Salivary gland surgery is the general name for operations aimed at removing a tumour in a gland or a diseased gland. The two most frequently performed operations are partial or complete removal of the parotid gland (parotidectomy) and removal of the submandibular gland. Because the facial nerve and other important nerves lie in this region, the surgery requires fine and careful work.
Preparation before surgery
Before the operation, the diagnostic process is completed: examination, ultrasound, fine-needle biopsy and, if required, magnetic resonance imaging (MRI) establish the location of the tumour and its relationship to the nerve. Your general health is assessed and the medicines you take are reviewed; blood-thinning medicines may need to be adjusted before surgery. If you smoke, stopping before the operation helps wound healing.1
Parotidectomy
This is the operation to remove the tumour from the gland in front of the ear. The incision starts in front of the ear, curves behind the earlobe and descends to the upper part of the neck; this line follows the natural skin creases. The facial nerve is identified at its main trunk and its branches are followed one by one so that they can be preserved; throughout the operation, the nerve’s response to stimulation can be tracked with a device (neuromonitor). In a pooled analysis of published studies, weakness straight after the operation was less frequent when the nerve was monitored; the rate of permanent weakness was not statistically different.2,3,4
- Superficial parotidectomy: If the tumour is in the superficial part of the gland, only this part is removed.2
- Total parotidectomy: If the tumour is in the deep part or is malignant, the whole gland is removed.
In malignant tumours, the lymph nodes of the neck are also removed in the same session if necessary.1
Submandibular gland excision
This is the removal of the whole gland under the jaw. The incision is made below the jawbone, parallel to a neck crease. The branch of the facial nerve that moves the lower lip and the nerves that supply sensation and movement to the tongue are identified so that they can be preserved. Apart from tumours, this operation may also be performed for recurrent stones and inflammation.2
Anaesthesia and the course of the operation
Both operations are performed under general anaesthesia. The duration of the operation depends on the size and location of the tumour and its relationship to the nerve. At the end of the operation, a thin drain may be placed in the area; the drain is usually removed within a few days, and most people return home after a short stay.
Possible risks
As with any operation, bleeding, infection and wound problems may occur. The risks specific to this region are:
- Temporary weakness of the facial nerve; permanent weakness is less common, and of the whole face rare3,5
- Numbness of the earlobe and the surrounding area
- Sweating and flushing over the operated area while eating (Frey’s syndrome)5
- A collection of saliva (sialocele) or a saliva leak; these usually resolve with simple measures5
- In submandibular surgery, temporary weakness at the corner of the lower lip and numbness of the tongue
Most of these risks are temporary and are discussed with you in detail before surgery.
How is the decision for surgery made?
The decision for surgery is made by weighing together the type, size and location of the tumour and your general health. In benign tumours, the likelihood of growth and transformation is decisive; in malignant tumours, the stage and extent of spread. Bring your questions to the consultation before surgery; having them answered makes the process easier to follow.
Frequently asked questions
How long does salivary gland surgery take?
The duration depends on the size and location of the tumour and its relationship to the facial nerve; protecting the nerve is the most meticulous and time-consuming part of the operation.
How is the facial nerve protected during surgery?
The nerve is identified at its main trunk and its branches are followed under direct vision; a nerve monitoring device is used when needed.
Will there be a scar after surgery?
The incision is placed in the creases in front of the ear and in the neck; the scar usually fades and becomes less noticeable with time.
How is a salivary gland tumour treated?
Salivary gland surgery removes the tumour or the diseased gland. In the parotid gland, only the superficial part is removed if the tumour lies there, and the whole gland if the tumour is in the deep part or is malignant; a tumour of the submandibular gland is removed together with the whole gland. In malignant tumours, the lymph nodes of the neck are also removed in the same session if necessary.
What are the risks of salivary gland surgery?
As with any operation, bleeding, infection and wound problems may occur. The risks specific to this region include temporary weakness of the facial nerve, numbness of the earlobe, sweating over the operated area while eating (Frey’s syndrome) and a collection or leak of saliva. Most of these are temporary; permanent facial weakness is less common, and permanent weakness of the whole face is rare.
Related articles
References
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Sood S, McGurk M, Vaz F. Management of salivary gland tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S142-S149. doi:10.1017/S0022215116000566 ↩
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Cancer Research UK. Types of surgery for salivary gland cancer [Internet]. London: Cancer Research UK; [reviewed 2026 May 7; cited 2026 Oct 5]. Available from: cancerresearchuk.org ↩
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Eren SB, Dogan R, Ozturan O, Veyseller B, Hafiz AM. How deleterious is facial nerve dissection for the facial nerve in parotid surgery: an electrophysiological evaluation. J Craniofac Surg. 2017;28(1):56-60. doi:10.1097/SCS.0000000000003186 ↩
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Sood AJ, Houlton JJ, Nguyen SA, Gillespie MB. Facial nerve monitoring during parotidectomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;152(4):631-637. doi:10.1177/0194599814568779 ↩
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ENT UK. Parotidectomy – surgery to remove a lump [Internet]. London: ENT UK; 2023 Aug 24 [cited 2026 Oct 5]. Available from: entuk.org ↩
This page is general information. Decisions about diagnosis and treatment are made for you personally, and only after an examination. If you have symptoms, see a doctor.