Salivary gland & Parotid surgery

Parotidectomy involves the removal of all or a portion of the major salivary gland located in the cheek, known as the parotid gland. This surgical procedure becomes necessary when a tumor develops within the parotid gland. While most tumors are noncancerous (benign), some may be cancerous (malignant). Removing the parotid gland is essential to prevent the cancer from causing damage to surrounding tissues and vital structures, most notably the facial nerve.

The parotid glands, positioned in front of and below the ears in the cheeks, are responsible for salivary production. Tumors can originate in these glands, prompting the need for a parotidectomy to excise the affected portions.

The facial nerve, an important nerve of facial functions, traverses each parotid gland, dividing it into two distinct lobes: the superficial and deep. Two variations of parotidectomy exist based on the location of the tumor within these lobes:

• Superficial Parotidectomy: This procedure involves the removal of a tumor situated superficially to the facial nerve.
• Total Parotidectomy: Total parotidectomy is performed to eliminate a tumor present exclusively in the deep lobe or in cases where tumors affect both the deep and superficial lobes simultaneously.

When is Parotid surgery Needed?

A parotidectomy becomes necessary when a tumor forms in the parotid gland. While these tumors are often benign, there is a possibility of malignancy. Both types, whether benign or malignant, typically require removal.

Benign tumors may necessitate removal to prevent them from growing larger and causing damage to surrounding tissues. Additionally, certain benign tumors have the potential to transform into salivary gland cancer.

On the other hand, malignant tumors damage surrounding tissues and can potentially metastasize, spreading to different parts of the body through the bloodstream or lymphatic system. In cases of parotid gland cancer, metastasis may occur in nearby limit nodes, facilitating further dissemination to other body parts.

Parotidectomy may also be recommended for conditions such as parotid gland infections or the presence of salivary gland stones. These stones, composed of calcium deposits, can accumulate in the parotid glands, obstructing saliva flow and leading to recurrent gland swelling and infection.

Is Parotidectomy A Major Surgery?

Considered a significant surgery, parotidectomy typically lasts three to four hours on average, and patients often need to stay in the hospital overnight.

The procedure demands the expertise of a skilled surgeon who can identify and preserve the facial nerve running through the parotid gland. The facial nerve is crucial for controlling facial muscles and is responsible for expressions such as smiling, frowning, and forehead wrinkling.

Given the intricate nature of the facial nerve’s location, the surgeon must navigate around it carefully, especially considering the challenge posed by the tumor’s specific location. Successful parotidectomy involves removing the gland while safeguarding the functioning of the facial nerve, requiring precision, expertise, and meticulous care during the surgical process.

What to expect while undergoing salivary gland & Parotid surgery?

Here’s an overview of what happens during these surgeries:

• Preparation:

Before the surgery, the patient undergoes a thorough evaluation, including imaging studies such as ultrasound, CT scans, or MRI, to identify the location and nature of the salivary gland issue.

• Anesthesia:

The surgery is performed under general anesthesia to ensure the patient is unconscious and feels no pain during the procedure.

• Incision:

The surgeon plans the incision so that it leaves a minimal postoperative scar and hides in the natural skin creases of the face and neck.

• Facial Nerve Exploration:

The surgeon carefully explores and identifies the facial nerve, the only nerve of facial movements, to ensure that the nerve is preserved. Sometimes, the nerve is also sacrificed to ensure complete tumor removal.

• Tumor Removal or Treatment:

If a tumor is present, the surgeon removes it while attempting to preserve healthy gland tissue. In cases of benign tumors, complete removal may be curative. Malignant tumors may require additional treatment.

Facial nerve grafting and reanimation

Sometimes, the facial nerve is sacrificed during parotidectomy. In such cases, the surgeon can perform a facial nerve grafting or reanimation procedure, which essentially helps retain some of the function of the lost facial nerve.

Conclusion 

After surgery, patients are monitored for any complications, and postoperative care may include pain management, wound care, and follow-up appointments to assess recovery.

Salivary gland and parotid surgery are delicate procedures that require precision and expertise to address the specific issues affecting these glands while minimizing the impact on surrounding structures and preserving essential functions, such as facial nerve function, in the case of parotid surgery.