Salivary Gland Surgery

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.

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 is hidden in the natural creases. The facial nerve is identified at its main trunk and its branches are followed one by one and protected; throughout the operation, the nerve’s response to stimulation can be tracked with a device (neuromonitor).

• Superficial parotidectomy: If the tumour is in the superficial part of the gland, only this part is removed.
• 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.

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 and protected. Apart from tumours, this operation may also be performed for recurrent stones and inflammation.

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 damage is rare when the nerve has been preserved
• Numbness of the earlobe and the surrounding area
• Sweating and flushing over the operated area while eating (Frey’s syndrome)
• A collection of saliva (sialocele) or a saliva leak; these usually resolve with simple measures
• 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. Asking your questions at the consultation before surgery helps you go through the process more comfortably.