parotidectomy

Parotidectomy is a surgical procedure to remove part or all of the parotid gland, the major salivary gland located anterior to the ear and extending into the cheek. The procedure prioritizes removal of diseased tissue while preserving the facial nerve, which traverses the gland and controls facial expression.

Indications include benign tumors such as pleomorphic adenoma and Warthin tumor, malignant tumors such as mucoepidermoid carcinoma or adenoid cystic carcinoma, chronic sialadenitis, and sialolithiasis with recurrent infection. The operation is typically performed as superficial parotidectomy, removing the superficial lobe, or total parotidectomy, removing both lobes. When feasible, the facial nerve and its branches are identified and preserved; if tumor involvement necessitates, nerve sacrifice with reconstruction or adjuvant therapy may be required.

Preoperative assessment uses imaging (ultrasound, CT, or MRI) and often fine-needle aspiration biopsy to characterize the lesion. Facial nerve monitoring is commonly employed to aid nerve preservation.

Surgical technique generally involves an incision in the preauricular region, sometimes a modified Blair incision, to expose the gland. The facial nerve trunk is identified near the stylomastoid foramen and followed to preserve the branches. The appropriate lobe or gland is dissected with adequate margins, while hemostasis is achieved and drainage may be placed to reduce collections.

Complications can include temporary or permanent facial weakness, numbness of the ear or cheek, Frey syndrome (gustatory sweating), salivary fistula, hematoma, and infection. Recurrence is a consideration for benign tumors, with superficial parotidectomy offering favorable outcomes when tumors are well localized. For malignant tumors, wider margins and adjuvant radiotherapy may be indicated.