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What is the parotid gland?  The parotid gland is a gland that produces saliva in the mouth when you chew to help you eat.  You have two of these glands, one on each cheek, just in front of each ear.  It is the gland that swells up when you have mumps.

 

Why do I need parotid gland surgery?  Benign lumps are also removed as they sometimes can become malignant.

 

How is the operation done?  You will be asleep. The skin is cut in front of the ear, under and behind the ear lobe, and down the hair line (a face lift incision).  This scar is very difficult to see! However this large cut does allow exposure of all  the parotid gland by pulling the skin forward.

An important nerve runs through the middle of the parotid gland.  This is called the facial nerve.  This nerve controls all the movements of the face on that side.  During the surgery, this nerve is identified and its branches are traced out. This is the best way to avoid damage to these branches. Then I can remove the parotid lump. It is for this reason that the surgery takes 2-3 hours, as it is meticulous work. A drain is placed under the skin to collect any old blood.

A facial nerve monitor is used during the surgery to help identify and preserve the facial nerve.

 

After the operation: You will be in hospital for 1-2 days after surgery. The side of your face will be sore.  You will be given painkillers to help to reduce this.  The stitches are removed about one week after the surgery. It takes about one week to get the result back from the laboratory about the nature of the lump. You should be off work for 2-3 weeks. You do not get dry mouth after the operation as the other saliva glands are more than able to make enough saliva. You will however have some numbness of the earlobe after the surgery, and whilst this improves, a small area of numbness will remain long term.

Sweating of the face, particularly during eating (Frey’s Syndrome) can also occur after the surgery, but usually settles after a few months.

 

Complications of the surgery:

  • Facial weakness: There is a very important nerve, the facial nerve, which passes right through the parotid gland. This makes the muscles of the face move and if it is damaged during the surgery can lead to a weakness of the face (facial palsy). In most cases the nerve works normally after the surgery, however occasionally (about 15-20% of cases), where the tumour has been very close to the nerve, a temporary weakness of the face an occur that can last for a few weeks. In 1% of cases there is a permanent weakness of the face following this sort of surgery for benign tumours.
  • Numbness of the face and ear: The skin of the side of the face will be numb for some weeks after the operation, and often you can expect your ear lobe to be numb permanently.
  • Blood clot: A blood clot can collect beneath the skin (a haematoma). 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 collection: In 2-5% of patients the cut surface of the parotid gland leaks a little saliva, in which case this can also collect under the skin. If this happens 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: 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 regrow to supply the sweat glands of the overlying skin, instead parotid. This can usually be treated easily by the application of a roll-on antiperspirant.
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