Parotid and Submandibular Gland Surgery

Risks and Warnings

 

Parotid Gland

Risk to facial nerve– this is lessened by the use of intraoperative facial nerve monitoring. Warn patient regarding numb ear lobe afterwards (great auricular nerve is sacrificed in the incision). There is also a risk of Frey’s syndrome, or post-gustatory sweating. Patients may experience perspiration of the cheek when salivating due to inappropriate cross-over of nerve fibres secondary to surgical trauma. Recurrence of original disease.

                                                                             

Submandibular Gland

There are three nerves in the vicinity which are at risk (or both iatrogenic and pathological damage)

1. Marginal mandibular branch of the facial nerve

2. Lingual nerve

3. Hypoglossal nerve

 

Initially there may be post-op discomfort, particularly on eating.

 

Parotidectomy

Principles are complete excision of tumour with margin of healthy tissue and preservation of facial nerve. Clinically benign tumours in superficial lobe have superficial parotidectomy, and in deep lobe total conservative parotidectomy. In possibly cases of malignancy frozen sections help to decide whether facial nerve can be preserved. Malignant tumours require radical excision +/- radiotherapy. Whether or not to sacrifice the facial nerve adjacent to the tumour is controversial.

 

Salivary duct calculi

History of recurrent pain and swelling in the obstructed gland, particularly before and after meals. Plain films (lower occlusal for submandibular , cheek for parotid) reveal radiopaque stones, but do not show up radiolucent stones and mucus plugs. Sialography reveals a stricture or obstruction. Commonest are in the submandibular gland.

 

Treatment:

Submandibular calculi lying anterior in duct  - remove by passing a suture behind the calculus  to prevent it slipping further down the duct. Dissect the duct from an intra-oral approach and lift out stone either marsupialize the duct or reconstruction.

Posterior calculus—excise duct and gland.

 

Parotid duct—expose duct via intra-oral approach for anterior stones or via a small skin flap on to a probe in the duct for more posterior calculi. Otherwise, selective superficial parotidectomy.

 

Recurrent Sialadenitis

Severe recurrent infection of the salivary glands lead to dilatation and ballooning of the ducts and alveoli called sialectasis. Sialography is often therapeutic in these cases, inducing long remissions between episodes of infection. Conservative treatment involves irrigating the gland with tetracycline solution. Definitive treatment involves gland excision with removal of 90% of the duct. Interventional Sialography with specialised balloon/ basket catheters are now being used to dilate or retrieve obstructions but have not replaced open surgery.

 

Surgery for drooling

It is possible to relocate the parotid ducts into the hypopharynx +/- bilateral submandibular gland excision or relocation to the back of the tongue. This helps to control drooling without impairment to swallowing and oral health. Excision of the sublingual glands may also aid this, as these are a major source of pooled saliva at rest.

Surgery for tumours, obstruction and inflammatory conditions.