Parotidectomy is a surgery to remove the parotid gland. The most common reasons for removing all or part of the parotid gland are from a tumour, infection or obstruction of the saliva flow, causing swelling to the gland. Parotid glands can become injured during facial trauma, sometimes requiring repair to the gland or the facial nerve, which runs through it. Sometimes the parotid gland needs to be removed to gain access to a deeper structure or deep tumour within the head. Most procedures are performed with minimal risk and a good chance of curing the infection or tumour
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Parotid glands make saliva, which enters your mouth through a tube. The other salivia glands, the submandlbuiar and sublingual glands, lie under and around your jaw. The salivary glands produce saliva to moisten the mouth, to help protect teeth from decay and to digest food. The parotid gland is the largest of your salivary glands. Parotid glands can become infected, swollen and can even develop tumours within the gland. When tumours develop, they are mostly benign but occasionally can be cancerous. The parotid is the most common gland for salivary tumours to grow.
The parotid gland is found overlying the mandibular ramus and inferior to the ear. The glad is in the parotid fascial space, which is an area between the jaw and the ear. The parotid gland looks like a three-sided pyramind. The apex of the pyramid is directed downwards. The parotid gland consists of four sufraces, the suprerior, the supericial, the antermodeial and the posteromedial. When an infection or turmor occurs within the parotid gland, the patient will often have a swollen bump between his jaw and ear.
Parotid infections cause fever, headache, muscle aches, joint pain and both sides of the face swell in front of the ears. With parotid tumours a lump sometimes grows in the roof of the mouth, the cheek, on the tongue or under the chin. It often glows slowly and is painful. Dry mouth, tooth decay, mouth sores, enlarged salivary glands, sialoliths and recurrent salivary gland infections are other possible symptoms of tumours. A painful lump in the cheek or under the chin and foul-tasting pus drains into the mouth are common symptoms of an infection in the parotid gland.
The three types of parotid surgery are classic superficial parotidectomy, total parotidectomy and extracapsular dissection. The classic superficial parotidectomy removes the outer portion of the parotid gland. This surgery is performed by lifting up the skin of the face, then finding the facial nerve and removing the outer portion of the parotid gland containing the tumour. This operation may be also used for recurrent parotid infections. Most tumours are located in the superficial lobe, so this surgery is an excellent oncological operation, with a high cure rate. The total parotidectomy is an operation similar to the superficial parotidectomy but is more commonly used when the tumour or infection is in the deep portion of the gland. There may be a tumour under the facial nerve, requiring that the facial nerve also be removed. With this surgery, there is a higher risk of having weakened facial movement, which is regained after a few months. Extracapsular dissection is a minimally invasive surgery for removing parotid tumours. This technique removes the tumour by dissection along the tumour itself. There are patient requirements that must be met before this operation can be performed. They include, mobility in two planes, no prior history of parotid surgery and no facial nerve weakness. The outer lobe of the parotid gland is usually not removed. The facial sensory nerves are moved during the procedure and not cut or dissected.
Risks and Complications
As with all surgery, parotid surgery does not come without risks and complications. Complication of parotid surgeries include the general risks associated with anaesthesia, post-operative bleeding and excessive bleeding, facial nerve weakness, numbness of the face and ear, facial indentation, possible recurrence of a tumour and Frey's Syndrome. Frey's Syndrome is redness and sweating on the cheek area adjacent to the ear. If a patient meets requirements and chooses to use extracapsular dissection, this surgery leaves a minimal scar, hidden in natural skin creases. Short-term complications include bleeding and infection. Very rarely, a salivary fistula can occur, where saliva drains from a small opening in the incision. Many patients experience numbness of the ear lobe and outer edge of the ear after parotid surgery. The risks and complications are minimal compared to the risk of not having the tumour of infection taken care of.
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