Parotidectomy is a surgical operation to remove all or part of a large salivary gland (the parotid gland) that is located in front of and just below the ear. The most common reasons for removal are: a mass in the gland, chronic infection of the gland, or obstruction of the saliva outflow from the gland causing chronic enlargement of the gland. Masses in the parotid gland are usually benign, but about 20% of the masses are malignant (cancerous). The most common tests to determine if a parotidectomy is necessary include: fine needle aspiration (removing a small amount of fluid from the parotid gland to see if malignant cells are present), biopsy, CT scan (an x-ray test that helps determine the size and position of the parotid tissues), and MRI (an imaging test that does not use x-rays, but also helps determine the size and position of parotid tissues). Often, no preoperative testing is needed prior to surgery.
The procedure is performed under general anesthesia. The amount of parotid gland to be removed is usually determined during surgery based on both the size and location of the diseased parotid tissue, and the extent of surgery may depend on pathological examination of tissues removed.
The nerve that controls motion to the face (the facial nerve) runs through the parotid gland. This nerve is important for closing the eyes, wrinkling the nose, and moving the lips. While the parotid gland can usually be removed without damage to this facial nerve, after surgery there may be decreased motion of the facial muscles as this facial nerve recovers from any bruising or stretching the occurred during the surgical procedure. In rare instances, facial motion does not fully return. However, there are ways to rehabilitate facial movement in these cases.
Other possible complications include bleeding and infection, and in rare instances, the development of a thick scar or keloid following surgery. Although many patients may experience numbness of the earlobe and outer edge of the ear, this numbness usually goes away over time. In a small proportion of patients, the face on the side of the parotidectomy sweats while eating (gustatory sweating). While this is almost always unnoticeable, if it should become bothersome, medication and additional surgery can help.
Very rarely, a salivary fistula may occur, with saliva draining from a small opening in the incision. While bothersome, this condition usually goes away with time. Based on the final tissue diagnosis after a pathologist review, additional diagnostic tests and follow-up examinations may be needed after surgery. However, most masses of the parotid are benign, and complete removal is the only treatment needed.