Information on removal of the parotid sinus / parotidectomy

Introduction

The purpose of this information is to provide you with generally applicable information about this type of operation. Of course, certain aspects of this document are not applicable in your individual case or should be discussed more or additionally with your surgeon. Remember to report to your surgeon all information regarding your general health, as well as any medications you regularly take (especially aspirin and related products, or other medications that may affect clotting).  Do not forget to report if you have experienced any allergic reactions, especially reactions to medication. Bring any recent medical records in your possession, such as blood results, radiologic and other preoperative exams.

The parotid gland (parotid gland) is located in front of and below the ear. There are 2 parotid glands, 2 under the jaw and 2 under the tongue. Together with numerous smaller salivary glands, they ensure saliva production. The parotid gland has a superficial and a deep lobe, between which runs the facial nerve (facial nerve). This ensures the mimicry of the face, the closing of lips and eyelids. When a tumor is found, it is best removed surgically. Most growths are benign.

Purpose of the procedure

When a tumor of the parotid gland needs to be removed, it is safe to do so after carefully locating the facial nerve to try to avoid facial paralysis.

The technical aspects of the operation

The operation is done under general anaesthetic. Through an incision, which runs in front of the ear and further into the neck, the parotid gland, the facial nerve and the tumor are searched for and the tumor is removed. Depending on the location and extent of the injury, the operation can take up to 4 hours. When you wake up, there is a drain at the bottom of the wound, through which excess wound fluid and saliva can drain. The drain is removed after 3 days, when no more fluid drains. By incising the skin and removing the tumor, the sensory nerve that supplies the earlobe and neck cannot be spared. After the operation, there is a numbness of the earlobe and the area of operation. The numb area gradually becomes smaller and smaller.

The immediate consequences

Swelling usually occurs in the wound area for several weeks. There may be bleeding from the wound. This usually happens shortly after the operation. Sometimes it is necessary to find the source of bleeding again under anesthesia and to burn the bleeding vessel shut. A crooked face may occur after surgery due to manipulation of the nerve during the procedure with (temporary) paralysis of the facial nerve. The paralysis usually recovers after some time (weeks to months).

The belated consequences

There may be a collection of saliva previously visible at the bottom of the wound, which may need to be punctured. Frey's syndrome can develop after a few months. Then there is redness and perspiration of the skin of the operating area during eating.

Serious and/or late complications

Any surgical procedure, even performed under ideal conditions and in the best possible way, can entail complications. Permanent facial nerve failure can occur but is extremely rare. Phlegmon or abscess formation in the neck area is rare. All of these risks must be weighed against complications that may arise if surgical treatment is not initiated.

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Purpose of the procedure

The aim of the surgery is to remove the overactive parathyroid gland(s) and thus normalize the calcium level in the blood.

The technical aspects of the operation

• Anesthesia: The operation is performed under general anesthesia.

• Procedure: The surgeon makes a small incision in the neck, usually just above the breastbone. Through this incision, the parathyroid glands are located and the overactive gland(s) are removed. Sometimes it is necessary to remove all four parathyroid glands. In that case, a small piece of a parathyroid gland is replaced.

• Duration: The operation takes on average 1 to 2 hours.

After the operation

• Recovery: After the operation you will usually stay in the hospital for one night.

• Wound care: The wound is sutured and sometimes a drain is placed to drain wound fluid.

• Check-ups: Your calcium levels will be checked regularly after the operation.

Possible complications

As with any surgery, there are risks associated with parathyroidectomy, such as:

• Post-operative bleeding

• Infection

• Hoarseness (temporary or, rarely, permanent) due to damage to the vocal cord nerve

• Low calcium levels (hypocalcemia) This can cause tingling around the mouth and in the fingers, muscle cramps and in severe cases seizures. This is usually temporary and can be treated with calcium supplements.

• Damage to the parathyroid glands: In very rare cases, all of the parathyroid glands may be damaged, leading to permanent hypocalcemia.