Parotidectomy in Singapore

What Is a Parotidectomy?

The two parotid glands sit in front of and below each ear. They are the largest major salivary glands and produce saliva for chewing, swallowing and digestion. A parotidectomy is a surgical procedure to remove all or part of a parotid gland, usually to treat a tumour. 

The facial nerve passes through each gland and divides into branches to control facial expression. Identifying and preserving the facial nerve is central to parotid gland surgery. Superficial parotidectomy and total parotidectomy require clear identification of the facial nerve, while partial superficial parotidectomy often attempts to limit the amount of normal parotid tissue removed.

The type of parotidectomy surgery depends on the position, size and likely diagnosis of the parotid gland lesion:

• Partial superficial parotidectomy: Removes a selected small, benign tumour and a rim of normal parotid tissue from part of the superficial lobe.
• Superficial parotidectomy: Removes most or all of the superficial lobe, which lies over the facial nerve.
• Total parotidectomy: Removes the superficial and deep lobes of the entire parotid gland. The facial nerve branches are preserved when disease does not involve them.
• Radical parotidectomy: Removes the entire parotid gland and an involved part of the facial nerve when cancer has grown into it. Nerve repair may be planned.

Extracapsular dissection removes selected small, mobile benign lesions near the surface with a cuff of tissue, without exposing the full facial nerve trunk, making for the most minimally invasive form of parotidectomy. However, it is not suitable for every tumour.

Why Is a Parotidectomy Done and Who May Need It?

Parotidectomy surgery is mainly performed to remove benign or malignant parotid tumours, and less often to manage severe recurrent inflammation or obstructive disease.

About 75% to 80% of parotid tumours are benign, meaning non-cancerous. These benign parotid tumours include pleomorphic adenoma, the most common benign tumour, and Warthin tumour.

Roughly 20% to 25% are malignant tumours. Mucoepidermoid carcinoma is among the most common cancers of the parotid gland. Skin cancer from the scalp, face or ear can also spread to lymph nodes within the parotid gland. Parotid surgery depends on the cancer type, grade, size, deep lobe involvement and spread to the facial nerve or lymph nodes in the neck.

Most solid parotid gland tumours cannot be reliably treated with medicine. Imaging and needle biopsy help guide the decision, but the final diagnosis sometimes becomes clear only after a laboratory examines the removed tissue.

Parotidectomy may also be considered for chronic parotitis, recurrent sialadenitis, or salivary stones causing repeated pain, swelling, or infection. Alternatives to parotidectomy include hydration, massage, antibiotics for bacterial infection, stone removal and sialendoscopy. Parotid surgery becomes an option when symptoms recur, and if gland-preserving care is unsuitable or has failed.

When to See an ENT Specialist

See an ENT specialist for a persistent or enlarging lump in front of your ear, below the earlobe, or along the jaw.

Many benign parotid tumours are painless and slow-growing, so even a painless lump needs assessment. Seek an earlier review if it grows quickly or occurs with:

• Facial weakness, an uneven smile or difficulty closing one eye
• Pain, numbness or altered feeling in the face
• Difficulty opening the mouth, chewing or swallowing
• A hard or fixed mass
• Enlarged nearby lymph nodes
• Skin changes over the lump

Importantly, swelling that worsens around meals can suggest a blocked salivary duct. Redness, fever, pus in the mouth, or increasing tenderness may indicate infection. Sudden facial paralysis, rapidly increasing swelling or breathing difficulty requires urgent care and should be dealt with immediately.

How to Prepare for a Parotidectomy

Preparation for a parotidectomy confirms the diagnosis, maps the parotid tumour in relation to facial nerve anatomy, and checks that you are fit for general anaesthesia.

The ENT specialist examines the lump, facial movement, mouth, neck nodes and nearby skin. Ultrasound imaging may show whether a mass is solid or cystic. Magnetic resonance imaging can map deep lobe tumours, while a CT scan may assess a larger disease or possible spread. Fine-needle aspiration or core biopsy collects cells or tissue, although results are not conclusive in every case.

Before your surgery:

• Provide a list of medicines, vitamins and supplements before parotid surgery. Blood thinners may need adjustment, but stop them only on medical advice.
• Report allergies, previous anaesthetic problems and conditions affecting healing.
• Stop smoking and vaping as early as possible because they can increase breathing and wound-healing problems.
• Adhere to the hospital’s fasting instructions for food and fluids.
• Arrange transport home and help during the first day or two after discharge.

The surgeon will explain the incision, extent of parotid surgery, facial nerve monitoring and risk, possible neck dissection and reconstruction. Selected patients may leave the hospital the same day. An overnight or longer admission may follow total surgery, cancer surgery, or reconstruction.

What Happens During a Parotidectomy?

Parotidectomy is performed under general anaesthesia and commonly takes about two to four hours, although complex tumour removals may take longer.

The main parotidectomy steps are:

1. Making the incision. A standard parotidectomy incision may use a modified Blair incision. It begins in front of the ear, curves around the earlobe and enters an upper-neck crease. A modified facelift incision continues behind the ear towards the occipital hairline. Both are external incisions that place part of the scar in natural creases.
2. Reaching the gland. Raise skin flaps to expose the parotid fascia. The greater auricular nerve and external jugular vein cross the sternocleidomastoid muscle. The posterior belly of the digastric muscle and external auditory canal are landmarks for facial nerve anatomy. The posterior branch of the greater auricular nerve may be preserved, but ear numbness can still occur.
3. Identifying the facial nerve. The main trunk and branches of the facial nerve are located. Electromyographic facial nerve monitoring may help locate and test the facial nerve branches, but cannot prevent every facial nerve paralysis or injury.
4. Removing the tumour. During superficial or total parotidectomy, the parotid gland tumour is separated from the nerve and the planned parotid tissue is removed. A benign mass is removed intact with an appropriate margin. Deep lobe parotid surgery or total parotidectomy requires working around the nerve branches.
5. Managing cancer. If a malignant tumour has invaded the facial nerve, the affected segment may need removal. A nerve graft may be considered. Nearby nodes may be sampled, or a selective neck dissection may remove at-risk groups.
6. Closing the wound. All tissue goes for laboratory examination. The skin flaps are repositioned. A small drain removes blood and fluid before closure.

What to Expect After Surgery and the Recovery Timeline

In a typical parotidectomy recovery timeline, most patients resume daily activities within one to two weeks. Swelling and ear numbness may take longer to settle. When the facial nerve remains intact, temporary facial weakness often improves over months and may take 6 to 12 months to resolve. A neck dissection or reconstruction can lengthen recovery. 

• Staff will monitor your breathing, bleeding, pain and facial nerve function. You may be asked to smile, raise your eyebrows and close your eyes to assess your facial nerves.
• Pain, swelling, bruising, jaw tightness, a sore throat, numbness or mild earache after parotidectomy are common at first. Oral medication usually controls the pain.
• The parotidectomy drain is removed when output is low, often after one or two days.
• Follow instructions for dressings, washing and drain care. Do not pick at the adhesive or soak the wound. Eating usually restarts after anaesthesia wears off. Soft foods may help until your chewing improves.
• Walking is encouraged. Many patients return to desk work or school within two weeks.
• Avoid heavy lifting, vigorous exercise and pressure on the area for about two weeks or until cleared.
• Drive only when neck movement is comfortable, and medicine does not impair alertness.

Follow-ups check the wound, facial movement and pathology, and whether the remaining salivary glands produce enough saliva for comfortable eating. If cancer is found, head and neck cancer care may include staging, radiotherapy or other treatment. Tumours can recur, particularly after incomplete or disrupted pleomorphic adenoma removal, so long-term surveillance or revision surgery may be advised.

For many benign tumours, complete removal may be the only treatment needed. Cancer outcomes depend on the tumour type, stage, margins and spread, and surgery may be one part of care.

Risks and Possible Complications

Parotid surgery risk varies with the tumour size, deep lobe location, cancer, repeat surgery and the amount of nerve dissection. Parotidectomy complications include:

• Facial weakness: Temporary facial nerve injury from stretching or manipulation can weaken one or more facial nerve branches. Permanent facial paralysis is much less common unless the cancer invades the facial nerve.
• Ear numbness: The greater auricular nerve may be stretched or divided. Feeling around the earlobe often improves over months but may not return fully.
• Bleeding or fluid collection: Some reports describe a haematoma in a relatively small number of cases, and it may need urgent drainage. A seroma contains clear fluid.
• Sialocele or salivary fistula: Saliva may collect under the skin or leak through the wound. Most cases settle without further surgery.
• Frey syndrome: Aberrant innervation can cause cheek warmth, flushing or sweating during meals.
• First bite syndrome: Sharp pain with the first bite may occur after deep lobe surgery and often eases as eating continues.
• Other risks: Infection, a visible or thickened scar, a hollow facial contour, skin flap problems and complications of general anaesthesia may occur.

Seek urgent help for rapidly increasing swelling, bleeding, difficulty breathing, inability to close an eye or sudden worsening facial weakness. Contact a medical professional for a fever of 38°C or higher, increasing redness, pus, foul-smelling discharge, persistent vomiting, worsening pain, or a wound that opens.

How Barrie Tan ENT Can Help

Barrie Tan ENT Head & Neck Surgery at Gleneagles Hospital in Singapore can assess a parotid lump, arrange the necessary tests and explain whether monitoring, gland-preserving care or parotidectomy is appropriate.

If you have a persistent lump near the ear or jaw, repeated painful parotid swelling or a parotid tumour diagnosis, contact Barrie Tan ENT Head & Neck Surgery to arrange a consultation and discuss the next appropriate step.

FAQs

How serious is a parotid tumour?

Most parotid tumours are benign, but about 20% to 25% are malignant. A painless or slow-growing lump may still need assessment because symptoms alone cannot confirm the tumour type. 

What are the side effects of a parotidectomy?

Common early effects include pain, swelling, bruising, jaw tightness and numbness around the ear. Temporary facial weakness can occur. Less common complications include permanent facial weakness, bleeding, infection, salivary leakage, Frey syndrome, first bite syndrome, scarring and a change in facial contour.

How long does it take to recover from a parotidectomy?

Many patients return to desk work and basic routines within one to two weeks. Swelling and chewing discomfort often improve over several weeks. Ear numbness or temporary facial weakness may take several months to recover. Timing depends on the operation, diagnosis, nerve involvement and whether neck dissection or reconstruction was performed.

Will I have a scar after a parotidectomy?

Yes. The parotidectomy incision usually begins in front of the ear and continues around the earlobe into a natural neck crease. A modified facelift incision may extend behind the ear and towards the hairline. The parotidectomy scar is visible at first and commonly fades over time, although its final appearance varies with healing, skin type and the extent of surgery.