Indications

Parotidectomy is indicated for:

• Benign tumors (e.g., pleomorphic adenoma, Warthin’s tumor).
• Malignant tumors (e.g., mucoepidermoid carcinoma, adenoid cystic carcinoma).
• Chronic sialadenitis (inflammation of the salivary gland).
• Salivary gland stones (sialolithiasis) causing obstruction and infection.
• Parotid gland abscesses.

Types of Parotidectomy

1. Superficial Parotidectomy
   • Procedure: Removal of the superficial lobe of the parotid gland, typically performed for benign tumors.
   • Indications: Benign tumors confined to the superficial lobe.
2. Total Parotidectomy
   • Procedure: Removal of the entire parotid gland, including both superficial and deep lobes.
   • Indications: Malignant tumors or extensive benign tumors.
3. Radical Parotidectomy
   • Procedure: Removal of the entire parotid gland along with surrounding tissues, including facial nerve if involved by the tumor.
   • Indications: Aggressive or advanced malignant tumors.

Procedure Steps for Parotidectomy

1. Preoperative Preparation
   • Evaluation: Comprehensive medical evaluation, imaging studies (CT scan, MRI, or ultrasound), and fine-needle aspiration biopsy to assess the nature of the tumor.
   • Anesthesia Discussion: General anesthesia is typically used.
   • Instructions: Fasting before the procedure and medication adjustments.
2. Anesthesia
   • General anesthesia to ensure patient comfort and immobility during the surgery.
3. Surgical Procedure
   • Incision: A preauricular incision (in front of the ear) extending down to the neck, sometimes in a facelift incision pattern to minimize visible scarring.
   • Dissection: Careful dissection to identify and preserve the facial nerve, which runs through the parotid gland.
   • Gland Removal: Removal of the affected portion or entire parotid gland.
   • Hemostasis: Control of bleeding.
   • Closure: The incision is closed with sutures, and a drain may be placed to prevent fluid accumulation.
4. Postoperative Care
   • Pain Management: Pain relief medications as prescribed.
   • Wound Care: Keeping the surgical site clean and dry. Monitoring for signs of infection.
   • Drain Management: If a drain is placed, it is usually removed after a few days.
   • Activity Restrictions: Avoid strenuous activities and heavy lifting for a few weeks.
   • Follow-Up: Regular follow-up visits to monitor healing and address any complications.

Risks and Complications

• Facial Nerve Injury: Temporary or permanent weakness or paralysis of facial muscles due to nerve injury.
• Frey’s Syndrome: Sweating and flushing of the cheek during eating (gustatory sweating).
• Infection: Risk of infection at the surgical site.
• Hematoma: Collection of blood under the skin.
• Salivary Fistula: Abnormal connection forming between the salivary gland and skin.
• Scarring: Visible scars, although efforts are made to minimize them.

Recovery

• Initial Recovery: Patients may experience pain, swelling, and bruising around the surgical site. These symptoms usually improve within a few weeks.
• Long-Term Recovery: Full recovery may take several weeks to months. Regular follow-up is important to monitor healing, manage any complications, and ensure the absence of tumor recurrence.

Conclusion

Parotidectomy is a complex surgical procedure to remove part or all of the parotid gland, primarily performed to treat tumors and other disorders of the gland. The procedure requires careful surgical planning and technique to preserve the facial nerve and minimize complications. Proper preoperative evaluation, skilled surgery, and diligent postoperative care are essential for achieving the best outcomes. Regular follow-up is crucial to monitor healing, manage any complications, and detect any recurrence of disease.