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The parotid is a gland near the ear. It helps produce and control the release of saliva. The facial nerve passes through the gland. This nerve controls the muscles of the face. If a tumor forms in the parotid gland, it can press on the facial nerve, causing discomfort and pain. Part or all of the face may be weak or paralyzed. To treat a parotid tumor, part or all of the gland is removed. This surgery is called parotidectomy. This sheet explains the surgery and what to expect.
Most parotid tumors are benign (not cancerous). A benign tumor may grow larger, but it will not spread to other parts of the body. In some cases, though, a tumor is cancerous. It can become metastatic, meaning it spreads cancer cells to other parts of the body. Whether the tumor is benign or cancerous, part or all of the parotid gland will be removed. If a tumor is cancerous, nearby tissues or lymph nodes may be removed as well. And further cancer treatments, such as radiation, may be needed.
During this surgery, steps are taken to protect the facial nerve from damage. This may include using a device called a facial nerve monitor to sense activity in and around the nerve. This helps to map the exact location of the nerve, so the doctor can avoid touching it during surgery. But in some cases the nerve can’t be completely protected. You and your doctor will discuss whether your facial nerve is likely to be affected by the surgery and what your options are.
Prepare for the procedure as you have been instructed. Be sure to tell your doctor about all medications you take. This includes over-the-counter drugs. It also includes herbs and other supplements. You may need to stop taking some or all of them before surgery. Also, follow any directions you’re given for not eating or drinking before surgery.
The surgery takes 3-5 hours.
Before the surgery begins:
An IV line is put into a vein in your arm or hand. This line delivers fluids and medications.
To keep you free of pain during the surgery, you’re given general anesthesia. This medication puts you into a state like deep sleep through the surgery.
During the surgery:
The doctor makes an incision from the front of your ear to partway down the neck.
The facial nerve is located. Great care is taken to avoid harming this nerve. A facial nerve monitor (a machine with a small sensor that is put onto your cheek) may be used to map the nerve’s exact location. This helps avoid damage.
The gland is removed.
If cancer is present, a margin of tissue around the gland is also removed. Nearby lymph nodes may also be removed.
The incision is closed with sutures (stitches), surgical glue, or both.
A tube (drain) may be placed into the surgical area. This drains fluid that may build up after surgery. The drain will likely be removed before you go home.
You will be taken to a recovery room to wake up from the anesthesia. You may feel sleepy and nauseated at first. You will be given medication to control pain. You may then be taken to a hospital room to stay overnight. Once you are ready to go home, you will be released to an adult family member or friend. Have someone stay with you for a few days to help care for you as your healing begins. If you’re sent home with a drain, you will be shown how to care for it.
Once at home, follow the instructions you have been given. Keep in mind that nerves take time to heal. It could be weeks or months before the facial nerve returns to normal. Discuss what to expect with your doctor. During your recovery:
Take all prescribed medication as directed.
Sleep with your head raised above the level of your heart for 3-5 days after the surgery. This helps reduce swelling.
Limit exercise as directed. Your doctor will tell you when you can return to your normal activities and routine.
Avoid driving until you are no longer taking pain medications that make you drowsy.
Care for your bandage and incision as directed. Do not get your incision or bandage wet until your doctor says it’s okay.
Check your incision daily for symptoms of infection listed below.
Be sure you have a contact number for your doctor. After you get home, call if you have any of the following:
Chest pain or trouble breathing (call 911 or other emergency service)
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Pain that gets worse or is not relieved by pain medication
Symptoms of infection at the incision site such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Severe facial swelling or weakness
Clear fluid draining from the incision site
During follow-up visits, your doctor will check on your healing. If you have drains that need to be removed, this may be done 1-2 days after surgery. Stitches or staples will likely be removed 5-10 days after the surgery. If your surgery was done to treat cancer, you may need further evaluation and treatment. Your doctor can tell you more.
Risks of parotidectomy include:
Injury to the facial nerve or some of its branches, which may result in permanent weakness or paralysis
Seroma (buildup of saliva that causes swelling)
Frey syndrome, a condition that causes sweating while eating
Inability to remove the entire tumor, requiring further cancer treatment
Return of cancer
Risks of anesthesia (you will discuss these with the anesthesiologist)