Salivary gland surgery means removing part of a salivary gland or the whole gland. The most commonly operated gland is the parotid, which sits in front of and below the ear, followed by the submandibular gland. The usual indications are a tumour in the gland, recurrent chronic infection that has not responded to conservative care, a large stone or duct obstruction, or a recurring salivary collection. The decision is based on clinical examination, imaging and the result of fine-needle aspiration where that is feasible. What makes parotid surgery distinctive is that the facial nerve passes through the gland and branches inside it, so identifying and preserving that nerve is the central task of the whole operation, frequently with the help of intraoperative nerve monitoring. Temporary weakness of facial movement afterwards is a recognised possibility: a drooping corner of the mouth, incomplete eye closure, or an asymmetric smile. In most cases this improves over weeks to months, but it can persist, and the risk is higher when the tumour lies against the nerve or when the surgery is a revision. In submandibular surgery the nerves to the tongue and the lip branch of the facial nerve are protected. Some things should be known in advance: temporary or permanent numbness of the earlobe, a change in the contour in front of the ear, a salivary leak or a fluid collection under the wound, and flushing with sweating over the cheek during meals that appears months later in some people. The definitive diagnosis is settled only by histology of the specimen after removal, because needle aspiration can be inconclusive, and the plan may change according to the result. The limits are explicit. Surgery does not treat a dry mouth, does not stop stones forming in the other glands, does not cure an underlying autoimmune disease attacking the salivary glands, and does not remove the need for additional treatment if the tumour proves malignant. Swelling that comes and goes with meals is usually a duct or stone problem, and in selected cases it can be managed with salivary gland endoscopy or a smaller procedure without removing the gland — clinical examination is what tells the two situations apart.
Procedure steps
- 1
Assessment, imaging and needle aspiration
The swelling, facial and tongue movement and the lymph nodes are examined, ultrasound is arranged with CT or MRI when indicated, and fine-needle aspiration is taken when feasible. The aim is to know the nature of the lesion, its extent and its relationship to the facial nerve before entering the operating room.
- 2
Anaesthesia and nerve monitoring
The operation is performed under general anaesthesia, and in parotid surgery a facial nerve monitor is connected to the facial muscles to alert the surgeon when the nerve is approached. The possibility of temporary facial weakness is explained beforehand and your consent is taken for it before starting.
- 3
Incision and identification of the facial nerve
An incision is made in front of the ear extending into a neck crease, or in a crease under the jaw, the skin flap is raised, and the trunk of the facial nerve is identified and followed branch by branch. This is the longest and most delicate stage, and its speed matters far less than the safety of the nerve.
- 4
Removing the targeted tissue
The superficial lobe, the whole gland, or the lesion with a clear margin is removed according to the diagnosis and its position relative to the nerve. The specimen is sent for histology, lymph nodes are removed if the plan includes them, and bleeding is carefully controlled before closure.
- 5
Closure, drain and follow-up
The wound is closed in layers with a small drain that is usually removed the next day, and facial movement is checked as soon as you wake. The histology result is reviewed at a later visit to decide whether additional treatment is needed, and facial movement, tongue function and voice are followed at review appointments.
Before the procedure
Tell your doctor about every medicine you take, especially blood thinners, anticoagulants, antiplatelet drugs, steroids and herbal supplements, and never stop any of them yourself; only the prescriber decides. Report any previous facial weakness, numbness of the face or tongue, dry mouth or autoimmune disease, and any earlier surgery or radiotherapy to the area. Mention heart disease, high blood pressure, diabetes, clotting disorders and allergies to medicines or dressings, and bring your imaging and any needle-aspiration report. Stop smoking before and after the appointment because it delays wound healing. Follow the fasting time set by the anaesthetic team, and arrange for someone to drive you and stay with you afterwards.
After the procedure
Sleep with your head raised, keep the wound clean and dry, and keep the appointments for drain and suture removal. Start with soft food and avoid sour or spicy dishes and heavy chewing in the first days to limit stimulation of the glands. If eye closure is incomplete, use the prescribed drops and ointment and protect the eye, and do not neglect this because the ocular surface is damaged quickly. Expect swelling, numbness of the earlobe and wound tightness that improve gradually. **Seek care immediately for new or worsening weakness of facial movement, an inability to close the eye, rapidly increasing or firm swelling under the wound, clear watery fluid leaking from the wound, fever with pus and spreading redness, sudden numbness of the tongue or lip, or severe pain not relieved by painkillers.**
Expected duration
Usually one to three hours depending on the gland, the size of the tumour and its relationship to the facial nerve, under general anaesthesia, with one night in hospital in most cases and a small drain removed the following day.
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