For many people, the idea of parotid surgery is daunting. In this short video, ENT surgeon Dr John Charles Hodge walks through what a parotidectomy involves, from the role of the facial nerve to incision options, hospital stay and recovery.
What is a parotidectomy?
A parotidectomy is an operation to remove part or all of the parotid gland, a salivary gland that sits in front of and below the ear.
Key points from the video
- Parotid surgery is facial nerve surgery. The nerve that controls the muscles of the face runs through the parotid gland, dividing it into a superficial and a deep lobe, so the operation is centred on protecting that nerve.
- Hospital stay. The surgery is done under general anaesthetic, and most people stay in hospital for one to three days. A drain is often used to collect fluid after the operation.
- Incision options. The standard incision runs from in front of the ear down onto the neck in a gentle curve, which looks better cosmetically than a straight cut. Dr Hodge also uses neck-only and facelift-style incisions where the type of lesion suits them.
- Facial nerve outcomes. Facial weakness can be temporary or permanent, but most people end up with good function. The more often a surgeon performs this operation, the lower the risk to the nerve.
- Numbness. The most common complaint after surgery is numbness around the ear. Dr Hodge preserves the branch of the great auricular nerve that supplies the earlobe where possible.
- Frey syndrome. In the year after surgery, most people notice facial sweating when they think about eating. It can be treated with Botox, though treatment is rarely needed.
Video transcript
Hi, I’m John Charles. I’m an ear, nose and throat doctor, and I’m going to talk to you today about a parotidectomy. That’s an operation to remove part or all of your parotid. I won’t go into the indications, but really the journey.
It scares a lot of people because essentially parotid surgery is facial nerve surgery. The nerve that controls the muscles of the face comes out through the skull base and basically splits the parotid in half, so you’ve got a superficial and a deep lobe, and there are five branches. So any surgery is essentially about managing that facial nerve.
Now, it’s a general anaesthetic. Normally people are in hospital anywhere from one to three days. I’ll often use a drain to collect blood that would have collected under there anyway, and you’re also sticking everything down, because when you cut through the parotid tissue, which is a salivary gland, you can get little balls of spit there as well. You want to try and reduce that incidence.
There are a number of incisions that I use. Essentially there’s a standard incision, which is called a Blair incision, which starts in front of the ear and is curvilinear down onto the neck. It’s curvilinear because if you do a straight cut it draws the eye and doesn’t look as good cosmetically. But I do do variations. Sometimes I just do the neck component, and sometimes I do a facelift component, so I do an incision in front of the ear and bring it up and over. Those incisions are cosmetically more acceptable, but only suited to certain types of parotid lesions.
So the facial nerve. The reality is it can not work at all, or it can be completely fine. Most people end up towards this end of the scale, and maybe they’re not blinking quite as quickly. It can be a temporary issue. It can be a permanent issue. There’s a whole school of surgery designed around facial nerve reanimation, and it’s the thing that scares people most about parotid surgery. The reality is the more that you do this operation, the less likely you are to damage the facial nerve. Your outcomes are better. Part of that is because you do it quicker, so the nerve isn’t drying out, because nerves don’t like that.
Looking at other complications or consequences of parotid surgery, the commonest is numbness. There’s a nerve called the great auricular nerve that goes up and splits into the earlobe and the parotid gland. A lot of people just cut it. I preserve the branch to the earlobe. I think that’s especially important in women who wear earrings. It feels unusual. And interestingly, the commonest complaint six months post surgery when I see my patients isn’t the facial nerve, because that’s fine. It’s actually the numbness. Patients really don’t like that, so I think preserving that branch is really critical.
Then there are a few weird things with parotid surgery. One’s called Frey syndrome. Up to about a year afterwards, most people, when they think about eating, will get a little bit sweaty in the face. That can be treated with Botox, but it’s actually quite rare to do that.
So hopefully that’s demystified parotidectomy surgery for you a bit.
Talk to Dr Hodge about parotid surgery
If you’ve been told you may need a parotidectomy and would like to discuss your options, book an appointment or get in touch with the rooms.
This information is general in nature and is not a substitute for personalised medical advice. Please speak with your GP or specialist about your individual situation.