PAROTID GLAND

WHAT IS THE PAROTID GLAND?

The parotid gland is a salivary gland, responsible for making saliva.  There are two parotid glands, one on each side of the face.  They are located in front of the ears and extend to the lower borders of the jawbones.  The glands secrete thin saliva which travels into the mouth to aid in chewing and digesting food. 

WHAT ARE PAROTID TUMORS?

Parotid tumors are abnormal growths within the glands.  Most of these growths are benign (non-cancerous), but occasionally they can be malignant (cancerous).  On rare occasion, the growths can be enlarged lymph nodes or even non-parotid tumors which have spread into the parotid glands.  Of tumors which arise from the parotid tissue, most (about 80%) are slow growing and benign.  In contrast, malignant parotid tumors have a range of characteristics and types, with a few being fast growing and life-threatening.

HOW IS THE DIAGNOSIS MADE?

If a tumor of the parotid gland is suspected by you or your primary care doctor, you should be seen by an Ear, Nose, and Throat surgeon.  A careful history and thorough physical examination will then be carried out by your surgeon.  A CT scan (an x-ray test that helps to determine the size and position of the parotid tissues) or an MRI scan (an imaging test that does not use x-rays and helps to determine the size and position of parotid tissues) will be ordered.  A fine needle biopsy (withdrawing a small amount of tissue from the parotid to see if malignant cells are present) is also helpful, and is usually “guided” by the use of ultrasound.

TREATMENT OF PAROTID TUMORS

The treatment of choice for parotid tumors is surgery.  Surgical treatment generally requires the partial or complete removal of the parotid gland, a procedure termed parotidectomy.  Besides tumors, there are a few other indications for parotidectomy.  The common reasons for removal of all or part of this gland are therefore:

• Tumor or mass in the gland
• Chronic infection of the gland
• Obstruction of the saliva outflow from the gland causing chronic enlargement of the gland

Alternatives

For benign tumors that that are not enlarging and causing no symptoms, observation may be a reasonable alternative.  This is especially true if your general medical condition is poor and you cannot safely undergo general anesthesia.  However, in most cases, surgery IS advised as benign tumors have the potential to be cancerous, and are much more difficult to remove the longer they are present and the larger they become.

RISKS

As with all surgeries, parotidectomy carries certain risks.  It is important that these risks be fully understood by the patient before surgery. 

• Facial weakness.  The nerve that controls the movement of the face (the facial nerve) runs through the parotid gland. This nerve is important for closing the eyes, wrinkling the nose, and moving the lips.  Most often the parotid gland can be removed without damage to the facial nerve.  However, the size and position of the diseased tissue may require that the nerve, or small branches of the nerve, be cut to assure complete removal of the tumor.  Cutting of such branches results in permanent facial paralysis.  In addition, even when the nerve is not permanently injured, there may be decreased motion of the facial muscles (weakness) as the nerve recovers from the surgical procedure.
• Scar.  A scar is to be expected as with all surgery.  You will have a scar in front of your ear and down onto the upper part of your neck.  In the majority of patients it heals very well.  After the surgery, some patients may have a red and slightly raised scar which will fade over time.  Although rare in parotid surgery, some patients may develop a thick scar or keloid.  In addition, there will also be a slight hollow in the cheek or jaw area where the parotid tissue has been removed.
• Numbness. Many patients experience numbing of the earlobe and outer edge of the ear after parotid surgery.  This generally resolves over time.
• Frey syndrome. In a small proportion of patients who have undergone parotidectomy, the face on the side of the surgery will sweat when the gland is stimulated during eating (so-called "gustatory sweating" or Frey syndrome). Most often this condition is minor and goes unnoticed.  However, if it should become bothersome, topical medication is available as treatment.
• Salivary fistula. Very rarely saliva from the remaining parotid tissue may drain through a small opening in the skin incision.  This is treated with compressive dressings and heals in a few days,
• Bleeding, infection, and general anesthesia complications. These occur rarely with parotid surgery, but are theoretical risks as with all operations.

THE SURGERY

The operation is performed under general anesthesia.  An incision is made in front of the ear, curving down behind the earlobe, and extending forward onto the neck.  The amount of parotid gland to be removed is often determined at the time of surgery based on the size and location of the tumor or diseased portion of the gland.  The extent of surgery may also depend on pathological examination of tissues removed during the surgery.  Most superficial tumors are treated with removal of the superficial lobe of the parotid gland (i.e.: the portion of the gland situated superficial to the course of the facial nerve).  Deep or extensive tumors may require removal of the tissue located deep to the facial nerve as well.  The facial nerve is carefully identified during the surgery and every effort is made to preserve it.  Certain very aggressive tumors have a tendency to spread to the lymph nodes in the neck.  In such cases removal of these nodes may be carried out as well.  For extremely invasive tumors that have eroded through surrounding structures, more extensive procedures may be required, possibly involving removal of the facial nerve, or even part of the jaw.  Fortunately, these aggressive tumors are very uncommon.  You will likely have a drain tube (a thin plastic tube) attached to your hospital gown.  This is placed in order to drain any fluid that may be oozing from the wound after surgery and is generally removed before you go home the following day.

WOUND CARE

You may shower 48 hours after surgery.  When you go home, you will need to gently clean the wound with a Q-tip soaked in hydrogen peroxide and then cover the incision line with antibiotic ointment three times a day.  Keep the wound exposed to air and DO NOT cover it with a dressing, gauze, or a scarf.  A little antibiotic ointment may be used at the site of the drain as well.  The drain wound might ooze a small amount of reddish fluid for 1-2 days before it heals over.  It is important that you do not strain or move the neck vigorously for two to three weeks to allow the wounds to heal.  You will be followed closely during this time by your surgeon to ensure that your wounds heal without complications.

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