A parotidectomy is surgery to remove part or all of a tumor (benign or cancerous) in the parotid gland.

Dr. Wojtek Mydlarz, director of Johns Hopkins Head and Neck Surgery for the National Capital Region and an assistant professor in the Department of Otolaryngology–Head and Neck Surgery for The Johns Hopkins University School of Medicine, reviews what’s involved with a parotidectomy. 

What is the parotid gland?

There are two parotid glands, one in front of each ear, on the sides of your face. These major salivary glands make spit (saliva), which empties into the mouth through small openings (ducts).

The facial nerve, an important nerve that controls facial movement and expression, divides each parotid gland into two halves, or lobes — the superficial lobe (above the nerve) and the deep lobe (below the nerve).

What is a Parotidectomy?

If a tumor forms in a parotid gland, your doctor may recommend a parotidectomy to remove the affected areas. The tumor may be benign or cancerous. There are a few types of parotidectomy:

• Radical parotidectomy: Due to cancer involvement, the entire gland and other soft tissues  are removed, including sacrificing the facial nerve — meaning it needs to be cut. 
• Superficial parotidectomy: removal of a tumor on the superficial (top) lobe of the parotid gland. The facial nerve may be dissected during the surgery.
• Total parotidectomy: removal of a tumor in the deep lobe or in both the deep and superficial lobes. The facial nerve may be dissected and possibly moved off the tumor during the surgery.

When is a Parotidectomy needed?

A parotidectomy is usually performed to remove tumors, also called neoplasms — abnormal masses of tissue that form when cells grow and divide more than they should or do not die when they should. After a tumor is detected, imaging studies and a biopsy are performed. Your surgeon will develop a treatment plan based on the characteristics of the tumor ― whether it is benign or malignant. In either case, treatment typically begins with surgical removal of the tumor:

• Removal of benign (noncancer) or malignant (cancer) masses of the parotid gland
• Removal of cancer in the parotid gland that has spread from another place (for example, the scalp, ear, skin of face or other sites in the body)

A parotidectomy could also be performed to treat infections in the parotid glands, or to treat salivary gland stones: calcium deposits that can block saliva from flowing into your mouth, potentially leading to swelling and infection.

Preparing for a Parotidectomy

A parotidectomy is done at a hospital under general anesthesia. Many people return home the same day, unless a lymph node neck dissection or reconstructive procedure is performed at the same time. For safety, do not eat or drink anything after 12 a.m. on the day of surgery. Ask a family member or friend to pick you up from the hospital and help you at home during the first few days. 

What happens during a Parotidectomy?

The surgeon makes an incision in the skin to reach the parotid gland. The cut is made where it is less likely to leave a noticeable scar, either in a crease of the neck or hidden along the earlobe and hairline. The surgical team then typically finds the facial nerve and delicately removes the parotid tumor, along with some normal tissue surrounding the mass so it can be safely removed.

Complications of a Parotidectomy

• Facial nerve injury: The surgeons take care to identify the facial nerve and trace out its branches. Nerve monitoring during surgery can help identify and protect the facial nerve. If the tumor has surrounded or invaded the facial nerve, that nerve may have to be removed along with the tumor. In this situation, experts in facial plastic and reconstructive surgery will perform a nerve transfer or other facial reanimation procedure and reconstruction.
• Facial weakness: Temporary facial nerve weakness can occur right after surgery, most likely due to dissecting and moving the nerve during surgery. The weakness should get better with time, but it may take several months or up to a year to recover function. Permanent facial nerve weakness is much less common and depends on the size, location and type of mass, and how much surgery is needed to remove it.

In addition to facial nerve injury and weakness, possible complications include:

• Bleeding
• Infection
• Salivary fistula: saliva leaking through the incision (this is usually temporary)
• Sialocele: a cavity or cyst containing saliva
• Frey’s syndrome: a rare complication of parotid gland surgery that causes sweating or flushing in an area of the face when eating, especially spicy, salty or sour foods
• First bite syndrome: a rare complication of severe, sharp pain, deep and in front of the ear on the side of surgery, when the mouth is opened wide or for the first bite of a meal. This is more common after total or deep lobe parotid tumor removal.
• Seroma: a pocket of fluid that forms near the surgical incision
• Earlobe numbness: You have a nerve near the parotid gland that gives feeling to your earlobe and surrounding areas. Some numbness of the earlobe can last as long as a year after surgery.
• Tumor recurrence: In some cases, the tumor comes back. It can be seen or felt, or it can be seen on imaging.

Recovery From a Parotidectomy

Everyone recovers at different rates. You may feel tired for the first couple of weeks after surgery. Give yourself time to rest and recover. A lot of the discomfort you initially experience is temporary and will improve. Some throat discomfort is expected due to having a breathing tube during surgery. This pain will improve in a day or two and rarely requires medication. 

Wound Care

Taking care of your wounds after surgery is extremely important. Guidelines vary, depending upon:

•  If skin glue was used: 
  
  • Keep the area clean and dry.
  • Do not pick off the glue.
  • Allow the glue to fall off by itself after a few weeks..

• If you have stitches:
  • Apply antibiotic (usually bacitracin) ointment and petroleum jelly along your stitches twice a day until they are removed.

• If you have a drain:
  
  • A drain may be placed in the neck to remove blood and fluid after surgery. While you are in the hospital, nurses will take care of the drain. If you leave the hospital with the drain, you will need to empty it and measure the fluid amount at least every 12 hours. Your nurses will teach you how to do this.
  • You will be asked to call a nurse to have your drain removed once the fluid amount within 24 hours is low enough (typically less than 25 milliliters).

Frequently Asked Questions

Will my incision leave a scar?

A scar will be hidden in a natural skin crease in your neck. It initially will be visible, but hopefully become barely noticeable over time. The incision is made as small as possible, while allowing good access to the neck structures. Development of thicker or darker scars can depend on patient factors. Use of an over-the-counter, silicone-based gel or silicone sheets are recommended to minimize the scar. Avoiding sun exposure and using hypoallergenic sunblock (SPF 30 or greater) for one year after surgery is also suggested.

What is normal after surgery?

It is common to have a sore throat that continues to improve each day. There may be some mild swelling, redness or puffiness around the incision. These symptoms may last for several weeks, but will eventually improve.

When can I eat?

The ability to eat after surgery is different for every patient. You may initially find it slightly difficult to chew because your neck and face feel tight and swollen. This is common. Start with drinking clear liquids. A mostly no-chew, soft diet is recommended. Once you can tolerate them, advance to more solid foods. Avoid overly sour, bitter, sweet, savory, acidic or spicy foods for two weeks after surgery.

When can I return to work?

Most people need about two weeks after surgery to recover at home before physically going to work. After several days to a week after surgery, most people are able to telework or work from home.

When can I exercise?

Start stretching slowly and gently the day after surgery. Don’t lift anything heavier than 10 pounds or do any strenuous activity for two weeks after surgery. After this, people can usually start doing light activity and exercise, but need to start slowly and be careful not to traumatize or irritate the incision and surgical site.

When can I drive?

You can drive when you are not taking prescription pain medicine and when you can easily turn your head and neck both ways without pain or restriction of movement.

When will I find out about final pathology results?

Pathology results will usually be available after about five business days, but depending on the extent of surgery and samples, it may take up to two weeks after surgery.