of blood under the skin) and infection. The most common long-term complication of parotidectomy is redness and sweating in the cheek, known as Frey's syndrome. Rarely, paralysis may extend throughout all the branches of the facial nervous system.
Although some facial numbness or weakness is normal immediately following parotidectomy, these symptoms usually subside within a few months, with most patients regaining full function within one year. Return of a benign tumor is very rare.
There is a 25–50% risk of temporary facial weakness following parotidectomy, and a 1–2% risk of permanent weakness. Frey's syndrome may be experienced by up to 90% of patients to some extent and causes perspiration on that side of the face with eating. There is very little or no risk of mortality associated with the surgery. The survival rate of malignant parotid gland tumors depends on their size, location, extension, and if metastasis has occurred. The 10-year survival rate ranges from 32% to 83%.
A benign parotid neoplasm may be managed expectantly (i.e., adhering to a period of watchful waiting) so that the growth is of a larger size before it is removed (the risk of facial nerve damage increases with each subsequent parotidectomy). There is generally no alternative to surgical treatment of parotid gland neoplasms, although radiation therapy may be recommended after the procedure in the case of malignant tumors.
Califano, Joseph, and David W. Eisele. "Benign Salivary Gland Neoplasms." Otolaryngology Clinics of North America 32, no. 5 (October 1, 1999): 861–73.
Carlson, Grant W. "The Salivary Glands: Embryology, Anatomy, and Surgical Applications." Surgical Clinics of North America 80, no. 1 (February 1, 2000): 261–73.
Sinha, Uttam, and Matthew Ng. "Surgery of the Salivary Glands." Otolaryngology Clinics of North America 32, no. 5 (October 1, 1999): 887–906.
American Academy of Otolaryngology. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. http://www.entnet.org .
Gordon, Ashley D. "Parotid Tumors, Benign." eMedicine, December 27, 2001 [cited April 7, 2003] http://www.emedicine.com/plastic/topic371.htm .
Johns, Michael M. "Salivary Gland Neoplasms." eMedicine, May 17, 2002 [cited April 7, 2003] http://www.emedicine.com/ent/topic679.htm .
Shelato, Dwight. The Patient's Forum on Tumors of the Parotid Gland, [cited April 7, 2003] http://patientsforum.com .
Mary K. Fyke Stephanie Dionne Sherk
Parotidectomy is performed in a hospital operating room , usually by an otolaryngologist, a medical doctor who specializes in the treatment of diseases that affect the ear, nose, throat, and other structures of the head and neck.
I enjoyed reading it, and i hope you do as well
Boima
then do they take a shotgun appoach in such avulnerable area. They have no target so they're
going to shoot at everything. Not on my head!
and it makes me feel ill is this normal so long after this operation.
Is facial nerve injury an avoidable sequale of total parotidectomy or it could be spared?
Is there any direct reason why benign tumors may grow in this area? I'm 19-years-old, and from what I've read and learned from the doctors involved in this case, it is very abnormal for someone at my age to have gotten one. Are there ways to prevent it in the future?
I will post a comment after the surgery.
Surgery was 7-1/2 hours long. The head of the cancer center at a local university hospital performed surgery with no immediate side effects.
Within the last year developed Frey's Syndrome. Sweating at temple, cheek and ear whenever I eat anything. It's a real problem as my face and hair at temple is wet. Must constantly be wiping when I eat. Trying botox injections this week to see if it will suspend this sweating at least during the winter!
Ask your surgeon about this complication. It is pretty common.
good luck.
Is there anyway to see answers to questions presented on this page (computer beginner)...may need parotidectomy shortly. Is there any additional ways to understanding this procedure beside internet sites, dr. consultation, etc., that anyone has found helpful before making a decision to have this procedure done.
thanks
cc
Where I had the tissue graft, the surface of the skin on my cheek is now rather lumpy (and more hirsute that the other side), but I won't do anything about this - just live with it.
If Botox had been around at the time, this might bave been an option, but back in the dark ages, it wasn't. Hope this story might help those of you studying or expecting to have this surgery.
BTW - I had a recurrent benign growth in the original site when I was about 38 and had further surgery to remove this. I haven't had any further problems - so far!
The tumor literally appeared over the course of five days as a lump at the end of my jaw beside my ear.
I was terrified before hand as the consultant gave me no option and told me I had to have surgery, he enver discussed what it was with me and it took a lot of researchon the internet - including watching an operation on Youtube to make me comfortable with it.
I has the operation at Sunderland Hospital (UK) by an excellent plastic surgeon and it took four and a half hours - quite a lot of this was spent sewing me back up. He cut the length of my ear and then tucked up behind it another inch and got it out. I had to spend a night in hospital (there was no way I was spending two!)afterwards I was very groggy and when the medication wore off boy did I know about it!!
It now looks amazing.
Nearly three years on the only signs I have of the op and tumor are a small divit in front of my ear where the tumor was, a slight line along the length of my ear and then a more obvious scar behind my ear. The sticky out middle bit of my ear is also very hard and doesnt like to be pushed flat.
I still have oversensitation on that side of my face and cannot wear a full face crash helmet. Lying on that side is also painful after a while. Cold is also not a friend to my face and I have to avoid getting too cold and cover my face with a scarf.
If anyone wants to see photos of me post op (literally just after and over the course of a few days) please free to email me at jillamberjanemerritt@yahoo.co.uk
In 1999 left side. Now I have another lump on the
Left, is that possible I will need another one ? I
Don't remember the types I had, noticed the lump
A few years ago, but now it's starting to give more discomfort.
The sweating has been a lot to deal with but other
Than that I did well after each surgery.I was 40
The 1st time, I'm now 60.
In 1999 left side. Now I have another lump on the
Left, is that possible I will need another one ? I
Don't remember the types I had, noticed the lump
A few years ago, but now it's starting to give more discomfort.
The sweating has been a lot to deal with but other
Than that I did well after each surgery.I was 40
The 1st time, I'm now 60.this site has been helpful, reading
What others have experience as well...thanks
Surgery went great with no nerve damage and surprisingly no post operative pain (I'm told pain is common). Drain tube was removed after about 36 hours.
Still have some swelling and numbness in cheek, jaw and ear. Fortunately this has been getting better every day.
2 x1.7 x .08 cm mass again noted posterior/anterior aspect of right parotid gland without change in size or signal characteristic., mildly enhances, no new adenopathy
Is identified. No significant change. Stable right parotid mass which may represent a lymph node.
I am recently feeling slight discomfort and pain and headache. Occasional pain and throbbing pain is felt in the upper right ear.
Do I need to have surgery soon? I've been reading this site for the last week and I need your recommendation on this. My daughter is getting martied in October and I am worried that I cannot help/assist her in the preparation, let alone the day of the event. PLS HELP ME! Thanks a lot!
Is there one? Any info greatly appreciated. many thanks
Thanks in advance...
I had one taken out 7 months ago in other side and swelling left after about 6 days.
I had one taken out 7 months ago in other side and swelling left after about 6 days.
To make a long story short, I finally wised up and went to a ENT doctor who immediately arranged for parotid surgery in Albuquerque. In the meantime I had a PET scan which revealed the extent of the tumor on the salivary gland which was 29mm by 27mm in size as well as in another . On Nov. 25, 2013 I had my total paroditectomy which took 5 hours to remove all the neoplasm which was indicative of being malignant. In the process I lost the lower third of my left ear and the feeling in my left cheek and parts of my left lower lip. I also have a somewhat drooping left eyelid which makes it a lttle more difficult to read.
But I am entirely free of pain!
There is still a rather large crust of black epidermis in front of my left rear which should drop off in the next three weeks. I make another report later after I get a copy of the surgery report.
Now I wake up in the morning with tingling and slight numbness in BOTH sides of my face. It goes away as soon as I get up.
Has anyone else had both sides of face numb and tingly after the surgery?
Also, to Judy L., I had a Warthins tumor removed from the parotid gland 11/14/2013 and I still have the same symptoms that you are describing: sort of like pins or electrical like feelings on my jaw and down my neck when I touch the area where my scar is located. My real problem is that I wake up in the mornings with numbness over my face slightly. (both sides of my face) It started happening when I still had the Warthins tumor in the gland. I am hoping it will clear up within a year, but I have read it can take slightly longer than a year sometimes. Also it is rare to have both sides of face get numb, so guess I am a rare case. I am sure yours will clear up over the next few months.
4 days after surgery, he was suffered from saliva leak till now.
Current treatment are having bandage of pressure dressing for 24/7 and having medicine to reduce the saliva flow.
Saliva still leak through from wound even after 5 weeks surgery.
This is very annoyed and we feel worry now.
Hope can get some advice
Can anyone tell me how they felt after surgery. How long is recovery.
I am currently having neck spasm but I wonder if this is all stress related as I have no pain in the site area of the tumour.
Which is a pleomorphic adeoma. I have had a FNA and have a MRI booked prior to surgery. It's all such a shock I'm 50 years of age.
Thanks.
had pr-op at new queen Elizabeth hospital, Birmingham and operation at city hospital, Birmingham.all the staff were helpful and kind and nothing was too much trouble for them.
Janie, I think it is hard to be positive because they cannot guarantee the sample they tested is an accurate sample of the whole mass. My biopsy was negative, but my ENT said that it was only 90% that it was actually benign. I mean, those are great odds, but I didn't know it was 100% until yesterday. My surgery is scheduled for April 2, and I wish it was tomorrow just so I could be done with it. I agree- the waiting is hard.
Erin
For folks in the Pittsburgh area, I would recommend Metropolitan Ear Nose & Throat, so far so good.
that come and go and they are more severe the minute i get a little tense, I went to see the doctor 2 weeks later because of this sharp pains & doctor said this electroshock pains are normal as the nerves are struggling to reconnect and in some cases the pain can last to 120 days after surgery, does anybody has this same issue. Other than this , a have the normal surgery pain, numbnesss in the ear but this electric shock pains are KILLING me!
sharp electric shock pains inside my right ear
this pains come and go come and go and they are more severe the minute i get a little tense, lift something or chew . I went to see the doctor 2 weeks later after my surgery regarding this sharp pains & doctor said this electroshock pains are normal as the nerves are struggling to reconnect and regenerate causing this pain , he said some people are more sensible to pain then others and apparently this could be my case. Doctor also explained that in some cases the pain can last up to 120 days after surgery. Does anybody has this same issue. I am taking Vicoden to help me ease this nerve electric shock pains .Other than this , a have the normal pins & needle pain, numbnesss in the ear but this electric shock pains are KILLING me! I have another appointment with him next month. He is an excellent doctor
Had a total parotidectomy 4 weeks ago in New Delhi. The FNA came back as Benign but after they had taken the hard mass from my parotid gland removing the whole gland the results came back as three different opinions but nothing certain although doctors said it was Malignant now and recommend Radiation now. They are saying it was a high grade possibility tumour plus another name malignant tumour plus benign tumour. They were not certain which type although biopsy was a final report with three different opinions of what it could be. Completely confused now because I would have thought a biopsy of the tumour that was taken out could actually determine what actually it was. The operation was performed at a top private hospital in New Delhi called Fortis Hospital. But I am really concerned as I really have not got an accurate report of what exactly the tumour was. Have quite a lot of numbness in my face and slight ache down my face. My eyes close fine and I can wink quite well. Smile is not fully back but I can eat well and just have slight drinking problems when drinking from a bottle with it spilling a little on my left side but not too bad. Face feels stinging sensation and quite stiff with cheekbone soreness. Do get quite a bit of sensitivity to light etc with slight headaches. Just concerned if it is Malignant will it get the better off me. I did have one Lymph node removed that was contained in the Parotid gland but all my other Lymph nodes had no sign of metastasis as tumour was contained within gland and not outside. But still do feel nervous especially when I do not have a real answer to the biopsy report as stated it could be any three that they said. Any help would be greatly appreciated.
I am 22 years old and had a superficial parotidectomy on the left hand side on the 27-10-2015. It was done at Heartlands hospital in Birmingham and was a successful procedure. Upon waking from the procedure I felt very sick and had a bad reaction to the anaesthetic (not uncommon) I had a drain on the wound and was released the next day (providing the drain slowed down and was not draining too much). For a few days after I was in a lot of pain and unable to eat much solid food. It was very swollen and I've seen found out it has become infected (apparently happens in 2-5% of cases). This has caused my wound to be seep pus. It has been happening quite regularly and is quite a steady steam coming from the wound. This has set my recovery time back a bit so that is a little frustrating. Although this has happened I still find the procedure very worth while when you way up the potential risks of getting cancer (if your growth is benign). The surgery was done by Mr Howe and it has to be said he is an absolute gentleman and he a very tidy job. It is just unfortunate it has gotten infected and I just put it down to being unlucky. I have not had any of the other side effects such as facial weakness which is positive the only thing I have is numbness of the side of my head and ear which was to be expected when you operate on such an area.
After CT scan and small biopsy/blood tests it was suggested a benign warthins tumour ( in bottom part of my saliva gland). (Neck) As it was small two decisions -to 'leave alone' ( where it may go unchanged for 15 years ) OR remove. If this tumour where to change or enlarge then the operation would become more invasive and could compromise more of my facial nerves. I chose to have it removed. It was given as 80% benign although no actual diagnosis can be reached - until it's out and under the microscope. Operated at 1.30pm and in recovery room by 4pm. ENT specialist. I was awake and fit to stand by 5pm. I felt no pain or discomfort. I was home by noon next day after the op.The 7" scar from behind ear to down to my throat was glued (not stapled or stitched). I didn't need any drain. I was informed to leave wound dry for five days to heal. The glue naturally disintegrated itself. I then used an antiseptic spray to cleanse gently all my wound. After ten days i began to use ordinary moisture cream along the scar. I am unable to feel half of bottom ear lobe and about 2" cheek below the ear but all is working facially as it should. I am just now in the 4th week feeling good enough to sleep on the injured side.
I have had no need of pain killers post op. The relief it's out and knowledge it WAS benign makes me pleased i had this operation. I feel vulnerable washing hair and using hairdryer but care has to be taken behind the ear esp as you can't feel this area. This I'm told may correct itself up to a years time. My hearing is as it was.
I had a very stiff neck prior to my diagnosis. I can say it's pain free now on movement. Would i do it again - YES no problem. Don't have fears over this operation.
Since i have had the operation i have been having pain on the left side of my forehead, a pain at the back of my head and a mild headache is this normal.
The operation took 4 hours