Salivary Gland Surgery

ENT microsurgical procedures performed for tumors, stones, or chronic infections of the salivary glands, with careful preservation of the facial nerve.

Indication

• Benign or malignant tumors detected in the parotid (in front of the ear) gland (e.g., pleomorphic adenoma)
• Recurrent stones and infection in the submandibular (under the jaw) salivary gland
• Chronic sialadenitis (salivary gland inflammation) unresponsive to antibiotic therapy
• Salivary gland masses larger than 3 cm, rapidly growing, or compressing the facial nerve
• Suspicious or malignant cells detected on fine needle biopsy
• Chronic gland enlargement and flares developing on the basis of Sjögren's syndrome

Preparation

• Ultrasound, MRI, or CT is used to map the location of the mass and its relationship to the facial nerve
• Fine needle aspiration biopsy is generally performed
• Anesthesia evaluation, complete blood count, and ECG when needed are requested
• Aspirin and blood thinners are discontinued with physician approval
• Fasting from food and fluids is required for 6-8 hours before the procedure

How it's performed

1. General anesthesia is administered; the patient lies supine with the head turned slightly to the side
2. In parotid surgery, an aesthetic incision extending from in front of the ear to the neck is made; in submandibular surgery, an incision under the jaw is preferred
3. The facial nerve is identified first; it is continuously monitored using a special nerve stimulator (neuromonitor)
4. The mass or diseased gland tissue is meticulously removed while preserving the nerve branches
5. The removed specimen is sent for pathological examination; frozen (intraoperative) section is performed when needed
6. The neck area is closed with a thin drain; the skin is sutured with aesthetic suture technique

Post-procedure

• Generally 1-2 days of hospital observation; the drain is removed when output decreases
• Soft food and hygiene attention is required for the first 1-2 weeks
• Skin sutures are removed within 5-7 days; the scar fades over time
• Additional treatment (such as radiotherapy) may be needed depending on the pathology result
• Temporary weakness in facial expression muscles usually begins to recover within 4-12 weeks
• Follow-up every 3-4 months in the first year, then annually is recommended

Risks

• Temporary weakness in facial expression muscles (most common complication, usually reversible)
• Permanent facial nerve insufficiency in a small number of patients
• Saliva collection (sialocele) or salivary fistula
• Wound infection, bleeding, and hematoma
• Temporary numbness around the ear; rarely Frey's syndrome (facial sweating/redness while eating)
• Rare temporary involvement of tongue movement and sensory nerves in submandibular surgery

FAQ

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