Parotidectomy

What you should know

• A parotidectomy is surgery to remove a part, or all of one of your parotid glands. Your parotid glands are found in your cheeks, over your jaw and in front of your ears. Your parotid glands are one of the glands that release saliva (spit) into your mouth. You need saliva to help with chewing and swallowing. You may need a parotidectomy to remove a growth. The growth in your gland may be caused by an infection, inflammation (swelling), or a tumor (lump of tissue). In most cases a tumor growth is not cancer (benign). The growth may cause you to have pain and swelling in your face. The growth may cause facial numbness (loss of feeling), or decreased movement in parts of your face.
  
  
• Before having a parotidectomy, imaging tests may be done to help plan your surgery. The amount of your parotid gland that will be removed depends on where the growth is found. During surgery, your caregiver will check if your growth has spread to other areas, such as your neck. Having a parotidectomy may decrease your symptoms such as pain and numbness. Removing your growth may return your facial movements, such as smiling or blinking. If you have cancer, surgery may prevent it from spreading, or from coming back.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• If you have cancer, when your tumor is removed, cancer cells may spill out and form a new tumor. Your facial nerve and muscles may be damaged, and you may not be able to move parts of your face. Movement in your face may or may not get better over time. After surgery, you may get an infection, and have bruising and pain in your face and neck. You may have a dry mouth, trouble chewing, and you may sweat when you eat. You may have tingling, or lose feeling around your ear. You may have a large scar on your face, and your surgery may change the shape of your face. An abnormal opening may form near your wound and cause saliva to leak out. Even if your growth is removed, it may come back, and you may need another surgery.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If you do not have a parotidectomy, your growth may become very large and painful. You may lose feeling in your face and have trouble chewing and swallowing. Your growth may cause changes in the shape of your face. If your growth is cancer, it may spread to other parts of your body. Certain parotid cancers may lead to death if they are not treated. Talk to your caregiver if you have questions or concerns about your surgery or treatment.

Getting Ready

Before your surgery:

• Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need imaging tests to help your caregiver learn more about the growth in your parotid gland. Imaging tests also can help your caregiver plan your surgery. Imaging tests include a computerized tomography (CT) scan, magnetic resonance imaging (MRI), and an ultrasound. You may also need a biopsy of your growth to learn if it is cancer. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask your caregiver before you take any medicine on the day of your surgery. Bring a list of all the medicines you take, or your pill bottles, with you to the hospital. Caregivers will check that your medicines will not interact poorly with the medicine you need for surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken on a stretcher to the room where your surgery will be done. Anesthesia medicine will be given to you to keep you asleep and pain free during your surgery. Your caregiver may need to remove only a part of your parotid gland. If your growth is large, deep inside, or spreading, your caregiver may remove the entire parotid gland. If only a part will be removed, an incision (cut) is made above your ear and along your hairline. A larger cut above your ear and along your jaw is needed when your whole gland needs to be removed. Your caregiver will uncover and move your facial nerve aside so it is out of the way during surgery. Your caregiver may need to remove part of your facial nerve to reach your growth. A special machine to monitor your facial nerve for damage may be used during your surgery.
  
  
• Your caregiver will then remove your growth by cutting out part, or all of your parotid gland. Your caregiver may need to make another cut in your neck to remove any growth that has spread there. After the growth is removed, one or more drains may be placed in your cut. A drain is a thin tube used to remove fluid and blood from your surgery area. If you have a large facial cut, a muscle flap may be needed to close the cut. A muscle flap is a piece of your muscle taken from another body area. A muscle flap closes a larger cut in your face that cannot be closed with just stitches. Your cut will be closed with stitches or staples, and a bandage is placed over it.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Do not get out of bed until your caregiver says it is okay. A caregiver may remove your bandage soon after surgery to check your wound (surgery site). When caregivers see that you are not having any problems, you will be taken to your hospital room. The drains in your wound area will be removed when the wound stops draining.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery.
  
  
• You get sick (a cold or flu), or have a fever (high body temperature).
  
  
• You have fluid coming out of your ear on the side of your growth.
  
  
• You have new trouble opening your mouth.

Seek Care Immediately if

• The pain in your face suddenly gets worse.
  
  
• You have new, or worsening numbness (loss of feeling) in your face.
  
  
• You have new, or worsening swelling in your face or neck.
  
  
• You suddenly cannot move a part of your face.
  
  
• You suddenly have trouble breathing or swallowing.
  
  
• Your growth suddenly feels bigger.