Parotidectomy Patient Information

The parotid glands lie in front of and below the ear. They form saliva that drains into the mouth through a duct that lies next to the upper back teeth. Benign or malignant tumors can develop in these glands and will present as a lump in front of or below the ear. Most tumors are benign and are present for several months with little or no growth before the patient is referred to a specialist for evaluation. Malignant tumors may cause facial nerve weakness, lymph node enlargement or pain at the site of the tumor.

The facial nerve exits the skull deep to the ear canal and travels through the parotid gland to the muscles of the face. Identification and protection of the facial nerve is an important part of parotid surgery. The nerve is usually identified 3-4 cm below the skin level, just in front of the ear canal and traced toward the midface as it divides into several branches. Most tumors lie in the portion of the gland above the nerve, so identification of the nerve allows mobilization and removal of the tumor safely with adequate margins around the tumor tissue and no injury to the facial nerve. This is described as a superficial parotidectomy.

When the tumor requires dissection both above and below the facial nerve, the procedure is called total parotidectomy. Rarely, branches of the facial nerve, or even the main trunk of the nerve, are surrounded or invaded by tumor and removal of all tumor tissue requires sacrifice of a portion of the nerve. This situation is very rare with benign tumors. Usually, facial nerve sacrifice is considered only for patients with who have a malignant tumor and facial weakness prior surgery.

The procedure is done under general anesthesia through an incision that courses just in front of the ear and into the neck (similar to a facelift incision). This incision heals well with minimal scarring and provides safe access to identify the facial nerve and remove all tumor tissue. Superficial parotidectomy takes 3-4 hours to complete. Total parotidectomy may take 5 hours to complete. The incision is usually closed with nylon sutures that are removed 4-6 days after surgery. A drain is also placed which exits the wound behind the ear. This is removed in clinic 2-4 days after surgery.

The risks of surgery are in part determined by the anatomy of the tumor. Great care is taken to protect the facial nerve during surgery, and most patients have normal function of this nerve following surgery. Temporary weakness of one or more branches of the nerve may occur and will usually recover in 3-4 months without the need for any additional therapy. Permanent weakness can also occur, but is very rare if the nerve is visibly intact at the conclusion of the procedure.

Wound infections may also occur and can usually be managed in the clinic with antibiotics and minor wound care. Bleeding in the wound is a rare event and may require a return to the operating room for safe management.

Saliva may collect in the upper neck or drain through the incision line during the post-operative phase. If this occurs let your doctor know. Salivary drainage is usually temporary without the need for additional treatment. A common long-term effect of parotidectomy is called Frey s syndrome. It is caused by the growth of salivary nerve fibers to the sweat glands of the skin and takes about 6 months to develop. Patients may notice sweating of the operated side of the face while eating. This may be controlled with antiperspirant applied to the cheek. If this remains bothersome, other treatment may be indicated.

Patients leave the hospital with sutures at the wound site. A small tube exits the skin behind the ear and is attached to a plastic bulb that collects blood, serum and saliva from the wound. No dressing is required. Once the drain output is less than 15-20 cc/day, the drain can be safely removed in clinic without discomfort.

Drain removal is usually possible on the 2nd to 4th post-operative day. Sutures may be removed on the 4th to 6th day after surgery.

Clean the wound with hydrogen peroxide using a cotton swab twice each day. Apply antibiotic ointment (bacitracin or polysporin) to the wound. Empty the drain bulb twice each day and record the output. Once the sutures are out, you may wash the wound with soap and water and gently dry the area. Your ear and cheek will be numb for several months after surgery. Three weeks after surgery, you may begin to massage the wound using a vitamin E or aloe containing lotion or oil. This will soften the scar over time. If you are scheduled for post-operative radiation therapy, check with the radiation doctors about what lotion is safe.

You will be seen in clinic for post-operative visits. Pathology results are usually available 3-5 working days after surgery and can be reviewed in clinic. After suture removal, you will be seen in clinic every 2-4 weeks until healing is complete. Long-term follow-up is determined by the pathology. Patients with benign tumors are seen every 3-6 months for two years, then yearly. Patients with malignant tumors are followed every 2-3 months for two years, then every 6 months for 5 years.

Call the office at 202-444-8186 to schedule appointments.

For patients of Dr. Bruce Davidson, his assistant, Sharon Robins, may be reached at 202-444-7035 for questions pertaining to surgery or scheduling difficulties. A resident is available by page 24 hours a day at 202-444-7243. If you have a non-emergent matter, please call the office first.

For general questions or information, you may also email us. Please note that we cannot guarantee the confidentiality of this e-mail — for confidential patient questions, please call the phone number listed above.

E-mail contact options are:

Sharon Robins  Syr2@gunet.georgetown.edu
Bruce J. Davidson, MD, FACS davidsob@gunet.georgetown.edu