Parotid Gland
The parotid gland is located just in
front of the ear, overlying the
upper part of the jaw bone.
The facial nerve divides the gland
into two lobes: superficial and deep
lobes. Tumors and chronic infection
can affect either lobe or the
entire parotid gland.
Superficial
parotidectomy
The
most common procedure on the parotid
gland is a superficial parotidectomy.
This procedure removes the
superficial lobe of the parotid
gland. This procedure is performed
under general anesthetic. A dose of
antibiotics is given to prevent
infection.An incision is made just
in front of the ear, following the
crease of skin under the ear lobe
and ending in a skin fold in the
neck. As a rule, the key portion of
this procedure is the location of
the facial nerve. The nerve is
followed until the tumor is
removed. A surgical drain is placed
in the defect to prevent
accumulation of fluid under the
skin. The incision is then closed
with stitches.
Total
parotidectomy
This
procedure involves removal of the
entire parotid gland. The operation
proceeds as described for a
superficial parotidectomy for the
skin incision, location of the
facial nerve, and the removal of the
superficial lobe. The facial nerve
is then separated from the deep lobe
and mobilized so that the remaining
portion of the gland can be
removed. Sometimes the disease
process within the gland does not
allow preservation of the facial
nerve, and this nerve has to be
sacrificed in order to remove the
disease process in its entirety. A
complete or partial facial paralysis
will result, depending on the number
of branches of the facial nerve that
are sacrificed. As with superficial
parotidectomy, a surgical drain is
placed in the defect to prevent
accumulation of fluid under the
skin. The incision is then closed
with stitches.
Risks of
Parotid Gland Surgery
As
alluded to above, the facial nerve
is the major anatomic structure that
is involved in parotid gland
surgery. Sometimes, though the
nerve is intact, the face is weak
following parotidectomy. If the
nerve is intact, then function will
generally return within weeks to
months following the surgery.
Other complications, such as
bleeding or infection, can occur.
These are treated appropriately, and
generally resolve in short order.
Frey's syndrome, or gustatory
sweating, occurs in some patients
following parotidectomy. The
incidence of this problem ranges in
various reports from 20 to 80% of
patients. The disorder occurs when
the superficial nerves that give
sensation to the face become joined,
through the healing process, to the
nerves that cause the parotid gland
to secrete saliva. The result is
that when one eats, the skin over
the parotid gland sweats. For most
patients, this is a minor and
sometimes unnoticed nuisance that
does not require any treatment.
Other patients have a more serious
problem which will require
treatment.
Submandibular Gland Surgery
This procedure is performed under
general anesthetic. A dose of
antibiotics is given to prevent
infection. The submandibular gland,
as the name implies, is located just
under the jaw bone. The facial
artery penetrates the center of the
gland. The marginal mandibular
nerve is located in the soft tissues
overlying the gland. This nerve
controls the muscles that cause the
lower lip and corner of the mouth to
lower. Two additional nerves are
located under the gland: (1) the
hypoglossal nerve that controls the
tongue, and (2) the lingual nerve
that gives general sensation to the
tongue.
The
surgery proceeds through an incision
placed about two finger breadths
under the jaw bone. The incision is
placed so that it will be below the
level of the marginal mandibular
nerve. The soft tissue overlying
the gland is divided and the capsule
of the gland is followed until the
gland is mobilized. The facial
artery and vein are tied off and
divided. The hypoglossal nerve and
lingual nerve are identified and
preserved. The salivary duct is
identified and divided, allowing the
gland to be completely removed. A
surgical drain is placed in the
defect to prevent accumulation of
fluid under the skin. The incision
is then closed with stitches.
Risks of
Submandibular Gland Surgery
The risks of surgery include damage
to any of the nerve listed above.
Injury to the hypoglossal nerve and
lingual nerve are much less common
(<1% of patients) than injury to the
marginal mandibular nerve (probably
5-10%).
Other
complications, such as bleeding or
infection, can occur. These are
treated appropriately, and generally
resolve in short order.
The
Expected Post-operative Course after
Salivary Gland Surgery
Generally, patients are kept in
hospital for one to two days
following surgery. The length of
stay depends on the amount and
duration of drainage through the
surgical drain. Antibiotics are
given usually for only one day.
Patients are seen in the office
about one week after surgery.
Usually the final pathology report
is available by that date, and its
findings will be discussed at that
time. Most patients can return to
work after a week of recuperation
and rest.
Post-operative
instructions
Wound care. If your wound is
covered by surgical tapes, leave
these tapes alone until directed by
your physician to remove them. If
your wound has exposed stitches,
then follow these instructions:
Wash your hands. Clean the wound
with hydrogen peroxide and apply
antibiotic ointment twice daily.
Polysporin and Neosporin ointments,
which are available over the
counter, are appropriate to use.
Medications. Take your
medications as prescribed by your
physician. Acetaminophen (Tylenol
or Extra-Strength Tylenol) might be
sufficient for pain relief. Avoid
any medications that contain
aspirin or ibuprofen.
Do not drive or make important
decisions while taking narcotic pain
medications. If you need refills
for medications, please call during
regular office hours.
Diet. Eat a well-balanced,
healthy diet. There are no
particular restrictions.
Activity level. Avoid any
strenuous activity for at least two
weeks after your surgery. This
means you should limit lifting
anything more than about ten pounds
following your surgery.
Showering and bathing. It is
permissible to shower and bathe
following your surgery. Avoid
getting the wound soaking wet.
Follow-up appointment. You
should call our office to set up a
postoperative visit for one week
following your surgery.
