Do you have a small swelling or lump in front of your ear, in the cheek area? Or do you feel pain in that area when you eat? The cause of such things may be a problem with the parotid gland, which is located near your ear. This is the main gland that produces saliva in our mouth. So, the surgery that is performed for problems with this gland is called Parotidectomy. Many people get scared when they hear this name. But if you are properly informed about this, you can eliminate that fear. Today, we will talk about this simply, in a way that you can understand.
Simply put, what is Parotidectomy?
Parotidectomy is the surgical removal of all or part of your parotid gland. Think about it, these two parotid glands are located in front of our ears, in the cheek area. Their main function is to produce saliva. When we eat, this saliva makes it easier to swallow food and keeps our mouths moist.
So why do you need to remove this gland? There are two main reasons:
1. Tumors: Sometimes tumors can form in this gland. Most of these tumors are benign, normal tumors . However, a small number can be cancerous. So, after knowing exactly what type of tumor it is, this surgery is done to remove it.
2. Salivary Stones: Some people develop "salivary stones" that block the ducts that carry saliva to this gland. This can cause the gland to swell and cause severe pain while eating. It can also lead to frequent infections. In such cases, surgery may be necessary.
What are the main types of this surgery?
The type of surgery you do will depend on where the tumor or problem is. A very important nerve runs through your parotid gland. It's the facial nerve. When we smile, close our eyes, and move our mouths, all of these movements are controlled by this nerve. So doctors perform this surgery without damaging this nerve.
There are two main types of surgery depending on where the problem is.
| Type of surgery | Description |
|---|---|
| Superficial Parotidectomy | This involves removing only the part of the gland above the facial nerve. Most of the time, if the tumor is in this area, this surgery is performed. |
| Total Parotidectomy | If the tumor is located deep in the gland, that is, under the facial nerve, or if it has spread throughout the gland, the gland will have to be completely removed. |
Both types can also be used to remove salivary stones. Your doctor will determine which surgery you need after examining you.
How do you prepare before surgery?
It's normal to feel a little nervous and scared when preparing for surgery. But with the right information and planning, you can manage it all. Your surgeon will give you a clear set of instructions about what to do. These are usually the things you'll be asked to do:
- If you smoke, stop: Smoking delays wound healing, so it is very important to stop smoking at least a few weeks before surgery.
- Tell your doctor about any medications you are taking: If you are taking blood thinners (such as aspirin, clopidogrel), vitamins, or traditional medicines, be sure to tell your doctor about them. You may be asked to stop some of them before surgery.
- Know when to fast: Find out exactly how many hours you need to abstain from food and drink before surgery.
- Ask if you will have to stay in the hospital: Find out in advance whether you can go home the same day after the surgery, or whether you will need to stay in the hospital for a day or two.
- Arrange for someone to help you when you get home: In addition to taking you home after surgery, it is very important to have someone to help you on the first day.
It's a good idea to bring a family member or friend with you when you go to see the doctor. While you're talking to the doctor, the other person can write down important information. That way, you won't forget anything.
Preoperative tests
If there is a tumor, the doctor may perform several of these tests before surgery to determine its exact nature.
- Fine-Needle Aspiration (FNA): This involves using a very fine needle to take a small sample of cells from the tumor. The sample is then tested to see if it is cancerous or not.
- CT scan or MRI scan: If the tumor is located very close to the important facial nerve, these scans are done. This allows the surgeon to plan the best way to remove the tumor without damaging the nerve.
How is the surgery done?
In the operating room, the anesthesiologist will give you medicine through a small tube (IV line) in a vein in your arm, putting you completely asleep. So you won't feel any pain during the surgery. Then the surgeon will follow these steps:
1. Incision: The incision is made starting in front of your ear, below the earlobe, and following a natural crease at the top of your neck. This incision is much less likely to show any scarring later on.
2. Exposing the gland: The skin is then pulled back to expose the parotid gland. A facial nerve monitoring device may be used to monitor for damage to the facial nerve during the procedure.
3. Removal of the gland: Next, part or all of the gland is removed. If tests have confirmed that the cancer has spread to nearby lymph nodes, those lymph nodes are also removed at the same time.
4. Stitching the incision: After the gland is removed, the incision is sewn back together neatly.
5. Inserting a drain (Surgical Drain): Finally, a small, thin tube (drain) is inserted to drain any blood or other fluids that may collect inside the wound.
This entire surgery can usually take about two to four hours .
What are the benefits and possible risks of surgery?
Like any surgery, Parotidectomy surgery has its benefits as well as some risks and side effects.
The main benefits of surgery
If it is a benign tumor, this surgery can completely cure it. It is also the most effective treatment for salivary stones and the infections that result from them. If it is a cancerous tumor, it can be removed before it spreads to other parts of the body, giving a better chance of curing the disease. However, cancerous tumors sometimes have a risk of recurrence .
Possible complications and risks
This is a slightly more complicated surgery, because the facial nerve needs to be very carefully protected. So some complications can occur. But most of these are temporary .
| Complication | Simply explained |
|---|---|
| Numbness in the face, ear, or jaw | After surgery, you may feel a tingling sensation in areas such as the ear and cheek. This usually gradually disappears within three to four months, sometimes within a year. |
| Facial Weakness | Due to the tension on the facial nerve during the surgery, one side of the face may temporarily appear droopy, the corner of the mouth may not turn up properly when smiling, and it may be difficult to close the eye. This also fully recovers in a few weeks or months. |
| Frey's Syndrome | This is a bit of a strange condition. It can occur a few months after surgery. When eating, the cheek on the side of the surgery that sweats is what happens. There is a treatment for this. |
| First Bite Syndrome | When I take the first bite of any food, I feel a sharp pain in the area where I had the surgery. This pain only occurs with the first bite and goes away with subsequent bites. |
In addition, there are some common risks that can be seen with any surgery.
- Allergic reaction to painkillers
- Excessive fluid accumulation around the wound
- Excessive bleeding
- Blood accumulation inside the wound (hematoma)
Common side effects
You can expect the following after surgery:
- Pain and swelling: Pain and swelling at the surgical site may persist for a week or two.
- Difficulty eating: You may have some difficulty eating because of the discomfort in your jaw. This will subside after two to four weeks.
What happens after the surgery?
When you regain consciousness, you will be in the recovery room. The nursing staff will check your pulse and blood pressure regularly. You will be given medication to help with pain. You may also be asked to smile, close your eyes tightly, and frown to check that your facial nerves are working properly.
Before you go home, you will be given a detailed explanation of how to care for your wound and the drain that has been placed. You will also be told when to see the doctor. This schedule may look something like this:
- 1-2 days after surgery: Remove the drain.
- 5-7 days after surgery: If non-dissolvable stitches were used, remove them.
- 4-6 weeks after surgery: See your surgeon again to check if the wound has healed.
How long does it take to heal?
It takes several weeks to fully recover. Most people can return to their normal activities after about two weeks . However, it can take several months, or even a year, for facial numbness or weakness to completely disappear.
If you have cancer, what is the long-term care like?
Parotid gland tumors can sometimes recur. Therefore, you will be monitored by your doctor for years after surgery. Having to undergo frequent tests and waiting for results can be emotionally draining. It is important to talk to your doctor and family about your concerns at times like these.
If you have these symptoms, call your doctor immediately!
If you experience any of the following symptoms after returning home from surgery, call your doctor without delay.
- If you have severe pain that does not subside even after taking medication.
- If you feel that your facial numbness or weakness is getting worse.
- If the wound is oozing pus, fluid, or blood .
- If the area around the wound feels hot to the touch or hurts when touched.
- If there is a bad smell coming from the wound.
These things mean that the wound may be infected, so it is essential to seek treatment quickly.
Take-Home Message
- Parotidectomy is a surgical procedure to remove part or all of the parotid gland, a salivary gland located near your cheek, as a treatment for conditions such as tumors or salivary stones.
- Before undergoing this surgery, follow your doctor's instructions exactly (stop smoking, inform them about the medications you are taking).
- Because this surgery involves the facial nerve, which controls facial expressions, complications such as temporary facial numbness or weakness may occur. Most of these resolve over time.
- It is very important to take good care of the wound after surgery and not miss the appointments given by the doctor.
- If you experience any problems, such as unusual pain, swelling, or pus draining from the wound, notify your doctor immediately.
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