Parotidectomy

Introduction:

The parotid glands are a pair of salivary glands located on the side of the face just in front of the ears. These are two of the 6 major salivary glands (and numerous minor salivary glands) located throughout the mouth to aid with salivary production, chewing, swallowing, digestion, cleansing. These glands have ducts that secrete saliva directly into the mouth.

Indications for Surgery:

The primary indication for surgery is a mass. These masses may be benign (non-cancerous) or malignant (cancerous) in nature. In most cases, masses are benign. The tumor will be sent to the lab to determine the type of tumor and if it is benign or malignancy.  Results typically return within 7 days.

 

Surgery:

  • Surgery is performed under general anesthesia.
  • Most patients will go home the same day of surgery. There are cases where an additional procedure called a neck dissection, may need to be performed (see additional handout). In this case you will be spending 1-2 nights in the hospital.
  • On average, the surgery takes 90 minutes.
  • An incision is made in front of the ear and extends downward to the jaw and sometimes into the neck (depending on the size and location).
  • A drain will be placed in the neck to allow for tissue fluid and blood to leak out and prevent infection. This drain is typically left in for 3-5 days.

Post Operative Care:

Pain Control: Generally pain is well controlled with a prescription pain medication that has acetaminophen (Tylenol) and a narcotic. Alternatively, plain acetaminophen may be used, but be careful not to take more than the maximum daily dose. After 3 days, 600 mg of ibuprofen every 6 hours may be used and is encouraged instead of the narcotic. A common side effect of narcotic medications is constipation. You may treat/prevent this side effect by taking an over the counter stool softener.

Wound care: Both absorbable and non-absorbable stitches may be used for wound closure. The absorbable stitches dissolve over 1-2 months. The non-absorbable sutures will need to be removed in the office 7-10 days after surgery.

Apply bacitracin or other antibiotic ointment twice per day for three days after surgery. Then you may apply Vaseline to incision twice per day. Avoid sun exposure for the least noticeable scar. You may use scar creams, such as Maderma, 1 week after surgery.

You may shower with soapy water 24 hours after surgery. Avoid products with fragrances. Refrain from bathing, swimming pools, and hot tubs until wound is fully healed.  Avoid shaving directly around incision area for at least one week.

Diet: You may return to your previous diet after surgery.

Activity: Avoid strenuous activity and heavy lifting (over 15 pounds) for at least 1 week after surgery. You must also refrain from driving or operating heavy machinery with using narcotic medications.

Nausea/Vomiting: You may experience nausea after surgery and vomiting. This is usually due to the anesthesia and resolves within 24 hours. Call the doctor if nausea/vomiting are severe and prolonged.

Follow-up: Most patients leave hospital with a drain in the neck. A nurse will educate you prior to discharge on how to properly care for drain until removed 3-5 days post-operatively. It is important to keep drain bulb compressed and record output until follow up visit. Please make an appointment to follow-up 1 week after surgery to ensure appropriate wound healing and review pathology results.  Additional information for a drain removal appointment will be given upon discharge.

Risks Of Surgery:

Facial Nerve Injury: There is a nerve that controls facial movement that may be injured during surgery. This can cause weakness or inability to move one/multiples parts of the face, including eye closure and the corner of the mouth. Most often this is a temporary weakness and rarely does permanent paralysis occur.

Ear Numbness: There is a sensory nerve that runs just below the surface of your skin on the side of your face that controls sensation to the ear. The nerve is intentionally severed during surgery to gain access to the tumor. This causes ear numbness. It does not cause any changes to hearing. Ear numbness typically resolves 6 months after surgery.

Frey’s Syndrome (gustatory sweating): A common side effect of surgery is gustatory sweating. You might experience sweating of the cheek overlying the area of the excised parotid gland when you eat.  During surgery, the nerves that go to the salivary gland from the brain that tell it to produce saliva are cut. When they re-grow, instead of to going the salivary gland they go to the sweat glands. When your brain is stimulated to produce saliva, the cross wired nerves induce you to produce sweat on the cheek. Rarely is there significant sweating. This condition may be helped with antiperspirant applied directly to the affected area, BOTOX or surgery.

Scar: The smallest possible incision is used and a plastic surgery technique for closing the wound is used, but it is impossible to make a skin incision without scarring. You may use a scar diminishing ointment 1 week after surgery.

Bleeding: There is a risk of bleeding after surgery. A drain is placed to help expel any extra fluids but if this happens, the skin may turn a red or blue color, the neck will swell, and it will be painful. If this occurs, notify your physician right away.

Infection: Very low risk. Antibiotics are not routinely prescribed post-operatively.

 

Conclusion:

The benefit of surgery is that your parotid tumor will be accurately diagnosed and treated. A parotidectomy is a well-tolerated procedure. Recovery usually takes 1-2 weeks. Our office will support you through the recovery period.

 

If you have any concerns or problems please call the office (708-460-0007) and you will be connected to one of our nurses or surgeons.