parotidectomy
Meaning of parotidectomy: Removal of the large salivary gland in front of the ear, an operation planned around the facial nerve threaded through it.
Definition of parotidectomy
A parotidectomy is an operation to remove part or all of the parotid gland, the largest salivary gland, which lies in front of and just below the ear. It is done most often for a lump in the gland. The facial nerve passes directly through the gland on its way to the muscles of expression, so the surgery is built around finding and protecting that nerve.
Why does the facial nerve dominate the operation?
The nerve enters the gland from behind the ear and fans out into branches that lift the eyebrow, close the eye, move the cheek and lift the corner of the mouth. It divides the salivary gland into a superficial part and a deep part, a surgical convention rather than a true anatomical split, since the gland is one structure with a nerve running through it. The surgeon identifies the trunk of the nerve first and follows it outward, often using a monitor that sounds when an instrument comes close. Handling alone can leave temporary weakness, and a face that droops after surgery usually recovers over weeks to months.
What are the types?
| Operation | What is removed |
|---|---|
| Superficial parotidectomy | The gland tissue lying outside the plane of the nerve |
| Total parotidectomy | Superficial and deep parts, with the nerve preserved |
| Radical parotidectomy | The gland together with the facial nerve, when tumor has invaded it |
| Extracapsular dissection | A small benign lump with a narrow cuff of normal gland |
What follows the surgery?
Numbness of the earlobe is usual, because a sensory nerve crossing the field is often divided. A hollow appears where the gland was. Saliva can leak and collect under the skin or drain through the wound for a time. The most distinctive late effect is Frey syndrome: nerve fibers that once drove saliva production regrow into the sweat glands of the overlying skin, so the cheek flushes and sweats at the sight or taste of food. It appears months after the operation and varies from trivial to troublesome.
Why is the lump not simply shelled out?
The commonest tumor here is a pleomorphic adenoma, which is benign but has a thin, incomplete capsule with tiny projections. Enucleating it spills those projections into the wound bed and it returns in multiple nodules that are far harder to remove. Taking a cuff of normal gland avoids that. For parotid gland cancer, the extent is decided by the tumor and lymph nodes in the neck may be removed as well.
Used in a sentence
A superficial parotidectomy was performed with facial nerve monitoring for a pleomorphic adenoma.
Good to know
A radical parotidectomy means the facial nerve is removed along with the gland, not simply that the whole gland is taken; temporary facial weakness after the nerve is handled is common and usually recovers.
Word origin
Where “parotidectomy” comes from
Parotid joins the Greek para, meaning beside, with ot-, meaning ear, so the gland beside the ear; the ending -ectomy means cutting out.