Parotidectomy
What is the parotid?
The parotid is a salivary gland located in front of the ear, angle of the jaw and onto the top of the neck, on both sides of the face.
As well as producing saliva, it also has several lymph glands which help fight infections and cancers and therefore can be the site of cancer spread for head and neck cancers.
The parotid gland has two parts, one above and one below separated by the facial nerve, the main nerve controlling facial movements.
There are also other sensory nerves, salivary ducts and arterties and veins passing through it.
The parotid gland drains a large area covering the side of the face, including ears, and the side of the scalp.
Cancers in this part of the head can spread to the parotid gland.
From the parotid gland, the cancer can and usually spreads to the lymph glands in the neck, and/or the blood stream to distant organs.
Most cancers are contained within the superficial (top) lobe of the gland.
In advanced disease, the cancer can extend to the bottom/deep lobe, as well as invading the facial nerve (causing facial paralysis) and can come through the skin.
How do I know if cancer has spread to the parotid gland?
Parotid cancer usually presents with a lump on the side of the face in front of the ear or at the angle of the jaw.
Such lumps can be picked up in several ways:
You may have noticed the lump yourself or others have pointed it out.
It could be picked up during your routine examinations at your follow up appointments.
It may also be picked on your routine regular staging scans.
Suspected cancer spread is confirmed by a needle sample test performed with ultrasound guidance.
What does it mean if I have parotid cancer?
Confirmed parotid metastasis is a sign that the disease has progressed to stage 3 at least.
You will require updated scans to rule out spread to distant organs such as the brains, lungs and liver.
Your care will be discussed at a specialist skin cancer meeting where all your scans are discussed and a management plan made.
Treating parotid cancer is a joint effort between my team and Oncologists.
You will be referred to the Oncologists to discuss other treatments that may be appropriate in addition to surgery (discussed below).
If parotid metastasis is found through SLNB, you may be offered Oncology treatments instead of surgery.
However, metastases that can be felt through the skin or visible on scans usually requires parotidectomy.
What is a parotidectomy?
Parotidectomy is an operation in which your parotid gland is removed.
In my practice, this is usually required to surgically remove a tumour that has spread to the gland.
There are several types of parotidectomy depending on where the cancer is located and also the function or involvement of the facial nerve:
Superficial parotidectomy: most common, only the top lobe of the gland is removed, the facial nerve is preserved
Total parotidectomy: both parts of the parotid gland are removed, the facial nerve may be preserved if appropriate, you will still have the other parotid and other salivary gland to make saliva.
Parotidectomy with facial nerve sacrifice: if the facial nerve appears invaded by cancer leaving it means the cancer will regrow. The nerve is sacrificed in order to improve chances of cancer removal. You may be offered facial rebalancing or reanimation via a variety of techniques depending on your specific situation (see facial paralysis section).
How is parotidectomy performed?
Parotidectomy is performed under general anaesthetic.
It requires long incisions which start around the temple/sideburn, proceed in front of the ear and into the neck.
Care is then taken to peel away the parotid gland from the underlying facial nerve and blood vessels.
In my practice, usually neck dissection is also performed to remove lymph glands from the neck.
This is because neck glands are usually the next stop for the cancer and so removing these glands may reduce the risk of progression to stage 4.
You will usually have two drains in the neck, and the neck may be closed with sutures/staples.
Parotidectomy and neck dissection is usually a 4 hour surgery.
What is the recovery and follow up after parotidectomy?
Patients usually stay in hospital for 3-5 days on average.
You will receive pain killers and other medications as required.
Drains are usually removed when they drain less than 30 mls of wound fluid in 24 hours.
Most patients are walking, washing and doing gentle tasks by themselves after 2-3 days.
Follow up with the Christie dressings clinic will be arranged for about a week following surgery, and more appointments will be made if required.
You will also receive a nursing follow up telephone consultation at 6 weeks.
You will be given specific instructions, usually more in line with the type of reconstruction you have undergone following wide local excision.
There will usually be minimal restrictions to your activites but these will be specified for your circumstances.
What risks does parotidectomy have?
The risks of anaesthetics will be discussed with you by the anaesthetic teams, but may include chest infections and clots in the legs or lungs.
Your specific risk will be discussed with you after anaesthetic assessment, which is offered to patients who might have higher anaesthetic risks.
The incision will form a scar which will need about 18months or more to fully mature.
You will find that your neck will be stiff to start with and will feel tight due to the scar.
Wounds can also become infected. Most can be treated with oral antibiotics from home but rarely, some need admission and/or surgery to wash the wound.
There is risk of injury to the facial nerve, causing total or partial facial paralysis.
Most patients will have a degree of facial weakness even if the nerve is preserved. This neurapraxia usually improves or resolves over time.
I think my skin cancer may have spread to the parotid, what do I do?
If you notice swellings on your face following a skin cancer diagnosis, you can contact my secretary directly or speak with the skin cancer Specialist Nurse.
Seeing your GP may delay your review and you may be incorrectly referred to Ear Nose Throat surgeons (who also deal with parotid tumours).
It is also approriate to contact your dermatologist.