• Parotidectomy

    (Superficial Parotidectomy; Total Parotidectomy)

    Definition

    Parotidectomy is surgery to remove all or part of the parotid gland. These glands make saliva. They are located on your jaw, in front of and below each ear.
    Salivary Glands
    Nucleus factsheet image
    The parotid gland is the largest of the salivary glands.
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    The surgery is done to:
    • Remove a tumor in the gland
    • Remove lymph nodes that could be cancerous
    • Treat recurrent infections in the gland

    Possible Complications

    If you are planning to have a parotidectomy, your doctor will review a list of possible complications, which may include:
    • Numbness of the face and ear
    • Damage to the nerve that controls movement of muscles in your face
    • Saliva drainage—Saliva may pool in the upper neck after surgery. It may also drain through the incision after it has been closed. This is temporary.
    • Frey’s syndrome—This happens when salivary nerve fibers grow into the sweat glands. While eating, some people may notice sweating on the side of the face where the surgery was done.
    • Fistula—This is an abnormal connection that may occur between the mouth, nose, throat, or skin.
    • Infection
    • Bleeding
    • Scarring
    • Swelling of your airway
    Having risk factors for heart disease can increase your risk for heart attack or stroke during or after surgery. They include:
    Discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    Before the surgery, your doctor may:
    • Do a physical exam and review your medical history
    • Order blood tests and have x-rays taken
    • Talk to you about any medicines, herbs, and dietary supplements that you may be taking—You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen , naproxen )
      • Blood-thinning drugs, such as warfarin (Coumadin)
      • Anti-platelet drugs, such as clopidogrel (Plavix)
    Be sure that you have a ride to and from the hospital the day of your surgery.

    Anesthesia

    General anesthesia will be used. It will block pain and keep you asleep through the surgery. It is given through an IV (needle) in your arm or through gas that you breathe.

    Description of the Procedure

    The doctor will make a cut in front of the ear and down into the neck. He will locate and protect the nerves in the area during surgery. There are two types of parotidectomy surgery. The type you will have depends on why the surgery is being done.
    If you have a tumor and it is above the facial nerve, then a superficial parotidectomy is done. The tumor and affected tissue can usually be removed safely without harming the nerve.
    If you have a tumor that surrounds or grows into the facial nerve, a total parotidectomy is done. The tumor, affected tissue, and parts of the nerve are removed.
    Once all tissue has been removed, the doctor will close the area with sutures. He will also place a drain behind your ear. It will be used to remove any fluids (eg, blood and saliva) from the wound.

    How Long Will It Take?

    • Superficial parotidectomy—3-4 hours
    • Total parotidectomy—Five hours

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. Pain or soreness during recovery will be managed with pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is one day. If you have any problems, you will need to stay longer.

    Post-procedure Care

    At the Hospital
    Once the surgery is over, you will be moved to a recovery room. The hospital staff will monitor you. The staff may:
    • Check your facial movements by asking you to smile or pout
    • Show you how to care for the drain since you will have it when you go home
    At Home
    When you return home, do the following to help ensure a smooth recovery:
      Keep the wound clean:
      • Use hydrogen peroxide and a cotton swab to clean the area. Do this two times a day.
      • Put antibiotic ointment on the wound.
    • Follow the instructions for caring for your drain. It will usually be removed in 2-4 days.
    • You may also need to return to the hospital to have the sutures removed. This may be in 4-6 days. Once the sutures are out, clean the area with mild soap and water.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow all of your doctor’s instructions.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, a lot of bleeding, or discharge from the surgery site
    • Nausea and/or vomiting that you cannot control with the medicines you were given
    • Pain that you cannot control with the medicines you were given
    • Cough, shortness of breath, or chest pain
    • Spitting or vomiting blood
    • New, unexplained symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org/

    American Cancer Society http://www.cancer.org/

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca/

    Canadian Society of Otolaryngology http://www.entcanada.org/

    References

    Dictionary of cancer terms. National Cancer Institute website. Available at: http://www.cancer.gov/dictionary/?CdrID=44770 . Accessed November 19, 2010.

    Ghorayeb B. Parotidectomy: frequently asked questions. Otolaryngology Houston website. Available at: http://www.ghorayeb.com/parotidectomyfaq.html . Updated November 17, 2010. Accessed November 22, 2010.

    Parotidectomy. Georgetown University Hospital website. Available at: http://www.georgetownuniversityhospital.org/body%5Fdept.cfm?id=1017 . Accessed November 19, 2010.

    Surgical procedures: neck dissection. Greater Baltimore Medical Center website. Available at: http://www.gbmc.org/body.cfm?id=198 . Accessed November 19, 2010.

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