Parotidectomy


What is the Parotid Gland?

Everyone has two parotid glands, and each gland is located just in front of and below the ear. It is the largest of all of the salivary glands located in the body. There are two other sets of large salivary glands, the submandibular and sublingual glands, as well as thousands of tiny glands located all over the mouth and throat. These glands secrete saliva during meals to help start the digestive process and protect the teeth. Over a liter of saliva is produced by the average mouth a day!

Tumors

Tumors can arise from any of the above mentioned salivary glands, but by far the most common is the parotid gland (80%). The majority of these tumors are benign (80%), while the remaining 20% are cancerous. Benign tumors do not spread to distant parts of the body, while cancerous tumors can.

The most common form of benign tumors are Pleomorphic adenomas. These tumors are slow-growing and in this form do not spread. Even though they are benign (non-cancerous) growths, it is important to remove them as soon as they are detected. This is because if left untreated for a long time, they can transform into a highly malignant form of cancer. Therefore, we remove them when they are still easy to excise and have not spread.

Surgery

TraditionalincisionOnce a tumor is detected and it is determined that excision is required, surgery is scheduled.  The traditional incisions used is shown on the right. The main challenge of this surgery is the facial nerve. This nerve controls all the movement of your face and if injured, can lead to significant disfigurement. The facial nerve is identified using several landmarks. Once this is done, the tumor can be safely removed. Another important nerve is the greater auricular nerve, which provides sensation to the ear lobe. This is also important to identify and preserve.

This surgery has been done using the above incision for years. It is effective, but medicine has progressed and we now focus on improving outcomes while reducing side effects. There are three main issues with the traditional approach. First, it can lead to large divot in the face where the tumor was removed. Second, a common complication of parotid surgery is Frey’s syndrome, in which the nerves that usually go to the parotid gland accidentally innervate the sweat glands of the face. This can lead to sweating of the skin over the parotid gland after surgery. Finally, the traditional approach leads to a significant scar on the face and neck. For the appropriate patients, there are newer techniques that are available.

actualincisionDr. Undavia uses a highly modified and advanced approach to remove parotid tumors. For appropriate patients, the incision is hidden just in front of and behind the ear. This makes the scar nearly invisible. Through this limited incision, the tumor can be removed in its entirety. To prevent the divot and Frey’s syndrome, the surrounding tissue and neck muscles are then rotated into the defect. This covers the nerves, and creates a smooth natural contour with minimal side effects.

The pictures below illustrate typical results from this surgery.

BeforeAfter
    
ResultIf you would like more information about parotid surgery, please call our office today to schedule a consolation with Dr. Undavia.