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 (some surgeons used a modified facelift incision). A skin flap is raised over the gland. The facial nerve is identified close to where it exits the stylomastoid foramen. The lesion is excised with a cuff of the surrounding parotid tissue, superficial to the facial nerve branches, which are followed carefully and protected throughout.

Length of procedure

Approximately 90-120 minutes.

 

Complications

NB: Patients may ask whether excision of a single salivary gland will lead to a dry mouth. They can be reassured that this is not the case.

Pain

Bleeding/haematoma  A drain is usually placed.

Infection

Scar

Tumour recurrence  Pleomorphic adenoma may occasionally recur, particularly if the capsule is ruptured.

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

Facial weakness  Can affect one branch, for example leading to lip droop, or cause weakness of the entire hemi-face. Permanent weakness is 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 often mild, but can be troublesome in a minority, and can be treated with botulinum toxin injection.

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  This is usually managed conservatively if possible.

 

Post-operative management

  • Patients usually stay overnight.
  • Drain output should be monitored closely. Observe for collection at the operative site, 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 2017