Parotid Gland Surgery

What is Parotid Surgery?

Parotid surgery is surgery to remove part or all of the parotid gland. The commonest indication for parotid surgery is to remove a tumour arising within the gland.

What has parotid surgery got to do with the facial nerve?

The facial nerve is the nerve that moves the muscles of the face. Damage to this nerve or one of its branches will result in paralysis to part or all of the face. The facial nerve and its branches run right through the parotid gland, dividing the gland into a large part superficial to the nerve (superficial lobe), and a small part deep to the nerve (deep lobe).

Parotid surgery is therefore intimately related to the facial nerve. During parotid surgery, the facial nerve and its branches need to be identified, traced and preserved. Accidental damage to the nerve may lead to permanent facial paralysis.

What are the risks of parotid surgery?

In addition to the standard risks associated with all forms of surgery (eg. bleeding, infection etc), the main risk associated with parotid surgery is accidental damage to the facial nerve.

While facial nerve damage can be a very debilitating injury, in trained, experienced hands, the risk of damage to the facial nerve should be less than 1%.

What types of parotid surgery are there?

In general, there are 3 types of parotid surgery.

a. A superficial parotidectomy involves removal of only the part of the parotid superficial to the facial nerve. This is the commonest parotid operation because most benign tumours of the parotid occur in the superficial lobe.

b. A total parotidectomy involves removal of both the superficial and deep parts of the gland. The facial nerve and all its branches are preserved. This operation is usually performed for benign tumours which arise within, or extend to involve the deep lobe of the gland.

c. A total parotidectomy + neck dissection involves removal of the entire parotid gland together with the surrounding lymph nodes in the neck. This operation is performed for parotid cancers where there is probable spread of cancer (metastases) to the lymph nodes.