Fast Facts

Stop aspirin and other drugs that cause bleeding one week before surgery.

One to two nights in hospital and two weeks off work.

Temporary or permanent weakness in the facial muscles can happen.

Numbness in the skin and ear lasts for months after surgery.

What is this for and is it effective?

The parotid gland makes saliva. The saliva enters the mouth through a small duct in the cheek. There is a parotid gland on each side of the face and neck, just below the ear. There are other large and small saliva glands as well, so removing one saliva gland won’t cause dry mouth.

The parotid gland may need to be removed if it:

  • Develops a tumour or lump. These can be benign (not cancer) or malignant (cancer).
  • Develops stones in the ducts that take the saliva from the gland to the mouth. This can cause painful swelling with meals and sometimes recurrent bacterial infections.

Tests on parotid gland lumps include:

  • Ultrasound shows the size and shape of the gland and the location and size of lumps or stones.
  • An ultrasound guided needed sample (FNA) can determine if the lump is benign or due to cancer. This is like having a blood test, but the needle is placed into the lump to draw out some cells rather than into a vein to draw blood.
  • Sometimes a CT of the neck and chest is needed.

Frequently Asked Questions

What could go wrong? Is there a chance that surgery could make me worse?

The facial nerve and parotid gland surgery

The facial nerve runs through the parotid gland like a skewer through an apple. During parotid gland surgery, the surgeon starts by locating the facial nerve behind the gland then follows the nerve carefully through the gland, to allow removal of the gland without damage to the nerve. A nerve monitoring device is used during surgery. This reduces the risk of damage to the nerve but can’t guarantee it won’t be damaged.

The facial nerve makes the muscles on one side of the face move. This includes closing the eye and lips and making facial expressions like smiling and frowning. If the facial nerve is damaged, one half of the face doesn’t move. This can be complete (no movement at all, paralysis) or incomplete (reduced movement). It can affect all the muscles of the face or just some of the muscles.

The most important function of the facial nerve is blinking and closing the eye. This is essential to keep the surface of the eye healthy. If a facial nerve injury happens, protecting the eye is the most important thing to do, to prevent change in vision.

6:100 people have temporary weakness in the muscles on one side of the face. This can last for up to 12 months.

1:100 people have permanent weakness in the muscles on one side of the face. There are procedures that can make the face look more symmetrical and to help the eye close, but can’t make the muscles move normally again.

Other temporary side effects: 

The skin around the wound and ear is always numb after surgery. For most people this gradually improves over 6 months.

3:100 people develop a collection of saliva under the skin (sialocoele) 1-2 weeks after surgery. This usually improves with wearing a pressure device. Occasionally it needs to be aspirated with a needle.

1:100 people have bleeding into the wound within 24 hours of surgery. If this happens, you will be taken back to the operating theatre to have the blood vessel sealed again.

Less than 1:100 people have an infection in the wound and need tablet antibiotics

Clots in the legs (deep vein thrombosis) can rarely occur. Prevention starts in hospital with TED stocking, compression devices on the legs and injections of medication.

Other permanent side effects

Sometimes numbness in the skin is permanent

Rarely, the scar is unattractive and needs to be improved with another operation

Less than 1:10 people have Freye’s syndrome (sweating on the side of the face when eating). It is often minor and easy to tolerate. If it is more severe, it can be treated with injections into the area to stop the sweat glands working.

Could I need more surgery or treatment in the future?

If part of the gland is removed, the other part may develop disease and need to be removed.

What are the alternatives to surgery? Are they appropriate for me?

Malignant tumours must be treated. Treatment is usually recommended for benign tumours (pleomorphic adenoma) as there is a 10% chance of becoming malignant (cancer) over time.

Stones and inflamed glands can often be managed with non-surgical treatments and surgery is only considered if these treatments fail.

What if I choose not to have surgery?

For mild disease, it may be ok not to have surgery. For tumours, there will be long term consequences of not having treatment.

See should I have surgery for more information.

How should I prepare for surgery?

Stop using any supplements and medications that increase bleeding (like Nurofen) one week before surgery and follow the fasting instructions provided by the hospital. Stop smoking for as long as possible before surgery.

See preparing for surgery for more information.

When will I come into hospital? How long will the operation take? How long will I stay in hospital?

You will come into hospital on the day of surgery.  The operation takes 1-4 hours depending on the size and shape of the gland.

You will have a small plastic tube called a drain tube inserted in the skin during surgery. This is removed by the nurse on the ward 1-2 days after surgery.

How long will I need off work/school/sport?

Don’t drive, operate dangerous machinery or make major decisions for at least 24 hours after an anaesthetic.

Take two weeks off work, sport and study.

Will I be awake or asleep for the operation? What kind of anaesthetic will I have?

Children and adults always have a general anaesthetic for this procedure.

For more information see anaesthesia.

How will I feel after surgery?

You will have mild pain in the wound. Most people need paracetamol only a few times in the first day after surgery and occasionally a stronger pain reliever. There are dissolvable stitches in the wound in the neck with a white steristrip dressing across the wound.

You will be eating, drinking and walking around normally within 4 hours of the procedure.

1:30 people feel sick or vomit after surgery.

What do I need to do to recover well?

Keep the wound dry and the dressing intact for a week. Don’t rub or apply heat packs. Eat as well as possible to aid healing. Avoid smoking.

When will I see the surgeon?

The surgeon will check on you in the recovery room, on the ward the next day and every day you are in hospital.

The surgeon will see you again in the office one week and six weeks after surgery.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non emergency advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

Your surgeon will take into consideration your work, sports/hobbies, support at home and other health problems as well as past reactions or complications with anaesthesia and surgery.

Your surgeon will answer any specific questions you ask.

After parotidectomy

How long will I need off work/school/sport?

You need 24 hours off driving after a general anaesthetic. You shouldn’t drive on any day when you have taken strong pain relievers. Take two weeks off work, sport and study to recover.

What do I need to do to recover well?

The better you eat, the better you heal, especially fruit and vegetables.  Keep the wound dry and the dressing intact until you see the surgeon in one week. Avoid vigorous activity (running, gym, competitive sports) and aim for some exercise like walking on most days.

What is normal? How will I feel after surgery?

The wound will be mildly painful. You may feel fatigued for a few weeks. There will be numbness around the wound and the ear.

What is not normal?

Contact your surgeon or attend your nearest emergency department if you have:

  • weakness in the facial muscles or asymmetry in the face.
  • increasing swelling under the wound.
  • vomiting lasting more than a few hours.
  • severe pain not controlled by the prescribed pain medication.
  • fever >38 degrees for more than 24 hours.
When will I see the surgeon?

The surgeon will see you in the recovery room, on the ward every day you are in hospital, in the office one week after surgery and six weeks after surgery. You will be given an appointment card today.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non emergency advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

The gland is sent to pathology for analysis. Your surgeon will discuss the results with you one week after surgery.

Explaining parotidectomy