Parotid surgery

Parotid gland tumor

The parotid gland is the salivary gland located behind the ascending ramus of the mandible. It is the site of the most frequent tumors, notably pleomorphic adenomas, also called mixed tumors.

Their treatment is exclusively surgical , it is an ablation of the entire parotid salivary gland or parotidectomy, after dissection of the facial nerve (responsible for facial mobility) which passes inside the gland.

Experience with this type of surgery and appropriate equipment (computerized control of the facial nerve or nerve monitoring) helps to minimize the risks of the surgical procedure.

The tumor is most often revealed by a mass or "lump" felt by the patient or his doctor; it is rarely painful or associated with swollen lymph nodes or facial paralysis.

The mass may be of significant size and located behind the mandible.

Ultrasound is the non-invasive examination that will confirm the diagnosis, but magnetic resonance imaging (MRI) the gold standard because it allows for excellent visualization of the tumor and can also detect multiple lesions. With certain sequences, a diagnostic indication of the tumor's nature can be strongly suggested. In claustrophobic patients, MRI can be replaced by a CT scan.

A fine-needle aspiration biopsy can be performed to analyze tumor cells and determine the nature of the mass, but it rarely changes the treatment approach, which remains surgical.

The Parotidectomy Procedure

This procedure involves removing the swelling and determining its nature. Indeed, some tumors can become infected or increase in size, making the procedure much more dangerous in order to preserve the facial nerve that passes through this gland; other tumors may be malignant or become cancerous later on.

The procedure is usually performed under general anesthesia.

The skin incision is best performed via a Lifting approach , allowing for minimal scarring.

The facial nerve will be located and dissected with the aid of a neurodetector to remove the tumor and the surrounding glandular tissue. The surgical specimen is then sent for histological analysis during the procedure to identify the nature of the tumor.

The facial nerve and its branches are dissected for this procedure.

A drain will, as a rule, be put in place at the level of the operated area.

The hospital stay lasts 24 to 48 hours. There is no post-operative pain.

The resulting scarring remains minimal with a lifting incision.

Surgical Risks

A post-operative hematoma is possible, but rarely a cause for concern. You may experience some temporary pain and difficulty chewing. Similarly, some neck pain is possible, related to the position of your head during the procedure.

A transient loss of sensation in the cheek and earlobe is systematic.

Facial paralysis is possible, varying in intensity depending on the surgical difficulties and the anatomical position of the nerve. It is most often temporary and partial, lasting a maximum of 8 weeks.

Permanent facial paralysis is exceptional. It is due to a particularly difficult intervention (inflammatory or infected tumor, re-intervention) or to a deliberate sacrifice of the nerve for a cancerous tumor that has invaded the nerve.

The formation of small subcutaneous cysts is exceptional after removal of the gland. Similarly, it is very rare for saliva to leak through the scar. These issues resolve quickly with proper care.

In the years following the procedure, you may experience sweating in the surgical area when eating. This phenomenon is called Frey's syndrome.