Parotidectomy – Anatomy and Physiology

The parotid glands are paired glands that are situated in front of the ears typically but portions of them extend below the ear and occasionally behind the lower ear. They are a salivary gland and are one of three major paired salivary glands the other two being the submandibular and sublingual glands. In addition there are multiple other minor salivary glands dotted around the oral cavity that help with saliva production.

Occasionally swellings occur in the parotid gland. It is important to determine if these swellings are benign or malignant. This can be done with a careful history and examination together with investigations such as fine needle aspirate cytology and further radiological imaging.

Thankfully over 90 % of swellings in the parotid are benign in their nature, however, even if benign they have a tendency to grow and it may be prudent to have them removed.

Parotidectomy

This operation requires some skill and experience as there are some definite hazards involved with doing the procedure.

Most importantly the facial nerve runs through the parotid gland and there is always a small risk of damaging it. This nerve has a number of branches that make you blink wink and smile on that side of your face. More often than not this damage is related to bruising and therefore temporary effect. The effect of this depends on the portion of the nerve that is affected. It is critical that the surgeon knows his landmarks and can identify follow and preserve the nerve and it’s branches to decrease the chances of damage.

A carefully placed incision often leaves a very difficult to spot scar, however, some people have a tendency to overscarring (hypertrophic or keloid scarring).

Incision for parotidectomy

It is not uncommon to have a numb feeling of the ear on the side that is operated on. This is related to the nerve supply to this portion of the ear that often is sacrificed in the approach. Most patients cope well with this as long as they are told in advance.

An unusual effect of the operation is that a large percentage of patients will experience sweating in and around the neck on chewing and eating. This side effect of the operation is called Frey’s syndrome or gustatory sweating as usually is not too troublesome a symptom.

The operation itself is performed under a general anaesthetic and the nerve will be stimulated or monitored through the operation.The operation may take between one to three hours on average depending on the degree of difficulty involved.

Normally patients would have a drain placed that would stay in place for a day or two and on removal usually can go home with an out-patient follow up with the results of the specimen sent for histology.