The parotid gland is a salivary gland located immediately in from the ear on each side of the face. This gland is the salivary gland most commonly affected by tumors, which will present as a lump in front of or below the ear. Most tumors are benign and are present for several months with little or no growth. Malignant tumors may cause facial nerve weakness, lymph node enlargement, or pain at the site of the tumor.
In some cases, additional procedures might be done at the same time as the parotidectomy. For example, a neck dissection might be indicated in certain types of parotid cancer, a facial nerve graft might be done if part or all of the facial nerve has to be sacrificed or a temporal bone resection might be required if the parotid cancer is growing into the side of the head where the ear is located.
The treatment for the vast majority of salivary tumors is surgical excision. Depending on the size and location of the salivary tumor, one of the following procedures may be recommended:
The parotid gland is artificially divided into a superficial and deep lobe by the facial nerve that runs in a set plane in the middle of the gland. A superficial parotidectomy requires removal of the parotid gland superficial to the plane of the facial nerve. This is the most common type of parotid surgery. A less than complete superficial parotidectomy, but one that has still removed the entire tumor with negative margin, may also be referred to as a partial parotidectomy.
Total parotidectomy requires removal of the entire parotid gland, including the superficial and deep lobe. If the facial nerve is not involved, this will require identifying all of the branches and carefully retracting them out of the way as meticulous dissection is performed.
Radical parotidectomy procedure is a total parotidectomy, along with resection of the facial nerve. An extended radical parotidectomy will involve removal of additional structures as well, such as the temporal bone or the skin of face overlying the parotid gland.
Frequently Asked Questions about Parotidectomy
Why is a parotidectomy done?
Parotidectomy is done for tumors of the parotid gland and occasionally for recurrent infections of the gland. For benign and low grade malignant tumors (acinic cell or low-grade mucoepidermoid cancers), surgery is usually curative without any need for additional therapy. For other malignant tumors, surgery is usually followed by radiation therapy. Occasionally, benign or low-grade malignant tumors that have recurred are treated with completion parotidectomy and radiation therapy.
Do I need to be admitted to the hospital?
After surgery, many patients are observed overnight at the hospital to ensure safe post-operative management. Once you are able to swallow liquids by mouth and can manage the wound drain, you may be discharged to home. Most patients are discharged within 24 hours of surgery.
What is the usual post-operative course?
Patients leave the hospital with sutures at the wound site. A small tube exits the skin behind the ear and is attached to a plastic bulb that collects blood, serum and saliva from the wound. No dressing is required. Once the drain output is less than 15 cc/day, the drain can be safely removed in clinic without discomfort.
Drain removal is usually possible about 4 days after surgery. Sutures may be removed 4 to 6 days after surgery.
What are the wound care instructions?
Apply antibiotic ointment (bacitracin or Polysporin) to the wound twice each day. Empty the drain bulb twice each day and record the output. 48 hours after surgery, you may shower and let water run across the incision. Gently dry the wound. Once the sutures are out, you may wash the wound with soap and water. Your ear and cheek will be numb for several months after surgery. Once the sutures are out, discontinue antibiotic ointment. Apply Aquaphor, vitamin E or aloe to the wound twice a day for a month. After this you may use Mederma for 2 more months. This should optimize healing.
What are the diet orders?
Expect to eat a liquid and soft diet for the first few days after surgery. Chewing may be uncomfortable due to irritation of the masseter muscle that lies below the parotid gland in the cheek.