Parotidectomy

If you would like to learn about parotidectomy, the reasons for parotidectomy and the benefits of parotidectomy, the following information will help you.

Before you agree to have a parotidectomy operation  on your parotid gland it is sensible to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when carrying out parotidectomy, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your parotid gland treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

Your parotid gland contains a lump. The lump is probably a type of tumour. It is most likely to be non-serious (benign) and not malignant.

The swelling could be an inflammation or infection of the gland. Stones in the saliva may obstruct the parotid duct that drains the parotid gland. The blocked parotid duct may lead to infection of the gland. An abscess may form in the parotid gland. Infections of the parotid gland may give fever and pain when eating. This is especially the case with sour foods, which increase the amount of saliva.

There is a chance that the swelling is not in your parotid gland at all, but is coming from something else in your neck, such as a lymph gland.

What is the parotid gland?

The parotid gland is one of the glands that make spit (saliva). These are called the salivary glands. Saliva is important in the breaking down (digestion) of the food that we eat. Saliva makes food moist, lubricating it as it passes from the mouth to the gullet.

There are two parotid glands, one on each side of the face. Each parotid gland is shaped a bit like a wedge. They fit over the back of the jawbone just in front of each ear. The name parotid comes from the Greek word meaning “near the ear”. Saliva runs from the parotid gland, along a tube called the parotid duct and into the mouth near the back teeth.

The nerve to your face muscles runs through the middle of the parotid gland. This nerve is called the facial nerve. The facial nerve supplies feeling to the muscles that move the face. The nerve to the skin of your ear runs past the back of the parotid gland.

The gland is made up of two parts: a deep part and a superficial part, which is close to the surface. Normally, the parotid gland cannot be felt.

The aims

The aim of the operation is to remove the swelling with a small rim of normal parotid gland. The rest of the gland is left alone. We make every effort to avoid damaging the facial nerve.

You will have a general anaesthetic and be completely asleep while the operation is done.

The benefits

You will lose the swelling on the side of your face or neck. The lump will be examined in the laboratory to find out exactly what it is and to see if further treatment is needed.

Having part of the parotid gland removed will not give you a dry mouth from a reduction in your saliva.

Are there any alternatives?

There are no drugs or x-ray treatments that will safely get rid of the lump. There are investigations that may be done to check the exact position of the swelling and what it might be. These may include:

• Fine needle aspiration (FNA) - a small needle is inserted into the swelling and some cells are sucked out. This tells us if the mass is parotid tissue, a lymph node or even a collection of pus.

• Sialogram - This is an x-ray investigation that uses a dye that shows up on x-rays (contrast). A small tube is put into the parotid duct and the dye is injected to outline the duct system. This may reveal a narrowing of the duct or a stone. Sometimes this is combined with a CT scan.

• CT or MRI scan – A CT scan or Computed Tomography scan is a detailed x-ray investigation using a computer to create images of the body. An MRI scan or Magnetic Resonance Imaging scan is done using a magnet, radio waves and a computer to create pictures. These investigations may show the size, shape and exact position of the swelling. This information helps in planning the surgery.

Both of these techniques are explained in depth in separate information leaflets within this series.

What if you do nothing?

If you do nothing, the swelling in your parotid gland will usually get slowly larger. The bigger the swelling, the more difficult it is to remove and the greater the risk of damage to your facial nerve.

There may be some uncertainty about the cause of your parotid swelling. Scans, needle tests and blood tests may not give a clear answer. If you do nothing when there is doubt about the cause of your swelling, you may miss out on important treatment.

If the swelling presses on your facial nerve, this may cause some weakness of the muscles of your face. For example, your eye may not close properly or the corner of your mouth may droop. A small percentage of the benign tumours can become malignant (cancerous) over time.

Who should have it done?

A person with a lump in the parotid gland should have it investigated and if necessary removed.

Who should not have it done?

People who have other medical conditions that would make it unsafe for them to have a general anaesthetic should not have one.

Author: Mr Robert Ruckley MB. ChB.  F.R.C.S.  Consultant ENT surgeon.

© Dumas Ltd 2006

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