Parotid gland surgery

Last modified on July 2nd, 2018

Parotid gland surgery

Parotid gland surgery is usually carried out for tumours – either malignant or benign. It is also sometimes carried out for stones forming within the duct.

The key issue with surgery of the parotid gland is the presence of the facial nerve (responsible for movement of the muscles of facial expression – smiling, raising eyebrows, closing the eye etc.) within the gland. About 80 % of the gland is above the nerve (superficial) , with the remaining deep portion below the nerve. Consequently most tumours are above the nerve.

It is vitally important that the nerve is preserved wherever possible during surgery. Conventionally the approach is to find the nerve and protect it, then lift the gland containing tumour carefully off the nerve.

Varieties of parotid gland surgery

A number of variations exist on parotid gland surgery including the following:

Extracapsular dissection

removal of a tumour within the gland with a thin small cuff of salivary tissue. The aim for this procedure is to remove the tumour completely but only minimal gland tissue. The approach of this technique is different in that the main branch of the nerve is not actively searched for. Instead dissection is performed in a careful manner carefully looking out for any incidental branches and protecting them.

This can be a quicker procedure but may have implications if the tumour turns out to be malignant. This technique is usually only recommended for benign tumours.

Superficial parotidectomy

Removal of the superficial part of the gland (approximately 80% of the gland) along with the tumour, after identifying and protecting the main trunk of the facial nerve and its subsequent small branches.

Partial superficial parotidectomy

This is a variation of the superficial parotidectomy but only the part of the gland containing the tumour is removed.

Total Parotidectomy

The superficial and deep aspects of the gland are removed. After identifying and protecting the facial nerve.

It is essential that the correct operation is performed for you and will depend on the result of investigations and clinical judgement. Our team are happy to offer second opinions if required.


Whilst there are differences between the types of operations broadly the risks are similar as outlined below. Your surgeons will discuss this specifically with you taking in to account a number of factors.


The surgery is carried out under General Anaesthetic and patients usually are admitted overnight for monitoring. Local anaesthetic is used during the operations and strong painkillers given. Normally patients only require mild analgesics on discharge.


Mild swelling is normal after surgery which typically resolves after 5-7 days.


This is classed as clean surgery. Sterile procedures are followed and antibacterial skin preparations used. Antibiotic prophylaxis will be used during and immediately afterwards. Specific advice will be given in the event of any problems encountered.


Rarely blood can collect under the skin where the gland was removed. This is a rare event and the chances are reduced by using small drains. Drains will be placed at the time of surgery, and secured to the skin with a small stitch. This can usually be removed the following day.


A Sialocele is a collection of saliva which can form at the site of the parotid surgery. This usually occurs a few days after surgery and is produced by residual salivary gland tissue. This is usually self limiting.

Salivary Fistula

This is a persistent leakage of saliva through the skin usually around wound. This is a rare occurrence and sometimes requires Botox injections in to any residual gland tissue.

Gustatory sweating / Freys syndrome

This is sweating of the skin overlying the parotid gland at meal times. It is thought to be caused by the nerve stimulus which would normally trigger saliva production instead stimulation sweat glands on the skin. This complication can be usually treated with directed Botox injections in to the skin.

Numbness to the Ear / Cheek

There is a superficial sensory nerve called the Great Auricular Nerve, which gives feeling to the skin around the ear lobe and cheek. This can normally be preserved but sometimes due to the position of the tumour it is not possible to save it. If this happens it doesn’t appear to cause much concern to patients.

Facial Nerve Injury

The facial nerve enters in to the parotid salivary gland from the skull. It then divides in to 2 main branches supplying the upper face and the lower face. These branches then further subdivide in to smaller branches which supply muscle of the face involved with facial expressions.

All efforts are made to save the facial nerve and its branches. This is achieved by careful technique and helped with facial nerve monitoring devices. The incidence of permanent facial weakness is around 1% but can be increased for example in re-do operations or malignancy.


The incision or cut normally used for parotid gland surgery is just in front of the ear and curls back behind the jaw before joining with a neck crease a few centimetres below the mandible. The scar that results is often very hard to spot because it heals inconspicuously.

Specifics of wound management including removal of the stitches will be explained to you by your consultant.