How to treat the pathologies of the parotid salivary gland through surgery (parotidectomy)
Parotidectomy is the partial or total ablation of the parotid gland, the largest salivary gland, located before and under the earlobe. The parotid gland may be the site of a malignant tumour or a benign tumour, but becomes very visible when it grows and may in some cases become cancerous after several years. Only surgery can remove a parotid tumour thus discovering its exact nature by microscopic analysis. The ablation of this gland does not hinder the secretion of saliva because of the large number of small salivary glands (accessory) existing in the mouth and five other large glands (major), distributed around the jaw (see Diagrams below).
The main issue of the intervention is related to the presence of the facial nerve which crosses the gland from end to end and which divides within the parotid gland into several branches. Tampering with the facial nerve can cause incomplete, complete or temporary facial paralysis. The procedure performed under general anaesthesia is conducted with the purpose of preserving this nerve and its branches, but the nature of the lesion, its secondary infection, its volume, and the anatomical disposition of the nerve are factors that can make the intervention much more dangerous for the facial nerve. The safety of the intervention is increased by the tracking of the nerve and its branches through a neurostimulator (NIM-response 3.0 by Medtronic).
The skin incision is located just before the ear and under the lobule of the ear and continues for a few centimetres at the level of the neck. The facial nerve will be located and dissected to remove the tumour and the surrounding glandular tissue. A second intervention is sometimes necessary to complete the ablation of certain tissues and in particular to perform the exeresis of the neck ganglia in case of confirmed malignant tumour.
A drain will usually be put in place through the skin at the end of the procedure and will be removed after a few days corresponding to the duration of hospitalization. A simple bandage or cervical band will cover the scar for a few days.
The suction drain is removed after 24 to 48 hours. The cutaneous threads will be removed after eight to ten days. The post-surgery effects are usually painless.
Immediately after surgery, bleeding complications and postoperative hematoma can occur and require a second intervention.
A fluid effusion may occur and need to be evacuated by punctures.
Scar opening and a secondary infection of the operated area are exceptional.
A fistula with salivary flow may occur when part of the parotid gland has been preserved. It dries up and usually disappears in a few days with localised care.
At the ablation of the dressing, there may be a depression just behind the angle of the jaw, corresponding to the gland that has been removed.
Mastication pains and difficulties are transitory, but a loss of sensitivity of the earlobe frequently persists.
In the years following the operation, in the operated area a flow like sweat when eating and chewing can occur. This phenomenon (called Frey’s syndrome), is of varying intensity, but must be reported urgently to the ENT head and neck surgeon.
Facial paralysis is a paralysis of the face on the side of the operation with an impossibility to close the eye and difficulties in mobilising the forehead, cheek and jaw. This paralysis is much more common in reoperations. It is the cause of immobility of the facial muscles on the side of the operation that can last from a few days to several months.
Dryness of the eye: the loss of occlusion of the eye by the upper eyelid is a risk for the cornea. The eye must be protected and controlled, if necessary, by a specialised examination.
Nerve graft: necessary in case of nerve resection that however will not allow the recovery of a normal mobility of the face.
Coverage of parotidectomy by social security.
This surgery is covered by social security, but your ENT head and neck surgeon may request an additional fee according to his degree of experience.
Dr. Stéphane Hervé is an ENT specialist and head and neck surgeon who graduated from some of the best universities in France. He has over 20 years of experience and a solid training, acquired in renowned hospitals and clinics. To increase the safety of the surgical procedure, he uses neurostimulation through the NIM Response 3.0 by Medtronic.