Parotidectomy/superficial parotidectomy

The parotid gland is one of the salivary glands and can produce a variety of tumours, most of which are benign, some are malignant, and some behave in a way, which can only be described as in-between. Removal of the parotid gland or its superficial portion may be both diagnostic and curative. Often lumps within the parotid may be diagnosed using a fine needle biopsy but unfortunately the interpretation is difficult and sometimes equivocal. The operation of parotidectomy is performed by those surgeons with a particular interest in the disease, as the surgery is quite delicate. The key issue is that the nerve which supplies movement to the side of the face runs through the middle of the gland and therefore has to be identified and preserved. Danger to the nerve is minimised by experience, careful tissue handling and the use of a nerve monitor within the operation. Post operatively the patient will normally have a drain i.e. a small plastic tube leading out of the side of the wound in order to drain away any blood that may accumulate within the wound. This drain is usually removed the next day. The wound is not usually particularly painful; indeed there would be an area of numbness over the side of the face and the ear due to the division of the superficial nerves. This area of numbness will regress over a period of 6-12 months but at least 50% of patients are left with the tip of the ear lobe being numb. Facial nerve weakness mentioned above may be temporary due to stretching or bruising of the nerve at operation and this will recover within a few weeks. Permanent weakness is possible and may be inevitable if the tumour is surrounding a nerve. Another complication is Frey’s syndrome where by the patient complains of a sweating of the ear on the side of the face when they eat or chew. This can be a little alarming at first but it is harmless and to most patients a minor irritation, however there are treatments available should it become a major problem.