Superficial or Partial Parotidectomy

Indications

  • Excision of benign parotid tumours e.g. pleomorphic adenoma.
  • Rarely, parotid sialolithiasis.

 

Procedure

A facial nerve monitor is used. A “lazy S” incision is made in front of the pinna and behind the angle of the mandible. A skin flap is raised anteriorly. The facial nerve is identified close to where it exits the stylomastoid foramen. The lesion is excised with the surrounding parotid tissue, superficial to the nerve, which is followed carefully and protected throughout as it branches within the gland.

 

Length of procedure

Approximately 90-120 minutes.

 

Complications

NBPatients may ask whether excision of a single salivary gland will lead to a dry mouth. They can be reassured that this is very unlikely.

Pain

Bleeding/haematoma  A drain is usually placed.

Infection

Scar

Tumour recurrence  Pleomorphic adenoma is prone to recurrence if the capsule is ruptured.

Need for further treatment  Depending on histology (the large majority of parotid lumps are benign).

Facial weakness  May affect one branch, causing for example lip droop, or the entire hemi-face. Thankfully, permanent weakness is quite rare. Some patients experience temporary weakness, often due to traction on the nerve, which subsequently recovers.

Frey’s syndrome  Gustatory sweating over the parotid, due to aberrant reinnervation of the skin with parasympathetic fibres. This is probably under-reported as it is often mild, but can be troublesome in a minority.

Numbness of the inferior pinna  Due to division of the greater auricular nerve. It is quite common to have to divide the nerve due to its position in the operative field, leading to lasting decreased sensation. Quality of life does not appear to be adversely affected however.

Salivary collection/fistula

 

Post-operative management

  • Patients usually stay overnight.
  • Drain output should be monitored closely. Observe for collection at the operative site, which can be haematoma, seroma or saliva, which can require aspiration or re-opening of the wound.
  • Removal of sutures at GP in one week.
  • Follow-up in clinic in 2-3 weeks for histology results.

 

TTO

  • Analgesia

 

 

 

 Page last reviewed: 23 September 2016