PAROTIDECTOMY:

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A large pleomorphic adenoma seen on the MRI scan. The tumor has been cut open on the surgical specimen below. The white arrows on the surgical specimen point to the tumour. A superficial parotidectomy was done.

The parotid gland is arbitrarily divided into two lobes.  The superficial lobe, which is superficial to the facial nerve, that runs through the gland and the deep lobe which is deep to the nerve. As most parotid tumours originate in the superficial lobe surgery involves removal of the superficial lobe of the parotid gland along with the tumour. This is called SUPERFICIAL PAROTIDECTOMY. When the deep lobe is involved the entire parotid gland must be removed and the surgery is called TOTAL PAROTIDECTOMY. The surgery is carried out under general anesthesia. An incision extending from the front of the ear to just behind the ear and upper neck is required. The incision usually heals very well and the scar is barely perceptible after a few months. One of the sensory nerves (greater auricular nerve) has to be divided during the surgery and this result in temporary or often permanent numbness over the scar. Another nerve that may be occasionally inadvertently traumatized is the facial nerve that supplies that part of the face. This nerve runs within the gland and injury to the nerve may result in partial paralysis of that part of the face. The operation may take two to two and half hours. A small tube is usually left inside the wound for 2-3 days. As the incision is closed and is almost watertight any oozing within the wound may accumulate and cause the blood to collect in the wound. This is called a hemotoma. The tube that is inserted drains the blood preventing hemotoma formation. Some pain and nausea is common after the operation. Appropriate medications are given postoperatively to counter this. Antibiotics are given to avoid infection. The patient may be required to stay in the hospital for 2-3 days after the operation. Once the drainage from the drain is minimal it can be removed and the patient can be discharged. Post- operative instructions are given on discharge. The stitches are removed in about a week by when the wound union has taken place. Complications of parotidectomy in addition to explained above include infection, hemotoma, bleeding, damage to the parotid duct with resultant salivary fistula, and excessive sensitivity over the cheek especially during meals ( Frey’s syndrome).