Parotid Surgery

Parotid Gland is the major and largest of the three pairs of major salivary glands. It is responsible for major component of saliva production. It secretes serous saliva.

A parotidectomy is the most common surgical procedure on the parotid glands. The procedure is most typically performed for neoplasms (tumours), which are growths of abnormally dividing cells. Neoplasms can be benign (non-cancerous) or malignant (cancerous). The majority of parotid gland tumours are benign, however 20% of parotid tumours are found to be malignant. Parotidectomy is a very delicate and demanding procedure because of the presence of facial nerve that courses through the substance of the gland and supplies most of the muscles of facial expression like smiling, frowning etc. Any damage to the nerve may lead to permanent disfiguration and weakness of facial muscles.It may also lead to drooling of saliva from the angle of mouth or inability to close the eyes completely.It is therefore a procedure that should be performed by surgeons with adequate experience and training to minimise possible complications.

Essentially three procedure are most common.

• Superficial Parotidectomy : Facial nerve courses through the substance of the gland.The part of the parotid gland superficial to the plane of the nerve is called the superficial lobe and likewise the part deep to the nerve is called the deep lobe of parotid nerve.Superficial parotidectomy can be defined as excision of parotid tissue that lies lateral to the plane of the facial nerve and its branches. Most benign and malignant parotid tumours can be adequately treated with this procedure. No specific preoperative preparation is necessary, but patients must be counselled about complications such as temporary and permanent damage to the facial nerve, numbness, gustatory sweating, seroma, hematoma, and cosmetic changes.
• Total Conservative Parotidectomy : Here by definition both the superficial as well as deep lobe of parotid are removed because the tumour extends to the deep lobe as well. Almost all of parotid gland is removed however utmost care is taken to identify and preserve the facial nerve and all its branches.
• Radical Parotidectomy : This is usually done only for malignant parotid cancers engulfing and involving the facial nerve. Facial nerve is sacrificed in this procedure to ensure complete resection of the malignant tumour. Surgeons may also need to remove part of overlying skin or underlying muscles, bones etc.