The estimated incidence of a benign parotid tumor is around 2.4 per 100,000 individuals (1).
Most serious complications of parotidectomy are associated with the injury to the facial nerve (2).
How Long Does It Take To Recover From Parotidectomy?
The recovery of the patient after minimally invasive parotidectomy is rapid and the incisions take around 6 weeks to heal; however, the wound remodeling continues for a couple of years. Pain medications are prescribed as needed for a few days postoperatively (4).
The main aim of the parotid surgery is to remove the tumor mass either through superficial parotidectomy or total parotidectomy with the preservation of the facial nerve since most of the complications of parotidectomy are associated with the injury of the facial nerve, which may either be temporary or permanent. The stretching of the nerve during the surgical procedure may be related to temporary facial paralysis. Even temporary facial palsy can cause an eye infection or exposure keratitis due to non-closure of the eyelid. However, most of the cases of facial palsy recover within a year (1).
The facial nerve function of the patient should be assessed with regular follow-ups and they should be followed-up for 18 months after parotidectomy. Permanent loss of facial nerve function is attributed to damage of 1 or 2 branches of the facial nerve, most commonly the marginal mandibular branch. Global facial nerve paralysis may be noted in the removal of malignant tumors due to the removal of facial nerve when close to the tumor (1).
Patients should also be followed-up for local recurrence and distant metastases every 3 months for 2 years, every 6 months for the next 3 years, and then yearly. Chest X-rays and liver function tests should also be obtained yearly (3).
What Type Of Surgeon Does Parotidectomy?
The removal of parotid gland tumor or parotidectomy requires a multidisciplinary approach, which includes a team of specialists, which includes Ear, Nose, and Throat physicians (otolaryngologists), head and neck surgeons, plastic surgeons, medical oncologists, radiation oncologists, radiologists, nurses, speech pathologists, psychologists, pathologists, and social workers. Oncologists are involved when the tumor is malignant. Reconstructive surgery may be required for cosmetic reasons when the tumor extension involves a larger area. A speech pathologist may be needed for assistance in speech and swallowing after surgery. The patient may follow-up with an ENT doctor postoperatively (5), (6).
Why Is There A Need For Parotidectomy?
Salivary gland disorders do not impose any health concerns. Moreover, tumors of the salivary glands are even rare accounting for less than 3% of the tumors in the US and 6% of all head and neck tumors. However, 80% of all the salivary gland tumors are found in the parotid glands. Of these, 70-80% are benign and the rest are malignant tumors (2).
These tumors are seen as a painless mass in most of the cases. Pain is less common in both benign and malignant tumors. Facial nerve paralysis is rare in benign tumors and is mostly indicates malignant transformation (3).
In both benign and malignant tumors, the definitive treatment is the surgical resection of the tumor mass, which is known as parotidectomy. In malignant tumors or recurrent benign tumors, this may be (if indicated) followed by radiation therapy. In approximately 90% of the cases superficial parotidectomy is carried out; however, when deep lobe is involved deep lobe parotidectomy or complete total parotidectomy may be carried out along with the removal of regional lymph nodes. Functional neck dissection may need to be carried out in high-grade and tumors >4 cm in diameter (2), (3).
The surgical incision should be made as esthetically as possible since the surgery is in the most esthetic zone. In most cases, the wound can be closed primarily. However, when the tumor size is large and extending to the surrounding structures reconstructive procedures, such as skin grafts and flaps (cervicofacial, trapezius, pectoralis, deltopectoral, and microvascular free flap) may be needed for the restoration of function and esthetics (3).