Is Parotidectomy A Major Surgery & How Long Does It Take?

The parotid gland is the largest of all the major salivary glands ^(1).

The most common reason for parotidectomy is a tumor in the parotid gland ^(2).

Since parotid glands are located in an esthetically demanding zone, i.e., the face, it is important to make the surgical incision considering the esthetics of a person. However, parotidectomy is associated with very little morbidity and mortality. Complications associated with parotidectomy include temporary/permanent facial paralysis, Frey syndrome (sweating on the affected side during chewing), infections, salivary fistula, seroma, and hematoma ^(1).

Parotidectomy is performed under general anesthesia and the surgical procedure usually takes around 1-2 hours. The surgical incision takes about 6 weeks to heal; however, the complete remodeling of the scar continues for a couple of years. Short term and long-term follow-up are necessary with an ENT doctor ^{(2), (4).}

Parotid glands are a pair of salivary glands located in front of the ears. They are the largest among the major salivary glands. The facial nerve divides the parotid gland into a superficial and a deep portion. The parotid gland secretes thin, watery saliva without any mucus via its duct known as Stensen duct inside the cheek opposite the upper second molar tooth ^(1).

The parotid gland can be enlarged due to various reasons divided into non-neoplastic masses and neoplastic masses. Non-neoplastic masses leading to parotid enlargement include cysts, inflammation of parotid gland (parotitis), collagen vascular diseases, lymph node enlargement (e.g. in AIDS), benign hypertrophy (e.g. in bulimia, sarcoidosis, actinomycosis, sialosis and mycobacterial infections). Non-neoplastic masses consist of 25% whereas neoplastic masses make up rest 75% of all parotid masses. 80% of all the parotid tumors are benign and the rest 20% are malignant ^(3).

The most common benign tumor of the parotid gland is the pleomorphic adenoma (mixed tumor) found in about 80% of the cases. Other benign tumors include Warthin tumor (papillary cystadenoma lymphomatosum), sebaceous tumors, monomorphic tumors, oncocytoma, benign lymphoepithelial lesion, and papillary ductal adenoma (papilloma). Benign tumors are mostly seen in females, except for Warthin tumors. People in their fifth decade of life are most commonly affected. Although salivary gland tumors are rare in children, they have a higher propensity for malignant tumors when compared to adults ^(1).

Mucoepidermoid carcinoma is the commonest malignant tumor, which accounts for approximately 30% of all parotid gland malignancies. Other malignant tumors include adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma, adenocarcinoma, acinic cell carcinoma, salivary duct carcinoma, primary squamous cell carcinoma, sebaceous carcinoma, lymphoma, malignant fibrohistiocytoma, and metastasis in parotid from other sites (skin, lung, kidneys, breast, GI tract and prostate gland malignancies) ^(3).

It is of utmost importance to differentiate non-neoplastic masses from neoplasms and benign tumors from malignant ones. This embodies complete history, physical examination, and imaging studies. Clinical presentation includes painless mass in >80% of the cases, pain associated with the mass in 30% patients, facial nerve weakness, or paralysis in 7-20% of malignant tumors. Pain increases the likelihood of malignant tumor and facial nerve paralysis, which is almost always associated with malignant tumors, is associated with a poor prognosis. Fine needle aspiration, core biopsy, sonography, sialography, CT scan, and MRI all help in reaching a definitive diagnosis of the parotid mass ^(3).

The management of benign parotid tumors includes complete surgical excision of the mass known as parotidectomy. Since most of the tumors are found in the superficial lobe of the parotid gland, superficial parotidectomy is the treatment of choice. The treatment of parotid malignancy is also complete excision of the tumor mass followed (if indicated) by radiation therapy. Tumors in the deep lobe necessitate total parotidectomy. Preservation of facial nerve is an important consideration in parotidectomy as it traverses through the parotid gland and its injury might lead to complications of facial paralysis ^{(1), (3).}

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