The surgical procedure that is used to remove tumors of the parotid gland, or sometimes stones or chronic infection of the gland, is called parotidectomy. The term itself means to remove the parotid gland, and it is a misnomer, in that the entire gland is almost never entirely removed. This is due to the fact that a large part of the gland extends deep into the neck and is not commonly involved in the disease process.
The skin incision for a parotidectomy is typically either a “modified Blair incision,” which runs in front of the ear and down onto the neck, or a facelift incision, which extends behind the ear instead of down into the neck and is more hidden than the Blair incision.
Once the skin flap is elevated out over the parotid, dissection is carried down to identify the facial nerve, which runs from the skull base behind the ear out into the face. This is the nerve that allows us to smile, wink, etc. It is the nerve of facial expression. In most cases, this nerve can be identified and preserved, but on occasion, it may need to be removed such as in cases of cancer that involve the nerve itself. It is common for the nerve to be weak for a period of time following surgery, but recovery is complete in most cases.
Once the tumor or gland is removed, there will often be a sunken or depressed area in front of the earlobe or below it. The doctor will commonly use a material such as Alloderm to help fill in the defect, or in some cases with a larger defect, fat from the abdomen or a muscle flap may be used to fill in the deformity instead.
Commonly, a plastic tube called a drain is placed into the wound to allow blood or serum to drain from the wound for several days, this is usually removed at the first postoperative visit. The skin may be closed with sutures or staples.
Most patients heal well with minimal deformity. True complications are not common after a parotidectomy, but there are several side-effects that are common - the skin in front of the ear and the earlobe itself is typically numb for months after surgery, and some numbness is permanent though the numbness does not bother most patients.
There also exists a situation called Frey's syndrome, or gustatory sweating, where the side of the face over the parotidectomy may sweat and blush when eating. This is due to the regrowth of nerves that incorrectly go to the sweat glands in the skin after the surgery. This is very common, but is usually mild and not bothersome. In some patients, it may be more pronounced and bothersome. There are several ways to treat this. Botox injections are effective, but it is best avoided by the use of Alloderm or other methods to prevent it. Patients should discuss this side-effect and treatment with their doctor.