Parotidectomy
Authors: Trevor Hackman, MD, Boyd Gillespie, MD, Kiran Kakarala MD
Explore more detailed information by visiting the AHNS Salivary Section, Parotidectomy Handout page.
What is the parotid? Why do I need a parotidectomy?
What happens before surgery?
Biopsy: You may have a needle biopsy to find out what type of tumor is in the gland and
whether it is cancer. This might be done with ultrasound to guide the needle into the right spot.
Imaging: You may have imaging to determine the size and extent of the tumor and whether it has
spread out of the parotid gland. This could be an ultrasound, computed tomography (CT) scan,
or magnetic resonance imaging (MRI) scan. A positron emission tomography (PET) scan may
be performed if the tumor is cancerous to make sure it has not spread anywhere else in the body.
Preoperative assessment: You may need evaluation by an anesthesiologist and other medical
providers to make sure you can safely undergo surgery.
What happens during surgery?
Surgery is done under general anesthesia, which means you will be completely asleep. An
anesthesiologist will go over the possible side effects and risks of general anesthesia, but it is
generally very safe.
A team will take care of you in the operating room including your surgeon, surgical assistants,
scrub tech, circulating nurse, and anesthesia providers. If you are having surgery at an
academic medical center, medical students, resident doctors, and fellows may assist with your
surgery.
An incision will be made through your skin and the skin lifted to expose the parotid gland and
tumor. Different incisions can be used, but the goal is to hide the incision in existing wrinkles to
minimize the scar.
The nerve that controls facial motion runs through the parotid gland. If this nerve is damaged,
the patient may lose all or portions of facial movement on that side, such as smiling, blinking,
and raising eyebrows. For some cancers, the nerve may need to be removed to clear disease,
even if there is normal facial function before surgery. This should be discussed with your
surgeon. In general, if the nerve is working before surgery, the goal is to preserve it, unless it is
surrounded by cancer. Imaging and biopsies of the mass may help to predict the potential need
for nerve removal. Many surgeons will use a facial nerve monitor; this device uses small
electrodes placed into the facial muscles to monitor the safety of the nerve during surgery. The
most important factor in protecting the nerve is good surgical technique and decision making.
The tumor should be removed as one piece with a small amount of normal parotid tissue around
it to minimize the risk of tumor regrowth.
When the diagnosis of cancer is known, surgery to remove some lymph nodes, called a neck
dissection, may be performed, usually through the same incision.
After the tumor is removed, reconstruction may be performed to fill in the hole left by the tumor,
to cover the raw gland to prevent saliva leakage, and to cover the facial nerve. Some options for
reconstruction include fat or dermal grafting, local muscle flaps, rotating nearby skin, regional or
free tissue transfer. The best option may depend on how much tissue is removed and from
where, your surgeon’s expertise, and your preferences. If one or more branches of the facial
nerve are removed by surgery, nerve grafting may be done to fix the nerve.
A drain, which is a plastic tube attached to a container, may be placed into the wound to remove
blood and fluid. The face may be wrapped with bandages to place pressure on the wound. Your
surgeon will decide whether these are needed, and how long they will remain in place.
There are different ways to close the skin after surgery including stiches, glue, and tapes. Some
stitches are absorbable, and others may need to be removed about a week after surgery.
There are different ways to close the skin after surgery including stiches, glue, and tapes. Some
stitches are absorbable, and others may need to be removed about a week after surgery.
What should I expect after surgery?
You may go home from the hospital the same day after waking up from anesthesia, or you may
stay in the hospital for monitoring.
You will be provided with information and instructions by your surgeon and/or the facility where
you have surgery. The following are some general expectations, but you should follow specific
instructions provided by your surgeon.
Pain control: you will likely have some discomfort of the surgical site and will likely get a
prescription for a narcotic to help with pain control. You may be able to avoid taking the
narcotic by taking over the counter pain medication such as acetaminophen instead. Taking the
smallest dose of narcotic for the shortest time possible helps to avoid addiction. Carefully follow
any instructions on the medicine bottles and from your surgeon. Your surgeon will let you know
when it is ok to take medications that thin your blood such as aspirin or ibuprofen.
Diet: you may have nausea, a sore throat, and pain with chewing, so a bland, soft diet may help
for a few days, however there are no foods you cannot eat.
Wound care and infection control: Your incision may be covered with a dressing or be left open
to air. Follow you surgeon’s instruction about wound care. In general, keep the area clean and
dry. If you have a drain, you will be taught how to take care of this.
Activity: do not lift anything heavier than a gallon of milk or do any hard exercise for 7 days.
Light activity, such as taking a walk, is helpful.
What are the risks of surgery?
Facial nerve injury
The risk of weakness of the face should be discussed with every patient before parotid surgery.
Even with a surgery performed with perfect technique, facial nerve injury can occur for unknown
reasons. The risk of nerve injury will depend on the reason for surgery, but in general the risk of
permanent injury is very low, around 1-5%, and the risk of temporary injury is around 10-20%.
If the nerve is damaged but not cut, it can recover, but it may take 6-9 months.
If eyelid closure is weak, this can be treated with the use of lubricants, taping the eye shut at
night, and moisture chambers during the day. Proper eye care is very important to keep the eye
healthy if it cannot close on its own. Consultation with an ophthalmologist may be needed. In
the case of long-term paralysis, surgeries may be performed to assist with eye closure.
If the facial weakness affects mouth function (smiling, speech, and eating), procedures may be
performed to improve this.
Gustatory sweating (Frey Syndrome)
Some patients may experience facial sweating when eating. Frey Syndrome has been estimated
to occur in up to 80% of patients, but many patients either do not notice it or are not bothered by