• Salivary Gland Surgery

    (Parotidectomy; Submandibular Sialoadenectomy; Sublingual Gland Surgery)

    Definition

    Salivary glands secrete saliva into your mouth through ducts. The salivary glands are found around the mouth and throat. The main glands are:
    • Parotid
    • Submandibular (submaxillary)
    • Sublingual glands
    • Smaller glands located throughout the mouth area
    Salivary Glands
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    Copyright © Nucleus Medical Media, Inc.
    This surgery is done to remove a salivary gland. There are different types of surgeries, depending on which gland needs to be operated on:
    • Parotidectomy —to remove the parotid gland
    • Submandibular sialoadenectomy—to remove the submandibular gland
    • Sublingual gland surgery—to remove the sublingual gland

    Reasons for Procedure

    Salivary glands can become infected; blocked; or have a tumor, stone, or other disorder. Surgery is done to treat the problem by removing part of or the entire affected gland. It may also be done to remove tissue for testing, like removing a tumor to test for cancer.

    Possible Complications

    Complications are rare. But, no procedure is completely free of risk. If you are planning to have salivary gland surgery, your doctor will review a list of possible complications, such as:
    • Numbness of the face and ear
    • Damage to the nerve that controls movement of muscles in your face
    • Saliva drainage—Saliva may leak through the incision after it has been closed.
    • 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.
    • Bleeding
    • Infection
    • Swelling of the airway
    • Scarring
    • Fistula formation—This is an abnormal connection that may occur between the mouth, nose, throat, or skin.
    Having risk factors for heart disease can increase your risk for heart attack or stroke during or after surgery. They include:
    Talk to your doctor about these risks before the surgery.

    What to Expect

    Prior to Procedure

    Before the surgery, your doctor may:
    • Do a physical exam and review your medical history
    • Have blood tests done
    • Have x-rays of other imaging tests done
    • 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)

    Anesthesia

    If you are having surgery on larger salivary glands (eg, parotid gland), general anesthesia may be used. This will keep you asleep and free from pain during the procedure. If smaller salivary glands are being removed, you may receive local anesthesia. Only the area that is being operated on will be numbed.

    Description of the Procedure

    This procedure is often done in an outpatient setting. But, if your surgery is extensive or is on a larger gland, you may need to stay in a hospital.
    Parotidectomy
    There are two types of parotidectomy surgery. The type you will have depends on why the surgery is being done.
    The facial nerve runs near the parotid gland. If you have a tumor and it is above the facial nerve, then a superficial parotidectomy will be done. The tumor and affected tissue will be removed without harming the nerve.
    If you have a tumor that surrounds or grows into the facial nerve, a total parotidectomy will be done. The tumor, affected tissue, and parts of the nerve will be removed.
    For both types of surgery, the doctor will access the gland by making a cut in front of the ear and down into the neck.
    Submandibular Sialoadenectomy
    The doctor will make a cut in the neck, below the jawline. She will remove the submandibular gland, and possibly surrounding lymph nodes. If you are having the surgery to remove a stone that has grown in the gland, the stone will also be removed.
    Sublingual Gland Surgery
    If you are having sublingual gland surgery, it is most likely because a type of cyst, called a ranula, needs to be removed. During this surgery, the doctor will make a cut through the mouth to remove the cyst. If the cyst is large, she may also need to make a cut into the neck.
    Minor Salivary Gland Surgery
    If you are having surgery to remove tumors from smaller salivary glands, the doctor will make a cut in the area where the gland is located. She will then remove the tumor and any surrounding soft tissue and bone that is affected.
    For all surgeries, once all tissue has been removed, the doctor will close the area with sutures. In some surgeries, temporary drains may be put in place to remove any fluids (eg, blood, saliva) from the wound.
    The doctor may send tissue that was removed to a lab for testing. This is often done if a tumor was removed, since tests will determine whether the tumor is cancerous. Knowing this can help the doctor plan for your care and treatment after surgery.

    How Long Will It Take?

    This varies depending on which gland needs to be removed. Simple glands may take less than an hour to remove. Complex surgeries may take up to five hours to do.

    Will It Hurt?

    Anesthesia prevents pain during surgery. Your doctor will give you pain medicine after surgery.

    Post-procedure Care

    At the Care Center
    Right after surgery, the staff may:
    • Check your facial movements by asking you to smile or pout
    • If you have a drain, show you how to care for it
    At Home
    When you return home, do the following for a smooth recovery:
      Follow your doctor’s instructions for:
      • Caring for your wound
      • Caring for your drain
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • You may also need to return to the hospital to have the sutures removed. Once the sutures are out, clean the area with mild soap and water.

    Call Your Doctor

    After arriving home, 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

    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

    Montemayor-Quellenberg M. Parotidectomy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 22, 2010. Accessed February 18, 2011.

    Salivary gland surgery. Cedars-Sinai website. Available at: http://www.cedars-sinai.edu/Patients/Programs-and-Services/Head-and-Neck-Cancer-Center/Treatment/Salivary-Gland-Surgery.aspx . Accessed February 18, 2011.

    Salivary gland surgery. James HF Shaw, Clinical Professor of Surgery website. Available at: http://www.jameshfshaw.co.nz/salivary%5Fgland%5Fsurgery.html . Accessed February 18, 2011.

    Salivary glands. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/salivaryGlands.cfm . Accessed February 18, 2011.

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