The parotid is part of the gland systems that makes your mouth water. This system has many extra sources of watering for the mouth. You won’t miss the gland we remove. In fact, one can be without all four of the major glands and be unaware of the missing saliva. The parotid gland develops from inside the mouth and wraps itself around the back of the jaw bone and around the nerve which moves the face. This nerve, called the facial nerve, comes out of a hole in the skull underneath the ear as a trunk about 1/8” thick and splits into a network connecting to different parts of the face.

The most important and dramatic risk of the surgery is damage to the facial nerve. In addition to the twisted appearance that can occur, partial damage can create difficulty closing the eye or produce an abnormal smile. If the eye cannot blink effectively, it becomes dry and blindness can occur. Fortunately, none of our patients who have the most common benign tumor has any permanent loss either to the eye or the smile.

One patient experienced temporary weakness of the eye.

Because danger to the nerve is greatest when the gland has previously been operated on, we approach the parotid the first time by removing it completely. We avoid returning to the area again. Simply removing the offending mass is considered to be unwise. The surgery technique first locates the nerve. We then use the nerve itself as the guide to removal of the appropriate portion of the gland.

We use a modification of the cosmetic face lift incision. We use the same techniques of opening and closing the wound as in a face lift. This surgery is done with you asleep and takes about three to four hours. We have never seen enough bleeding to require blood for such a procedure. Although we will arrange for you to stay in the hospital for two nights, if you feel up to it you may be allowed to go home sooner.

Parotid surgery is relatively painless. In the course of exposing the parotid, the nerve that comes from the back of the neck that provides feeling (not movement) to the cheek may be in the way. If we need to divide it, the wound becomes numb, making the surgery painless. The sensation returns over the next few months long after the wound has healed. Occasionally the ear lobe remains numb indefinitely.

At the end of the procedure, a drain is left behind the ear. This allows any small pieces of the gland which continue to salivate to drain out of the wound without lifting the flap. This temporary situation can go on for as long as a month or two. There are many salivary glands, so removal of all or a part of one produces no shortage of saliva.

Many years later, the peculiar phenomenon of mealtime sweating of the cheek can occur. This strange event is rarely bothersome. It occurs when the stumps of the nerves that control mouth watering heal connected to the sweat glands. There exist pastes and procedures which can control this phenomenon. I have never had a patient sufficiently bothered to have to do anything about this.

All in all, parotid surgery is more sloppy than painful.