Salivary Gland Surgery

The three major sets of salivary glands are the parotid, submandibular and sublingual glands. There are 750-1000 minor salivary glands located from the lips down to the trachea.

Bilateral salivary gland enlargement may be caused by viral diseases (such as mumps and human immunodeficiency virus), autoimmune diseases (such as Sjogren’s disease) or other systemic diseases (such as diabetes).

A painful enlargement of one of the major glands is often due to a bacterial infection usually following a period of dehydration. Treatment for this requires antibiotics, hydration and stimulation of salivary flow with sialagogues such as lemon drops. Salivary duct stones can also obstruct the outflow of saliva and cause a painful enlargement of the gland and secondary bacterial infection. This most commonly affects the submandibular gland. Treatment for this is stone removal.

Masses in the salivary gland need to be evaluated. Typically a fine needle aspiration is performed to determine if a malignancy is present. Often an imaging study (such as a CT scan or MRI scan) is obtained as well. Use of these two tests is helpful in diagnosing 95% of cases. Most masses of the parotid gland are benign. However, even these benign masses will continue to grow and some can transform into a malignant mass. Therefore, earlier excision is recommended to confirm the diagnosis and ensure an adequate margin of excision to prevent recurrence. Parotidectomy must be performed carefully to avoid injury to the facial nerve, the major nerve that moves the face. The facial nerve runs right through the parotid gland.

Half of the masses of the submandibular gland are malignant while the majority of masses of the sublingual and minor salivary glands are malignant. The main risks during excision of a submanidbular gland are to the lingual nerve (the nerve that provides taste sensation in the tongue) and hypoglossal nerve (the nerve that moves the tongue).

What to expect after a parotidectomy:

  • Most patients go home within 2 days of surgery.
  • A drain tube is placed under the wound to prevent fluid accumulation under the skin. This is usually removed 1-2 days after surgery is complete.
  • Numbness of the ear and surrounding skin is common. Extra care must be taken when removing clothes over the head or shaving. This generally resolves slowly over time.
  • Other possible short term complications include bleeding and infection
  • Over time, some patients will experience sweating at the site of the parotidectomy while eating (“Frey’s syndrome” or gustatory sweating). Usually this is not bothersome, but symptomatic cases can be treated with medications or occasionally surgery.
  • Very rarely, a salivary fistula may occur (where saliva drains out through the skin at the incision site).

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