Surgical Procedures: Parotidectomy

Author: OncoLink Team
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What is a parotidectomy?

A parotidectomy is a surgery done to remove the parotid gland. The parotid gland is the largest of the salivary glands. It is located in front of the ears. The parotid gland is responsible for making and secreting saliva. Saliva is important for digestion of food, killing bacteria in the mouth, and preventing tooth decay.

Salivary gland cancers often start in the parotid gland. They are rare and most parotid tumors are benign (not cancerous).

A parotidectomy may be done to treat some cases of salivary cancer. It may also be done to treat non-cancerous conditions like chronic infection or obstruction (blockage) of the salivary glands.

How is a parotidectomy done?

There are two types of parotidectomy:

  • Superficial parotidectomy: The superficial (outer part) of the parotid gland is removed. The surgeon makes a cut (incision) in front of the ear and down the neck. This does not often affect how the face moves, because it attempts to avoid the facial nerve.
  • Total parotidectomy: The entire parotid gland is removed. The surgeon makes a cut in front of the ear and down the neck. The facial nerve, as well as other tissues, may need to be removed depending on where the tumor is. This could affect how your face is able to move. 

In some cases, lymph nodes in the neck may need to be removed. This is called a lymphadenectomy. This may require removal of connective tissue, muscles, nerves and blood vessels. To do this, a long incision (cut) is made in the neck. 

Each case is different, and your provider will talk to you about the specifics of your surgery. 

What are the risks of having a parotidectomy?

As with any surgery, there are risks and possible side effects. These can be:

  • Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
  • Bleeding.
  • Blood clots.
  • Infection.
  • Facial nerve damage. This can lead to facial muscle loss, facial droop, issues with tongue movement, problems with speech or swallowing, arm weakness and/or weakness in the lower lip.
  • Frey syndrome (A condition caused by facial nerve damage. It causes facial flushing and sweating when eating a meal, or even thinking, dreaming or talking about eating.)
  • Loss of feeling in the ear.
  • Dry eye.
  • Salivary fistula (An abnormal opening in the skin that saliva may leak through).
  • A change in your physical appearance.

Before surgery, your provider will talk to you about any other risks based on your health and the specific surgery you are having. 

What is recovery like?

The recovery and hospital stay from a parotidectomy will depend on the extent and type of procedure you have had. 

You will be told how to care for your surgical incisions or drains and will be given any other instructions prior to leaving the hospital.

Your care team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your provider will talk to you about any changes in your activity level, which will depend on the surgery you had. Often, it is recommended that you:

  • Take prescribed medications as directed.
  • Eat a bland diet, avoiding sour, tart or spicy foods.
  • Treat constipation as needed to reduce straining when having a bowel movement.
  • Sleep with your head elevated above your heart.
  • Talk to your healthcare team about when you should resume your pre-operative medications, specifically medications that can affect blood clotting, like blood thinners, aspirin and non-steroidal anti-inflammatory medications (i.e. ibuprofen, naproxen)
  • Avoid drinking alcohol.
  • You should not smoke because this will lessen the blood flow to the surgical wound. If the wound does not have enough blood flow, it will not heal.
  • No lifting anything over 10 pounds.
  • No bending to lift objects or exercise until told to do so.
  • Avoid air travel for 2 weeks after surgery.
  • Perform incisional care and showering as directed. Do not submerge the incision in water.

What will I need at home?

  • Thermometer to monitor for fever (101°F/38.3°C), which can be a sign of infection.
  • Wound and drain care supplies if needed.

When should I call my provider?

Your provider should give you instructions about when to call the office. It is often suggested you call the office if you have:

  • Fever of 101°F/38.3°C or higher.
  • Redness, swelling and/or drainage at the incision.
  • Any other questions or concerns.

How can I care for myself? 

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity. 

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms. 

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.  

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense. 

  • Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders. 

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.   

References

ACS. What is Salivary Cancer? Retrieved from http://www.cancer.org/cancer/salivaryglandcancer/detailedguide/salivary-gland-cancer-what-is-salivary-gland-cancer 

Surgery for Salivary Cancer. Retrieved from http://www.cancer.org/cancer/salivaryglandcancer/detailedguide/salivary-gland-cancer-treating-surgery 

Cedars-Sinai. Salivary Gland Surgery. Retrieved from https://www.cedars-sinai.edu/Patients/Programs-and-Services/Head-and-Neck-Cancer-Center/Treatment/Salivary-Gland-Surgery.aspx 

Chicago Nasal and Sinus Center. Salivary Gland Surgery Post-Oeprative Instructions. Retrieved from http://www.chicagonasalsinuscenter.com/pdf/PostOp-SalivaryGland.pdf 

South Valley Ear, Nose and Throat. Post-Operative Instructions: Parotidectomy / Salivary Gland. Retrieved from http://www.southvalleyent.com/files/Parotidectomy.pdf

Function and Diseases of the Parotid Gland. Retrieved from https://www.verywell.com/parotid-gland-513663

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