The parotid glands lie in front of and below the ear. They form saliva
that drains into the mouth through a duct that lies next to the upper
molars. The parotid gland consists of a superficial and a deep lobe, with
the main trunk and branches of the facial nerve, or nerve that moves the
muscles of the face, in between the lobes. Some of the reasons for parotidectomy
include chronic infection of the gland or tumors. Benign or malignant
tumors can develop in these glands and 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 before the patient is referred to a specialist
for evaluation. Malignant tumors may cause facial nerve weakness, lymph
node enlargement or pain at the site of the tumor.
Parotidectomy is done for tumors of the parotid gland and occasionally
for recurrent infections of the gland. For benign and low grade malignant
tumors, surgery is usually curative without any need for additional therapy.
For other malignant tumors, surgery is usually followed by radiation therapy.
Most tumors lie in the portion of the gland above the nerve, so identification
of the nerve allows mobilization and removal of the tumor safely with
adequate margins around the tumor tissue and no injury to the facial nerve.
This is described as a superficial parotidectomy.
When the tumor requires dissection both above and below the facial nerve,
the procedure is called total parotidectomy. Rarely, branches of the facial
nerve, or even the main trunk of the nerve, are surrounded or invaded
by tumor and removal of all tumor tissue requires sacrifice of a portion
of the nerve. This situation is very rare with benign tumors.
The procedure is done under general anesthesia through an incision that
courses just in front of the ear and into the neck (similar to a facelift
incision). This incision heals well with minimal scarring and provides
safe access to identify the facial nerve and remove all tumor tissue.
The main trunk of the facial nerve is identified and the parotid gland
is dissected free from all branches of the nerve. Surgery takes about
2.5 to 4 hours depending on the size and location of the mass. A drain
is placed which exits the wound behind the ear, and is left in place for
one or more days depending on the amount of drainage. Most patients are
able to go home one day after surgery.
Complications of surgery include bleeding, infection, facial nerve weakness
which is usually temporary, and numbness of the skin around the neck and
ear. Other complications include a seroma or fluid collection under the
skin, which is why the drain is placed.
Once the patient is discharged home, light activity is recommended. Avoid
heavy lifting and strenuous exercise for one week. Avoid ibuprofen, aspirin,
or other medications that can increase the risk of bleeding. Bathing and
showering is permitted on the first day after surgery, although it is
recommended to keep the incision dry for about 48 hours. Sutures are usually
removed one week after surgery.