Parotidectomy is recommended when the gland is affected by conditions that may compromise its function or pose a health risk.

Causes

1. Parotid Tumors: The most common reason for parotidectomy is the presence of tumors in the gland. Benign tumors such as pleomorphic adenoma and Warthin's tumor account for the majority of cases. Malignant tumors, although less common, include mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma, and metastatic lesions from skin cancers.

2. Chronic Parotitis: Long-term inflammation of the parotid gland can occur due to bacterial or viral infections, autoimmune conditions like Sjögren's syndrome, or duct obstructions. Persistent inflammation can lead to scarring, repeated infections, and functional impairment, necessitating surgical intervention.

3. Obstructive Conditions: Salivary stones, strictures, or narrowing of the salivary duct can block saliva flow, resulting in recurrent infections, swelling, and pain. Surgery may be required if conservative treatments fail.

4. Cysts and Non-Tumorous Lesions: Congenital cysts, lymphoepithelial cysts, or post-traumatic cysts may require removal if they interfere with normal function or cause cosmetic concerns.

Risk Factors

1. Age: Tumors are more common in adults aged 30-70 years.

2. Smoking: Increases the risk of certain tumors like Warthin's tumor.

3. Radiation Exposure: Past radiation therapy to the head and neck region can increase risk of malignant growths.

4. Autoimmune Disorders: Conditions such as Sjögren's syndrome may predispose individuals to chronic parotitis.

5. History of Skin Cancer: Malignant skin cancers like melanoma can metastasize to the parotid gland.

Symptoms vary depending on the underlying condition, but several key signs indicate the need for evaluation and possible surgery.

Common Symptoms

1. Swelling or Lump: A painless lump near the jaw or in front of the ear is often the first indication of a parotid tumor.

2. Facial Pain or Discomfort: May result from pressure due to the growth or inflammation of the gland.

3. Difficulty Chewing or Swallowing: Swelling or obstruction can interfere with normal oral function.

4. Dry Mouth: Reduced saliva production can occur due to chronic inflammation or gland dysfunction.

5. Recurrent Infections: Chronic parotitis or duct obstruction may cause repeated bouts of infection, swelling, or fever.

Red Flags Suggesting Malignancy

1. Facial Nerve Weakness or Paralysis: Tumors affecting the nerve may cause asymmetry or loss of movement in part of the face.

2. Rapidly enlarging mass or fixed lumps

3. Pain radiating toward the ear

4. Enlarged nearby lymph nodes

Prompt medical evaluation is critical if these signs appear.

Accurate diagnosis is vital for selecting the appropriate treatment plan.

Clinical Evaluation

The diagnostic process begins with a detailed medical history, assessment of facial nerve function, physical examination, and inspection of the oral cavity and neck.

Imaging Studies

1. Ultrasound: Useful for detecting superficial masses and guiding biopsies.

2. CT Scan: Provides detailed information about tumor size, involvement of surrounding tissues, and any calcifications.

3. MRI: Best for evaluating deep-lobe tumors and differentiating benign from malignant lesions.

4. Sialography: Special imaging to assess duct obstruction and chronic parotitis.

Biopsy Techniques

1. Fine-Needle Aspiration Cytology (FNAC): Minimally invasive and effective for distinguishing benign from malignant lesions.

2. Core Needle Biopsy: Provides a larger tissue sample for more accurate histopathological evaluation when needed.

A combination of imaging and biopsy results guides surgical planning and helps predict postoperative outcomes.

Treatment depends on the diagnosis, tumor type, size, and involvement of surrounding structures. Surgery is often the definitive treatment.

Surgical Procedures

1. Superficial Parotidectomy: Removes the outer lobe while preserving the facial nerve; commonly used for benign tumors.

2. Total Parotidectomy: Complete removal of the gland; indicated for malignant tumors or deep-lobe involvement.

3. Partial Parotidectomy: Limited removal of affected tissue, preserving as much healthy gland as possible.

4. Radical Parotidectomy: Involves removal of the gland along with the facial nerve in aggressive malignancies; often followed by nerve reconstruction.

Non-Surgical Treatments

1. Medications: Antibiotics for infections, anti-inflammatory drugs for pain, and steroids for autoimmune causes.

2. Sialendoscopy: Minimally invasive procedure to remove stones or widen ducts.

3. Radiation Therapy: Often used post-surgery for malignant tumors or when surgery is not feasible.

4. Chemotherapy: Reserved for advanced cancers, usually in combination with radiation.

While not all conditions can be prevented, patients can reduce risks and maintain parotid health.

1. Hydration: Drink plenty of water to maintain saliva flow.

2. Avoid Smoking: Reduces risk of certain tumors.

3. Oral Hygiene: Regular brushing, flossing, and dental checkups prevent infections.

4. Manage Autoimmune Diseases: Proper treatment can prevent chronic parotitis.

5. Sun Protection: Protecting the skin reduces the risk of metastasis to the parotid.

Before surgery, managing infections and maintaining nutrition can improve outcomes and reduce complications.

Despite modern techniques, complications may occur due to the gland's anatomy and proximity to the facial nerve.

Immediate Complications

1. Facial Nerve Weakness: Temporary weakness is common; permanent paralysis is rare.

2. Hematoma: Bleeding may occur and occasionally requires drainage.

3. Infection: Rare due to rich blood supply.

Long-Term Complications

1. Frey Syndrome: Sweating and flushing while eating due to nerve misdirection; treatable with Botox or surgery.

2. Salivary Fistula: Leakage of saliva under the skin, usually resolves conservatively.

3. Numbness: Particularly around the earlobe; often improves over time.

4. Cosmetic Concerns: Scarring or facial asymmetry; advanced techniques can minimize these effects.

Most patients recover very well after parotidectomy and can return to normal life with few long-term effects.

A. Recovery Timeline

1. Hospital stay: 1-2 days

2. Return to daily activities: 1-2 weeks

3. Complete healing: Several weeks to a few months

4. Facial nerve recovery: Weeks to one year (if affected)

B. Lifestyle Adjustments

1. Maintain good hydration

2. Adopt a soft diet during initial healing

3. Protect incision from sunlight to avoid scarring

4. Attend physiotherapy for facial muscle strengthening

5. Avoid high-impact activities during recovery

C. Emotional and Psychological Support