Parotid gland and parotid surgery parotidectomy in india
This is the gland that is affected by Mumps. Lumps (tumours) in the parotid gland are common and are seen in all age groups. They are the result of an abnormal growth of cells within the gland, though the exact reasons for this are not clear. The vast majority (approximately 80%) of these tumours are not cancerous and are called benign tumours. Rarely, however, some tumours can be cancerous.
Other common causes of lumps in the gland include stones in the duct of the gland, which often block the flow of saliva. This blockage often gives rise to infections, which can sometimes be troublesome. Whatever the cause, however, it is prudent to establish the EXACT NATURE of the swelling.
Investigations and Treatment of Parotid Problems
During the initial consultation, a detailed history is taken and also an assessment of your problem. This is usually followed by an ultrasound scan, which is performed by an expert radiologist. During the ultrasound scan, a needle may be inserted into the lump to collect a sample of cells. These cells are then analysed under the microscope by the pathologist who will often determine the nature of the swelling. Rarely, other tests such as a plain X-ray, CT scan, MRI scan or a sialogram may be required. These will be discussed with you where necessary.
Treatment depends on the nature of the lump and the results of the tests. Removal of the swelling is usually recommended because the exact nature of the swelling is often ascertained after removal and analysis of the whole lump. Additionally, if the lumps are not removed, the majority of them will grow further and often become cosmetically unacceptable and even turn cancerous. Large, cancerous lumps are difficult to remove and complicate surgery.
Facial Nerve Considerations
Where the parotid mass is located relative to the facial nerve also determines how extensive the surgery will be. Regardless of location, the BEST way to protect the facial nerve is to identify and protect all branches of the facial nerve BEFORE removing the mass. Facial nerve identification is done by microscopic dissection with nerve monitoring. It is this facial nerve identification that takes so much time. After the facial nerve is protected, removing the mass itself takes about 5 minutes. In the illustrations below, the parotid mass is colored in green.
[ Parotid Mass is on TOP of the Facial Nerve ]
In this scenario, the surgical procedure performed is "superficial parotidectomy". What this means is that the parotid gland under the facial nerve is not touched at all.
The surgery typically is of short to average duration.
[ Facial Nerve is Going THROUGH the Parotid Mass ]
This scenario is quite tricky. A "total parotidectomy" may be required and 1 or 2 branches of the facial nerve may need to be deliberately cut depending on level of concern. If the facial nerve is preserved by dividing the mass, post-operative radiation may be required, even if the tumor is benign.
Why? Because a phenomenon called "tumor spillage" occurs resulting in seeding of the surrounding tissues with the tumor causing a recurrence of the tumor in the future. Post-operative radiation prevents this recurrence from happening.
[ Parotid Mass is BELOW the Facial Nerve ]
A "total parotidectomy" is required. Risk to facial nerve paralysis is higher than the first scenario. Surgical duration is quite long.
In order to perform this surgery and safely identify and protect the facial nerve, a LONG facial incision is potentially required... up to 6 inches long as shown in red in the illustration below. Depending on the parotid mass location, however, the incision required may be shorter. Regardless, the scar is usually not very noticable... in fact, this incision is very similar to the incision used to perform facelifts for cosmetic reasons.
Surgery (parotidectomy) explained
The surgery to remove the parotid lump is called a parotidectomy. This involves removing either part or all of the parotid gland. The operation is usually performed under a general anaesthetic, which means that you will be asleep throughout the procedure. A skin incision (cut) is made, which runs from the front of the ear curving towards the back of the ear just to the level of the hair line. Most surgeons differ in making the skin cut and tend to extend the cut into the neck.
This is nearly the same incision as that used in face-lift surgery and has excellent cosmetic results. At the end of the operation a small drain (plastic tube) is placed through the skin to facilitate drainage of blood and tissue fluids. The skin cut is closed with stitches and the drain is removed in 24-48 hours, when you will be able to go home. Stitches will be removed usually after 6 days.
Potential complications
In the following section some of the common and serious risks of parotidectomy are discussed briefly. Please note that the chances of these happening are very low.
Weakness (paralysis) of the face
The facial nerve that moves the muscles which help the eyes to close and the mouth to smile and eat runs through the parotid gland. We always diligently identify and preserve the nerve. We also use a specialised nerve monitoring technique which adds further safety to the procedure. In most cases, the nerve works normally after surgery. Occasionally, however, (about 15-20% of cases) where the lump has been very close to the nerve, a temporary weakness of the face may occur. This usually lasts for a few weeks and then recovers back to normal. Permanent damage, resulting in permanent weakness of the face, is rare in surgery of the benign (non cancerous) tumours.
Bleeding and leakage of saliva
Rarely, blood can collect beneath the skin resulting in swelling in the operated area. It is also normal for small quantities saliva to leak from the cut surface of the gland and cause it to swell. Most often this blood and saliva is mopped up by our body and therefore the swelling is self limiting. Occasionally, however, it may be necessary to return to the operating theatre to rectify the problem.
Numbness/altered sensation of the face and the ear
The nerves that are responsible for appreciating sensation on the face, side of the neck and the ear lie just under the skin and are damaged to a variable degree. This transpires as numbness of the ear, particularly felt in the ear lobe and to a variable degree on the side of the face and neck. One is more likely to be aware of it when wearing earrings and whilst shaving in men. Generally speaking, with time the numbness and altered sensation improves.
Cosmetic deformity
You may notice some hollowing under the skin at the back of the jawbone from where the gland and swelling has been removed. This is usually mild and is not a concern to the majority of patients. There are various ways of treating this should it become troublesome.
Skin changes - sweating and flushing (frey's syndrome)
You may notice that the cheek skin on the operated side becomes flushed and sweaty, particularly associated with eating or thought of food. Should this occur and become troublesome, it can generally be treated by the application of simple roll-on antiperspirant and very occasionally further surgery may be required.
Pain and stiffness
You may notice pain and stiffness in the area of the neck and shoulder. This recovers quickly. Gentle daily massage with your regular skin cream starting two to three weeks after surgery helps to supple the scar and eases the discomfort.
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Other common causes of lumps in the gland include stones in the duct of the gland, which often block the flow of saliva. This blockage often gives rise to infections, which can sometimes be troublesome. Whatever the cause, however, it is prudent to establish the EXACT NATURE of the swelling.
