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Parotidectomy

Side view of a female head showing the parotid gland and facial nerve next to the ear and over the jaw.

The parotid is a large salivary gland near the ear. It helps produce and control the release of saliva. There's one on each side of your face. The facial nerves pass through each parotid gland. This nerve controls the muscles on that side of the face. If a tumor forms in the parotid gland, it can press on the facial nerve, causing discomfort and pain. Part or all of one side of the face may be weak or paralyzed. To treat a parotid tumor, part or all of the gland is removed. The amount of the gland removed depends on how much of it is affected. Your doctor may not know how much needs to be taken out until surgery is done. This surgery is called parotidectomy. This sheet explains the surgery and what to expect.

Types of tumors

Most parotid tumors are not cancer (benign). A benign tumor may grow larger, but it will not spread to other parts of the body. But in some cases, a parotid tumor is cancer. It can become metastatic, meaning it spreads to other parts of the body. Whether the tumor is benign or cancer, part or all of the parotid gland will be removed. If a tumor is cancer, nearby tissues or lymph nodes may be removed as well. And other cancer treatments, such as radiation, may be needed.

Protecting the facial nerve

During this surgery, steps are taken to protect the facial nerve. This may include using a device called a facial nerve monitor to sense activity in and around the nerve. This helps to map the exact location of the nerve, so the healthcare provider can avoid touching it during surgery. But in some cases, all of the nerve can’t be completely protected. The facial nerve helps you move your lips, close your eye on that side, and wrinkle your nose. You and your healthcare provider will discuss whether your facial nerve is likely to be affected by the surgery, what changes you might have, and what your choices are.

Getting ready for surgery

Get ready for the procedure as you have been instructed. Be sure to tell your healthcare provider about all medicines you take. This includes over-the-counter medicines. It also includes herbs, vitamins, and other supplements. You may need to stop taking some or all of them before surgery. Also, follow any directions you’re given for not eating or drinking before surgery.

The day of surgery

The surgery takes 3 to 5 hours.

Before the surgery begins:

  • An IV (intravenous) line is put into a vein in your arm or hand. This line is used to give you fluids and medicines.

  • To keep you free of pain during the surgery, you’re given general anesthesia. This medicine puts you into a state like deep sleep through the surgery so you don't feel pain.

During the surgery:

  • The healthcare provider makes a cut (incision) from the front of your ear to partway down the neck to expose the parotid gland.

  • The facial nerve is located. Great care is taken to avoid harming this nerve. A facial nerve monitor (a machine with a small sensor that is put onto your cheek) may be used to map the nerve’s exact location. It makes noise when the nerve is triggered. This helps avoid damage.

  • The gland is removed.

  • If cancer is present, a margin of healthy tissue around the gland is also removed. Nearby lymph nodes may also be taken out.

  • The incision is closed with stitches (sutures), surgical glue, or both.

  • A small tube (drain) may be placed into the surgical area. This drains fluid that may build up after surgery. The drain will likely be removed before you go home.

After the surgery

You will be taken to a recovery room to wake up from the anesthesia. You may feel sleepy and nauseated at first. You will be given medicine to control pain. You may then be taken to a hospital room to stay for a day or so. Once you are ready to go home, you will be released to an adult family member or friend. Have someone stay with you for a few days to help care for you as your healing begins. If you’re sent home with a drain, you will be shown how to care for it.

Recovering at home

Once at home, follow the instructions you have been given. Keep in mind that nerves take time to heal. It could be weeks or months before the facial nerve returns to normal. Discuss what to expect with your healthcare provider. During your recovery:

  • Take all prescribed medicine as directed.

  • Sleep with your head raised above the level of your heart for 3 to 5 days after the surgery. This helps reduce swelling.

  • Limit exercise as directed. Your healthcare provider will tell you when you can return to your normal activities and routine.

  • Don't drive until you are no longer taking pain medicines that make you drowsy.

  • Care for your bandage and incision as directed. Don't get your incision or bandage wet until your healthcare provider says it’s OK.

  • Check your incision daily for symptoms of infection listed below.

When to call your healthcare provider

Be sure you have a contact number for your healthcare provider. After you get home, call if you have any of the following:

  • Chest pain or trouble breathing (call 911)

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Pain that gets worse or is not relieved by pain medicine

  • Symptoms of infection at the incision site, such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage

  • Severe facial swelling or weakness

  • Trouble eating or drinking

  • Fluid draining from the incision site

  • Trouble breathing

  • Severe nausea or vomiting

  • Leg pain or swelling

Follow-up

During follow-up visits, your healthcare provider will check on your healing. If you have drains that need to be removed, this may be done 1 to 2 days after surgery. Stitches or staples will likely be removed 5 to 10 days after the surgery. If your surgery was done to treat cancer, you may need further evaluation and treatment. Your healthcare provider can tell you more.

Risks and possible complications

Risks of parotidectomy include:

  • Infection

  • Bleeding

  • Scars

  • Ear numbness

  • Injury to the facial nerve or some of its branches, which may result in permanent weakness or paralysis. (This often gets better over time as the nerves slowly heal.)

  • Buildup of fluid around the wound that causes swelling (seroma)

  • Sweating on the affected side of the face while eating due to changes to the nerves (Frey syndrome)

  • Inability to remove the entire tumor, needing further cancer treatment

  • The cancer returns

  • Risks of anesthesia. You will discuss these with the anesthesiologist.

  • Changes in the way you look because tissue is taken from one side of your face and may leave a depression in that area

Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call with questions during office hours, nights, and weekends.

© 2000-2017 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.