Parotidectomy

What is a parotidectomy?

A parotidectomy is surgery to remove all or part of your parotid gland. Parotid glands are major salivary glands in front of your ears. They make saliva (spit) that helps you swallow food. This procedure is treatment for tumors or a salivary stone that blocks your salivary gland.

Types of parotidectomies

Healthcare providers classify parotidectomies by the part of the gland that the disease affects. Your parotid gland has two sections separated by your facial nerve. This nerve manages your facial expressions and movement. Types of parotidectomies are:

• Superficial parotidectomy: Surgery to remove a tumor in the superficial section on top of your facial nerve
• Total parotidectomy: Surgery to remove a tumor in the deep section below your facial nerve or a tumor in both sections

Both types may be treatment for salivary gland stones.

How should I prepare for this procedure?

Your otolaryngologist will give you specific instructions. In general, you should:

• Quit smoking
• Ask your surgeon if there are medications or supplements you should stop taking before surgery
• Find out when you should stop eating or drinking before surgery
• Ask if you’ll need to stay in the hospital after surgery or go home the same day
• Plan to have someone drive you home and care for you during the first 24 hours after surgery or for a few days after surgery

You may feel a bit overwhelmed by what you need to do to get ready for a parotidectomy. You might want to have a family member or friend with you when you meet with your surgeon. They can take notes while you and your surgeon discuss what you should do to get ready for surgery.

You may have the following tests before surgery if you have a tumor in your parotid gland:

• Fine-needle aspiration to get a small piece of tissue from your parotid gland (a medical pathologist will check the sample to see if the tumor is cancerous)
• CT scan or MRI scan if the tumor is close to your facial nerve (the scans help your surgeon plan the best way to protect your facial nerve while they remove the tumor)

What happens during a parotidectomy?

Your anesthesiologist will give you general anesthesia through an IV. You’ll be asleep during surgery. Then, your surgeon will:

1. Make an incision (cut) in front of your ear — the cut goes down to the area below your ear lobe and reaches back and down into the natural crease in your upper neck
2. Pull back skin so they can see your parotid gland — they may use a facial nerve monitoring device during surgery, which lets your surgeon check on your facial nerve
3. Remove all or part of your parotid gland — they’ll also remove any nearby lymph nodes if tests show there’s cancer in those lymph nodes
4. Close the incision
5. Insert a small tube (surgical drain) to catch any blood or fluid that collects at the surgical wound

The surgery will take about two to four hours.

What are the potential benefits and risks of a parotidectomy?

A parotidectomy may cure a benign (noncancerous) tumor in your parotid gland. It’s effective treatment for severe salivary stones and infections. The surgery may cure parotid gland cancer by removing a cancerous tumor before it can spread. But cancerous tumors may come back.

This is a major surgery because it involves removing part of your parotid gland. Complications from a parotidectomy include:

• Numbness in your ear, face or jaw that may last three to four months up to a year
• Facial weakness that may last a few weeks or months up to a year after surgery
• Frey’s syndrome (sweating when you eat), which may develop several months after surgery
• First bite syndrome, which is when you have severe pain when you take your first bite of food

There are potential risks, including:

• Allergic reaction to pain medicine
• Damage to a nearby organ during surgery
• Excessive fluid collecting at the surgery site
• Excessive bleeding
• Hematoma (blood collecting at surgery site)

Parotidectomies may cause the following side effects:

• Pain and swelling at the surgery site (lasting about one to three weeks)
• Discomfort in your jaw when you’re eating (can last up to two to four weeks)

What happens after?

You’ll wake up in a recovery room. A healthcare provider will check your vital signs. They’ll give you pain medication. They may ask you to smile or close your eyes so they can confirm your facial nerve works like it should.

Your care team will explain how to take care of your surgical wound and surgical drain when you go home. They’ll tell you when you’ll need to come back so a provider can remove the surgical drain and sutures. Timing varies, but you may see a provider:

• One to two days after surgery to remove the surgical drain
• Five to seven days after surgery to remove non-absorbable sutures
• Four to six weeks after surgery, when your surgeon will check to confirm the surgical wound is healing

What is the recovery time?

Recovery typically takes a few weeks. Most people will be able to get back to their usual activities after about two weeks. It may take a few months up to a year for you to recover from any numbness or facial weakness.

Parotidectomy follow-up care

Cancerous parotid gland tumors can come back. You may have regular checkups for up to 20 years after your surgery. A typical checkup schedule may look like the following:

Regular long-term checkups can be stressful as you have tests and wait for results. Cancer survivorship support may help you manage anxiety and stress.

When should I call my healthcare provider?

Contact your surgeon if:

• You have pain that doesn’t go away with medication
• Your face feels numb or weak
• There’s pus, fluid or blood coming from the surgical wound
• The area around it feels warm to your touch or it hurts when you touch it
• The surgical wound smells bad