Parotidectomy

As with any surgery, there are both potential benefits and risks.  The following information will help you understand the risks of surgery.  As with any operation, there may be some unanticipated complications in addition to those listed here:

The risks of parotidectomy include, but are not limited to:

Bleeding, including hematoma: If there is severe bleeding after the procedure, your surgeon might need to quickly take you back to the operating room to stop the bleeding.

Seroma: This is a collection of normal body fluid in the neck after removal of the drain. This can be treated with observation, as the body will eventually resorb it, or repeated needle aspirations. The risk of leaving seroma is that it could become infected.

Infection: Parotidectomies are done under completely sterile conditions. Still, as with any surgical procedure, there is always risk of an infection after the surgery. This might require antibiotics and/or drainage of the infection.

Sialocele: This is a collection of saliva under the skin. This can occur because a cut end of the parotid gland might continue to make saliva. It will manifest as a fluid-filled swelling somewhere near the surgical site and get bigger with eating. Treatment can include doing nothing, applying a pressure dressing or repeated aspirations to draw off the saliva.

Sensory disturbance: A decrease in sensation of skin of the neck, around the face and the lobule occur when the greater auricular nerve or some of its branches are cut. This is required in most parotidectomy procedures. Over time, the area of numbness will shrink, but the lobule of the ear will probably remain numb forever.

Frey’s syndrome: Another term for this is “gustatory sweating.” This manifests by sweating on your face when you eat or even think about eating. This occurs because after removing the parotid gland, the nerve endings that normally stimulate saliva production and secretion (from the auriculotemporal nerve) end up against the skin (now that the parotid gland is gone). Because the same neurotransmitter that stimulates salivary release also stimulates sweating, whenever that nerve is activated, it causes sweating instead of salivary release. The severity of this problem can vary from not even noticeable to very severe and troublesome. Treatment options include applying antiperspirant to the facial skin, injecting botulinum toxin (Botox) in that region of the skin (which blocks the neurotransmitter that causes sweating), surgery to place a barrier just under skin or extensive middle ear surgery to cut the nerve that causes all of these problems near its origin. One way to prevent this complication is to place a barrier between the free nerve endings and the skin at the time of the parotidectomy itself. This barrier can be in the form of sewing the parotid fascia back together (thereby covering up those free nerve endings), moving muscle into the defect or using a dermal substitute immediately under the skin.
Facial nerve injury: This is an important risk of parotidectomy. It will manifest as inability to move all or part of your facial muscles on one side. The nerve injury can be partial (if only some of the branches of the facial nerve are injured) or total (if the main trunk of the facial nerve or all branches of the facial nerve are injured). It can be temporary (if the nerve is just stretched) or permanent (if the nerve is cut). This can be prevented by meticulous surgical skill; but in some cases, especially if the nerve goes directly through the cancerous tumor, one or more branches might have to be sacrificed. Treatment is geared toward preventing complications related to facial nerve injury, including making sure the eye is well lubricated at all times if you can no longer blink as well as performing nerve grafts to attempt to maintain tone of the facial muscles and possibly get some sort of movement. Facial reanimation procedures to improve appearance might also be undertaken.

You will be put completely to sleep with general anesthesia. Dr. Reilly may choose to use a special monitor that makes a noise when the facial nerve (including certain branches) is stimulated. A parotidectomy is done via an incision just in front of the ear in a natural skin crease that extends down into a natural skin crease in the neck. This allows the scar to be hidden as much as possible rather than making an incision directly in the middle of your face.

When the tumor is in the deep lobe of the parotid gland, a different or additional approach might be required. For example, a deep lobe tumor can be approached from an incision in the neck (without an incision in front of your ear). More rarely, the deep lobe could be approached through the mouth.
At the end of the procedure, your surgeon might place a small drain temporarily coming out of the skin. This will drain any fluid and/or blood that accumulates in the space where the surgery was performed. When the time is right (one day to a few days), the drain will be removed by your surgical team. This takes only a few seconds, and you can think of it as removing a bandage. There will be a little discomfort, but it will be over quickly.

Depending on whether any additional procedures were done, you will go home the same day or within a few days of the surgery. You should be able to drink and eat very soon after the surgery. There is little pain associated with this procedure, but you will probably be given a little pain medication anyway. You should be up and out of bed by the same or next day. You should be able to drink liquids and eat by the same or next day as well.