What is a parotidectomy?

Surgery to remove the parotid gland is called a parotidectomy. This surgery is performed through an S-shaped incision starting in the crease in front of the ear, extending below the earlobe and sweeping forward onto the upper neck. A parotidectomy involves locating the facial nerve (the nerve that moves the muscles of expression in the face) and dissecting the parotid gland off of this nerve. The facial nerve runs through the middle of the gland. Approximately 75% of the gland is superficial to the nerve (the superficial lobe), with the remaining 25% lying deep to the nerve (the deep lobe). Most tumors of the parotid gland reside in the superficial portion of the gland, although some tumors may reside in the deep lobe or in both. When only the superficial lobe of the gland is removed, this is referred to as a superficial parotidectomy. When both the superficial and deep lobes are removed, this is referred to as a total parotidectomy. Parotid surgery is performed under general anesthesia and may take two to three hours to complete. It is usually well tolerated, not painful, and most patients resume normal activities within a few days.

What are the risks of a parotidectomy?

Patients who undergo parotidectomy will typically experience permanent numbness in the area around the earlobe, and will have a small depression in the area where the parotid gland was located. The most important risk of parotidectomy is the possibility of injury to the facial nerve, resulting in weakness in some, or all, of the muscles on that side of the face. This injury, if it occurs, is usually transient, although permanent injury to the nerve is also possible. Transient injury to the facial nerve may take weeks to months to recover from. The likelihood of nerve weakness after surgery is significantly higher following a total parotidectomy than it is after a superficial parotidectomy. The risk of facial nerve weakness is also significantly higher with malignant tumors, since these may be attached to the nerves. Other risks of surgery include the development of gustatory sweating, or Frey’s syndrome, a condition in which stimulation of the salivary glands by eating leads to sweating of the skin over the parotid area, and salivary fistula, in which saliva from residual parotid tissue leaks out through the incision.

By Cary Moorhead, MD