PAROTIDECTOMY
Why a Parotidectomy?

Parotidectomy is the medical term for an operation to remove all or part of the Parotid gland. The Parotid gland is one of the "spit" glands and is located in front of the ear. This is the gland that swells with the mumps. A parotidectomy is typically advised when one has a mass within the parotid gland. Roughly 80% of these masses are benign and approximately 20% are malignant. Since malignant lesions can spread and be deadly it is obvious why they should be removed. It may not be as obvious why a benign lesion should be removed. First of all, a small number of these lesions can later degenerate into malignant lesions. It is preferable to remove these while they are still benign. Secondly, most of the benign lesions continue to grow and can begin to cause problems just because of their size. By the time they enlarge and become problematic that are more difficult and risky to remove. We therefore prefer to excise them when they are initially detected and are smaller in size. The surgery to remove these is called a superficial parotidectomy. This operation is best performed by head and neck specialists with extensive experience. There is certainly very little risk to one's life from this sort of surgery, but there are certain other risks and aspects of the surgery which would be helpful to explain.

First of all, the incision is made in front of the ear, curving behind the lower jaw, and then curving forward in the upper neck along a neck crease. Even for small tumors the incision needs to be of this length because at least half of the gland needs to be removed. It would seem that small tumors could easily be cut out from the gland itself, but experience has shown that removal of less than the outer one-half of the gland results in very high rates of tumor recurrence and risks injury to the facial nerve. Because of this, the approach to even small tumors is exactly the same as to that of larger ones. The incision is made so that the skin of the face can be reflected forward to expose the entire gland. The nerve to the face, which controls all movement on one side, goes through the middle of the gland. This nerve must be identified and carefully preserved. Most tumors are in the outer half of the gland and by taking out the entire outer half, very high cure rates, on the order of 95--98%, are possible.

The chance of injury to the facial nerve is less than 5%. Usually if the nerve does not work postoperatively this is only temporary. On rare occasions, however, permanent paralysis could follow a routine operation (less than 1 out of 1,000). This would result in drooping of the face on that side. The eyelids may not close and may require corrective surgery. The nerve is never intentionally cut unless it is known preoperatively that the tumor is malignant. We typically do fine needle biopsies as part of the work-up before surgery to determine if the tumor is malignant. Based on the results of this test, we will have discussed preoperatively the probability of intentionally sacrificing the facial nerve. Numbness to the ear and sometimes surrounding tissue on the side of the surgery can be expected to occur routinely because the main nerve that supplies sensation to these areas must be cut in order to remove the lateral half of the gland. Most people have some or total return of feeling, however, within six to twelve months after surgery.

Another change that can occur after a parotidectomy is facial sweating in the area of surgery while eating. This is called Frey's syndrome and is caused when nerves which previously supplied the parotid gland grow into facial sweat glands postoperatively. When you eat, these nerves cause sweating, whereas previously they would have stimulated the parotid or "spit gland" to make saliva. This is usually not a problem unless a lot of make-up is worn. There are some treatments which can be helpful if you are one of the very few people who is bothered by this (less than 1 out of 100).

We always talk about bleeding and infection with any surgical procedure. Infection occurs less than 1 out of 100 times and we will give antibiotics at the time of surgery as a preventative measure. Bleeding rarely occurs. In order to prevent any problems with bleeding, we insert drains that will be in place for about 48 hours postoperatively. This usually prevents any of the problems which typically are associated with bleeding.

Many people ask if their mouth will be dry because of removal of the gland. Usually this is not the case because the other glands make up for the loss of any single gland.

You may be in the hospital for a few days. At home, you should clean the incision two or three times a day with Peroxide and a Q-Tip, and then coat it with an antibiotic ointment such as Neosporin. The sutures will be removed in the office 5--8 days after your surgery.

We hope this information has been helpful. It is meant to be informative and not to cause concern about the surgery. Obviously, you may have specific questions which we will be more than happy to answer at any time.

I have read this information, asked my doctor any pertinent questions, and fully understand the recommended procedure.

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Patient or Guardian

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