Parotidectomy: Types, Procedure, Recovery, and Success

Parotidectomy is a surgical procedure to remove all or part of the parotid gland to treat tumours. There are three types of parotidectomy, based on the extent of the gland being removed. These include: 

1. Superficial Parotidectomy is the most common type in which the superficial lobe of the parotid gland is removed. It is typically performed for benign tumours. 

2. Total Parotidectomy involves removing the entire parotid gland, including both the superficial and deep lobes. It is usually performed for malignant tumours.

3. Radical Parotidectomy is a more extensive total parotidectomy procedure that involves removing the entire parotid gland along with the facial nerve. 

Anatomy and Physiology of the Parotid Gland

The parotid gland is the largest of the salivary glands. It is located on each side of the face, just in front of and below the ear. The anatomy of the gland is as follows: 

1. Stensen’s duct is the main excretory duct of the parotid gland that carries saliva to the mouth. It opens near the upper molar teeth. 

2. Lymph nodes are located around the outer part of the parotid gland. 

3. The inner grooved surface of the gland rests against the jaw and the masseter muscle, which connects the lower jaw to the cheekbone.

4. The facial nerve (cranial nerve VII) divides the gland into superficial and deep lobes. 

The parotid gland plays a vital role in the digestive system through its production and secretion of watery saliva that aids digestion. It keeps the mouth moist and prevents bacterial cavities in teeth.

Parotidectomy is performed to treat various conditions affecting the parotid gland. The following are some primary conditions treated with this surgical procedure:

1. Benign tumours such as pleomorphic adenomas.

2. Malignant tumours like mucoepidermoid carcinoma.

3. Persistent parotid gland infections that do not respond to antibiotics and other conservative treatments.

4. Chronic parotitis (inflammation of the parotid gland).

5. Sialolithiasis (salivary gland stones) blocks saliva flow and causes pain and swelling.

Parotidectomy is recommended for those exhibiting certain symptoms that suggest the need for surgical intervention. These symptoms may include the following: 

1. A painless lump or swelling in the face or jaw 

2. Numbness or burning sensation in the face 

3. Muscle weakness on one side of the face 

4. Difficulty eating or swallowing 

5. Loss of facial movement, leading to trouble opening the mouth

A parotidectomy surgery is performed under general anaesthesia and takes about three to four hours to complete. Superficial parotidectomy steps may differ slightly from those of total parotidectomy. However, the general procedure is as follows: 

1. Incision: The parotidectomy incision is made in front of the ear, extending back and downwards into the upper part of the neck. It minimises visible scarring. 

2. Identifying Facial Nerve: The surgeon exposes the parotid gland. They identify and isolate the facial nerve to prevent nerve damage. 

3. Superficial Parotidectomy: If only the superficial lobe is affected, the surgeon removes this portion of the gland while preserving the facial nerve.

4. Total Parotidectomy: If the entire gland needs to be removed, the surgeon carefully dissects both the superficial and deep lobes. The nearby lymph nodes in the neck affected by cancer cells will also be removed. 

5. Closure: The incision is closed with sutures. A drain may be placed to prevent fluid accumulation. 

Doctors provide detailed instructions on preparing for a parotidectomy. Adhering to these guidelines before and on the day of the procedure is crucial to ensure the success of the surgery. 

Before Parotidectomy 

The preparations for a parotidectomy begin two weeks before the procedure. The patient is asked to quit smoking as it can increase the risk of breathing problems during the surgery. Other preparatory guidelines are as follows: 

On the Day of Parotidectomy 

On the day of the procedure, patients should arrive at the hospital at the scheduled time for last-minute check-ups. The pre-operative process includes the following: 

It is common to experience pain and swelling at the surgical site for about three weeks. Patients should adhere to post-operative care instructions for a smooth hospital and home recovery. 

In Hospital Recovery 

Patients usually need to stay in the hospital overnight after the parotidectomy procedure. During this stay, they can expect the following: 

1. They are moved to a recovery room, where they are closely monitored for vital signs, including heart rate, blood pressure, and oxygen levels.

2. Pain medications are administered to keep individuals comfortable. 

3. The doctor asks patients to smile, close their eyes, and perform other facial movements to check the function of the facial nerves. 

At-home Recovery 

Recovery after parotidectomy generally takes 7-10 days. Patients can return to their normal activities one-month post-procedure. However, numbness and facial weakness may take up to a year to subside. The recovery guidelines that one should follow at home include the following: 

1. Keep the surgical site clean and dry. Follow the doctor’s instructions for changing dressings and caring for the incision.

2. Take prescribed pain medications to manage discomfort.

3. Start with a bland diet. Avoid sour or spicy foods. 

4. Sleep with the head elevated above the heart level for 3-5 days to reduce swelling. 

5. To prevent strain on the surgical site, avoid strenuous activities, heavy lifting, and bending over for at least 2 to 4 weeks.

6. Avoid smoking and excessive alcohol consumption for two weeks after surgery, as these can impair healing. 

Follow-up Appointment

The timing of follow-up visits can vary from individual to individual. However, generally, the first visit is scheduled one or two days after the procedure to remove any surgical drains. The next appointment is scheduled five to seven days post-surgery, during which the sutures are removed. Four to six weeks after the operation, doctors assess the healing process. 

Parotidectomy offers several procedural benefits that enhance the safety and effectiveness of the surgery. The advancements in surgical techniques ensure a more precise approach, contributing to better patient outcomes and quicker recovery times. Other advantages of the surgery are as follows: 

1. The use of minimally invasive techniques in modern parotidectomy reduces damage to surrounding structures.

2. Advanced imaging techniques during surgery help accurately locate tumours or affected areas.

3. During surgery, a facial nerve monitoring device is used to protect the facial nerve. This minimises the risk of nerve damage and preserves facial function.

4. The parotidectomy incision is hidden once it heals. 

Parotidectomy, while generally safe, carries potential complications like any surgical procedure. Understanding these can help prepare and manage expectations. Some common side effects of the procedure include: 

1. Infection 

2. Bleeding and haematoma (collection of blood outside of blood vessels) 

3. Fluid collection at the operation site 

4. Damage to nearby organs 

5. Allergic reactions to anaesthesia 

Risks specific to parotidectomy are as follows: 

1. Numbness in the face, ear, or jaw 

2. Frey’s syndrome (sweating on the cheek area while eating) 

3. First bite syndrome (severe pain initiated on the first bite of a meal)

When to call a doctor?

After a parotidectomy, patients should monitor their recovery and be aware of signs that may require immediate medical attention. The following are specific situations when they should call a doctor:

1. A fever of 100.4 F or higher.

2. Signs of infection, such as increased warmth, swelling, redness, or pus draining from the incision site.

3. New or worsening facial weakness or swelling. 

4. Trouble eating, drinking, blinking, or smiling.

5. Nausea or vomiting.

Delaying a parotidectomy, especially when indicated for treating tumours or severe infections, can lead to several complications. The potential consequences of postponing this surgery are as follows:

1. Progression of Disease: If left untreated, benign parotid tumours can become malignant. 

2. Tumour Growth: If the parotidectomy is delayed in tumour cases, whether benign or malignant, the tumour may continue to grow. Larger tumours can be more difficult to remove. 

3. Increased Risk of Malignancy: For malignant tumours, delaying surgery can allow cancer to spread to nearby tissues or distant organs.

4. Functional Impairment: Larger tumours or prolonged infections might lead to more significant discomfort, impacting jaw movement, swallowing, and speaking.

Cost of Parotidectomy 

The cost of a parotidectomy in India can vary depending on several factors. Generally, the cost starts at ₹ 40,000, with an average price of ₹ 90,000. The maximum expense can reach up to ₹ 1,20,000. 

Note: These are approximate costs. For accurate pricing details, please speak to a HexaHealth expert. 

Factors that affect the cost of parotidectomy are as follows: 

1. Surgeon’s Expertise: Highly skilled and renowned surgeons have a higher fee for their services.

2. Type of Hospital: Private centres generally charge more than public hospitals due to better facilities available.

3. Geographic Location: Urban areas have higher prices compared to rural areas due to differences in the cost of living.

4. Type of Parotidectomy: A superficial parotidectomy is less expensive than a total or radical parotidectomy.

Parotidectomy is a surgical procedure for addressing various issues related to the parotid gland, including tumours and chronic infections. The success of the surgery depends on surgical technique and post-operative care. Patients considering this procedure should consult with experienced surgeons to discuss its benefits and risks. 

For those undergoing procedures like superficial parotidectomy, HexaHealth ensures access to experienced surgeons and top healthcare facilities. We help you achieve a smooth and speedy recovery. Our team delivers the highest-quality care tailored to each patient’s specific needs.