A parotid gland tumour is an abnormal growth in the largest salivary gland, which sits just in front of the ear and extends into the cheek. These glands help produce saliva, but they can also develop lumps or masses that range from harmless growths to cancer. Most parotid tumours are benign, but roughly 20% are malignant, so any persistent lump in this area warrants proper assessment by a medical specialist.Â
Parotid gland tumours are uncommon overall, but they make up the majority of salivary gland tumours. To explain it simply, there is the ‘Rule of 80s’: around 80% of salivary gland tumours arise in the parotid gland; about 80% of these parotid tumours are benign; and about 80% of benign parotid tumours are pleomorphic adenomas. Parotid gland tumour causes vary, but they include radiation exposure (especially to the head/neck), smoking, older age, and certain occupational exposures like silica dust.
Among malignant salivary gland tumours, mucoepidermoid carcinoma is the most common. Some cancers found in the parotid gland are actually skin cancers that have spread into lymph nodes within the gland.Â
Regardless of the type of tumour, it is worth examination and treatment, if necessary.
The salivary glands include three major salivary glands, the parotid gland, the submandibular gland, and the sublingual salivary gland, as well as hundreds of minor salivary glands scattered throughout the lining of the mouth and throat. Salivary gland tumours can arise in any of these locations and are classified as follows:
Minor salivary gland tumours, submandibular gland tumours, and sublingual gland tumours have distinct risk profiles: for example, a tumour in the submandibular gland or a minor salivary gland tumour has a higher likelihood of malignancy than one in the parotid gland.
Adenoid cystic carcinoma and acinic cell carcinoma are salivary gland cancers more often seen in minor salivary glands and the submandibular gland.
Parotid gland tumours, by contrast, are predominantly benign, though malignant parotid tumours do occur and include mucoepidermoid carcinoma, acinic cell carcinoma and carcinoma ex pleomorphic adenoma.
These distinctions matter because parotid gland tumour types cover a wide spectrum. Some lesions grow slowly over the years and remain noncancerous. Others are more aggressive and may affect nearby structures, especially the facial nerve, which runs through the parotid gland. This is one major reason not to ignore a parotid lump near the ear, even when it is painless.
Salivary gland malignancies vary by site of origin. This is why a head and neck surgeon experienced in salivary gland disorders is best positioned to guide evaluation and treatment for salivary gland malignancies.
The most common symptom of a parotid gland tumour is a slow-growing lump near the ear, cheek, or angle of the jaw. Many patients first notice a fullness on one side of the face, or an asymmetry that seems subtle at first and becomes clearer over time. Some are discovered incidentally on scans performed for unrelated reasons. Because benign parotid tumours often cause painless swelling, they can be present for months or even years before a patient seeks attention.
Parotid gland tumour symptoms become more concerning when the lump is painful or when the surrounding tissues are affected. Trouble swallowing, difficulty opening the mouth widely, numbness in part of the face, facial muscle weakness and facial pain are among the more concerning symptoms.Â
A particularly important sign is facial weakness on the same side as the parotid gland tumour. Malignant tumours can invade the facial nerve, leading to facial weakness or even facial paralysis. Rapid growth, skin tethering or ulceration, neck lymph nodes and facial nerve palsy are all features that raise concern for malignancy.
You should see an ENT specialist or neck surgeon if you notice a persistent parotid gland tumour or lump near the ear or jaw, especially if it is enlarging or associated with pain, numbness or facial weakness. Many benign parotid tumours behave quietly, but patients cannot reliably tell a benign parotid tumour from a malignant one by feeling alone. A parotid gland tumour specialist assesses the parotid gland tumour itself and the facial nerve, nearby lymph nodes, the skin of the head and neck, and the mouth and throat for any related abnormalities.
You should seek earlier review if the parotid gland tumour grows quickly, becomes painful, causes difficulty swallowing, limits how wide you can open your mouth, or changes facial movement. These features do not automatically mean parotid gland cancer, but they do make assessment by parotid gland tumour specialists more urgent.Â
As some parotid cancers are metastatic cancer that spreads from skin cancers of the scalp, temple, face or ear, an ENT review may also carefully inspect the surrounding skin. Early diagnosis gives parotid gland tumour treatment the best chance of a successful outcome.
Diagnosis of a parotid gland tumour usually involves examination, imaging and needle biopsy. The consultation starts with a focused head and neck examination. The size, firmness, and mobility of the parotid gland tumour matter, but so does the facial nerve examination. There are various conditions that can mimic parotid gland tumours, such as inflammatory or obstructive salivary gland disorders.
Non-surgical treatment of parotid gland tumours has a limited but important role, especially when the tumour is malignant or parotid surgery is not immediately appropriate.Â
For most benign parotid tumours, definitive treatment involves surgical removal because the parotid lump may continue to enlarge and, in rare cases, some long-standing pleomorphic adenomas can undergo malignant transformation. Benign pleomorphic adenomas carry a low but real risk of malignancy and of recurrence if incompletely removed.
When the parotid gland tumour is malignant, non-surgical treatment may complement or occasionally substitute for parotid surgery. Radiation therapy may be recommended after surgery to reduce the risk of remaining cancer cells, or it may sometimes be used if surgery is not possible. Chemotherapy and targeted therapy are generally reserved for selected advanced cases of parotid gland cancer rather than routine first-line parotid gland tumour treatment.Â
In practical terms, non-surgical care is usually part of a broader parotid cancer plan rather than a replacement for surgery in most operable parotid gland tumours.
A parotidectomy is the main operation used by parotid gland tumour surgeons, whether the tumour is benign or malignant.Â
The exact type of surgery depends on the size, site and suspected nature of the tumour. Removal of the superficial lobe is performed for many parotid tumours, while a total parotidectomy is used for larger tumours, cancers and tumours affecting the deep lobe.
The parotid gland wraps around the facial nerve, which controls movement of the forehead, eye, nose and mouth. Parotid surgery is therefore not just about removing a parotid gland tumour; it is about removing it completely while preserving facial nerve function whenever it is safe and oncologically sound to do so. Surgeons may use electrical nerve monitoring during surgery to reduce the risk of a facial nerve injury.
For benign parotid tumours, the aim of surgery is a complete surgical resection with an appropriate margin while avoiding tumour spillage, which can raise the risk of recurrence, particularly with a pleomorphic adenoma.Â
For malignant parotid gland tumours, the operation can be more extensive. A neck dissection of nearby lymph nodes, bone, muscle or other head and neck structures may be required if the parotid gland cancer has spread, and nerve repair or reconstructive procedures may sometimes be needed if the facial nerve is involved. Prompt surgical intervention by experienced parotid gland tumour surgeons, such as Dr Barrie Tan, offers the best chance of clear margins.
Patients often worry that removing one parotid gland will leave them with a persistently dry mouth. In most cases, that does not happen because the remaining salivary glands, including the submandibular, sublingual and minor salivary glands, usually compensate.
Most patients recover well after a parotidectomy, but temporary facial weakness, numbness and wound-related issues are potential short-term complications. The incision is usually placed in a natural skin crease, around the ear, or into the hairline to reduce scar visibility. Uncomplicated parotid surgery is often performed as day surgery, while a drain may be placed and removed the next day to prevent blood or fluid from building up.
The risk patients usually fear most with parotid gland tumour surgery is facial nerve injury. Temporary facial weakness can occur because the facial nerve is stretched or manipulated during the surgery, but a permanent facial paralysis is uncommon in experienced hands. Other recognised complications of surgery include bleeding, infection, seroma, salivary fistula, Frey syndrome, numbness around the ear, and scarring.Â
If the parotid gland tumour has invaded the facial nerve, part of the facial nerve may need to be removed to clear the disease, and repair or reanimation procedures may be considered.
Recovery following surgical intervention generally takes about one to two weeks for initial wound healing, though the exact parotid gland tumour surgery recovery timeline depends on how extensive the surgery was and whether further treatment is required.Â
If the final result shows a parotid gland cancer with higher-risk features, postoperative radiation therapy may be discussed.
If you have a persistent swelling near the ear or jaw, facial weakness, pain, numbness, or a concern about a salivary gland tumour, a careful ENT specialist assessment can clarify whether it is a benign or malignant parotid tumour, or another condition entirely.
At Barrie Tan ENT Head & Neck Surgery, patients receive a structured evaluation with close attention to diagnosis, facial nerve function, surgical planning, and recovery from a parotid gland tumour surgery. If you are looking for ENT specialists or need a second opinion on parotid gland tumour treatment, contact Barrie Tan ENT Head & Neck Surgery to arrange a consultation and discuss the most appropriate next step for you.
MBBS, MRCS (Edinburgh), MMed (Otorhinolaryngology), FAMS
Dr Barrie Tan is an ENT specialist at Gleneagles Hospital, Singapore, with more than 20 years of clinical and surgical experience. He previously served as Head of ENT and Director of the Centre for Hearing and Ear Implants at Singapore General Hospital. The information provided is not intended as medical advice. More about our medical experts.
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