Parotid surgery refers to the surgical removal of the parotid gland (one of the major salivary glands) due to the presence of an abnormal growth. These growths usually do not cause immediate symptoms. In most cases, patients seek medical advice after noticing a lump on face near their ear.
Fortunately, parotid tumours are often benign and do not cause serious complications once removed. If you are diagnosed with a parotid tumour and require surgery, understanding the condition, the surgical procedure, potential complications, and available solutions can help you better prepare.
What is a Parotid Tumour
A parotid tumour refers to an abnormal growth occurring in the largest of the three main salivary glands. This gland is responsible for producing saliva to keep the mouth moist and helps with eating, swallowing and speaking. Every individual has two parotid glands found on each side of the face, just in front of the ears.
Most parotid tumours are non-cancerous (benign), with the most common types being:
- Pleomorphic adenoma: The most common parotid tumour, slow-growing and usually painless.
- Warthin tumour of the parotid gland (Adenolymphoma): This is the second most common benign parotid tumour. Multiple researchers suggest that smokers are more likely to develop Warthin tumours than non-smokers.
Notably, there is still a 1 in 5 chance that parotid tumours can be cancerous, according to the Cleveland Clinic. In fact, the National Center for Biotechnology Information suggests that the longer a pleomorphic adenoma in the parotid gland remains in place, the higher the chance of it becoming cancerous. Approximately 1.5% of these tumours become malignant within the first five years, rising to 9.5% after 15 years.
When a parotid tumour is found to be cancerous, removal of the parotid gland may be necessary to eliminate cancerous cells. A cancerous parotid tumour is one of the most common types of salivary gland tumour cancer, with mucoepidermoid carcinoma being the most frequently diagnosed malignant form.
Symptoms of a Parotid Gland Tumour
Patients with a benign parotid tumour may notice the following symptoms:
- A visible parotid gland lump or swelling on one or both sides of the face. Specifically, look out for:
- Lumps that grow in size
- Lumps that persist for more than 2–3 weeks
- Lumps located near the ear or the lower cheek
- If no visible lump is present, one side of the face may appear larger than the other.
- A sore or lesion may develop at the site of the lump.
- Painful muscle spasms around the jaw joints (trismus), leading to difficulty opening the mouth.
- Trouble swallowing.
If the tumour is cancerous, additional symptoms may include:
- Constant or intermittent pain near the parotid gland may worsen during eating or chewing and sometimes spread to the ears.
- Facial numbness or weakness if the tumour presses on certain facial nerves.
Most parotid gland tumours develop slowly. It is possible for you to develop a tumour over months, years, or even a decade without noticeable symptoms. Often, a parotid gland tumour is diagnosed during a checkup for unrelated conditions, such as a dental visit, or when the lump becomes apparent to touch or sight.
How Serious is a Parotid Gland Tumour?
While symptoms can be painful, most parotid tumours are not a serious cause for concern and can be swiftly managed by a head and neck, parotid surgeon. Nevertheless, given the possibility of malignancy or the presence of serious symptoms, it is necessary for patients to seek an accurate diagnosis and appropriate treatment.
In Singapore, there are several ways to get tested for a parotid tumour:
- Medical History Review: Your surgeon will begin by evaluating your medical history and reviewing any records of infections that may contribute to your risk. Key risk factors include:
- Age: Tumours are more likely to develop in individuals over 50 due to the increased likelihood of genetic mutations with age.
- Radiation Exposure: Patients who have received radiation therapy for cancers, particularly head and neck cancers, may face a higher risk of tumour development.
- Smoking: Chronic throat irritation and inflammation caused by smoking can increase the risk.
- Viral Infections: A history of certain viral infections, such as Epstein-Barr virus, human immunodeficiency virus (HIV), or human papillomavirus (HPV), may elevate the risk of developing a parotid gland tumour.
- Occupational Hazards: Exposure to harmful substances in industries such as manufacturing or mining may raise the risk of parotid gland tumours.
- Physical Examination: Your surgeon will assess for lumps, tenderness, and any signs of infection or nerve involvement in the mouth and throat area.
- Fine-Needle Aspiration Biopsy: A small needle is used to extract cells from the lump for microscopic analysis. This procedure is essential in differentiating benign from malignant growths.
- Imaging Tests: Additional imaging, including ultrasounds, CT scans, and MRIs, helps determine the size, location, and characteristics of the lump.
As with any cancer, early detection is crucial in ensuring a favourable prognosis. Without proper treatment, there is also a risk of a cancerous parotid tumour spreading to other parts of the head and neck, such as the lymph nodes.
If you suspect the presence of a parotid tumour or observe any lump on the face near the ear, consult an ENT head and neck surgeon at Aglow ENT Centre for prompt diagnosis and personalised treatment.
Survival Rate for Parotid Tumours in Singapore
Survival rates for parotid tumours in Singapore are generally high, with a low risk of complications. Of course, to increase the chances of successful treatment, you should consider the following:
- Choose the right specialist to manage your condition. Parotid tumours are typically treated by an ENT head and neck surgeon.
- Review your specialist’s training and experience to ensure they have expertise in managing parotid tumours.
- Understand your specialist’s success rate in treating parotid tumours.
By taking these factors into account, you will feel more confident in your choice of doctor and be more likely to have a successful recovery.
Who Can Perform a Parotid Gland Tumour Surgery?
The treatment of a parotid tumour involves surgical removal of the growth. In Singapore, parotid surgeons, who are either ENT, head and neck surgeons or general head and neck surgeons, can perform this procedure. These two groups of surgeons are well-trained to operate on the area where the tumour is located.
Given the close proximity of the parotid gland to the facial nerve, which controls essential facial movements such as smiling and blinking, a skilled surgeon is required to navigate around this nerve carefully to minimise the risk of injury. Parotid surgeons undergo specialised training in delicate microsurgical techniques to ensure the preservation of facial nerve function while effectively removing the tumour.
In cases where the tumour is malignant or has spread to nearby structures, a multidisciplinary team approach may be needed. This can include collaboration with oncologists, plastic and reconstructive surgeons, and radiologists to provide comprehensive treatment and post-surgical care.
What is a Parotidectomy?
Parotid gland tumour surgery, also known as a parotidectomy can be done as a Day Surgery.
Typically, the procedure involves the removal of a portion (superficial parotidectomy) or the entirety of the parotid gland (total parotidectomy). Here is what you can expect during the surgery:
- Patients are placed under general anaesthesia to ensure they remain pain-free throughout the procedure.
- Your surgeon will then make an incision along the hairline and earlobe or within the natural crease of the neck to minimise visible scarring.
- Your surgeon will then remove the tumour along with other tissue in the surrounding area.
- If the tumour has affected the facial nerve, the affected portion may need to be removed along with the tumour.
- Once the procedure is complete, your surgeon will close the incision with sutures.
After a few hours, patients may be permitted to return home if they show signs of recovery and are free of complications. One key step after parotid surgery is to check facial function to ensure no facial nerve damage has occurred. This usually includes testing movements such as smiling, closing the eyes, or frowning.
Once home, patients should still be mindful of the following post-operative care tips:
- As you will be provided with a wound drain, make sure to keep it clean and dry. It can typically be removed a few days after surgery.
- Pain and swelling are normal after surgery and should subside on their own after a few days. Your doctor may prescribe medication to help manage the pain.
- You may eat and drink as usual after surgery. However, eating softer foods may help reduce discomfort during the initial phase of recovery.
- Avoid engaging in strenuous activities to support the healing process.
Is a Parotidectomy a Major Surgery?
Due to its complexity, a parotidectomy is considered a major surgery. During the procedure, the surgeon must remove the affected parotid gland, which is divided into upper and lower sections by a major facial nerve. This nerve is positioned very close to the gland and requires a skilled surgeon to navigate it carefully.
As the facial nerve controls many of an individual’s facial movements, such as smiling and frowning, preserving its function and preventing any accidental damage is vital.
Dr Ker Liang of Aglow ENT Centre is an experienced parotid surgeon that is able to perform parotidectomy. As an ENT head and neck specialist, she has over 14 years in Otolaryngology, and has previously served as a Consultant at Singapore’s National University Health System (NUHS), providing specialised ENT care across National University Hospital (NUH), Alexandra Hospital, and Ng Teng Fong General Hospital (NTFGH). Recognised for her dedication, she received the NUHS Long Service Award for a decade of quality service.
Dr Ker Liang graduated from the Yong Loo Lin School of Medicine, NUS, in 2009 and pursued specialist training in Otolaryngology under Singapore’s ACGME-I Residency Programme. She holds postgraduate qualifications, including Membership of the Royal College of Surgeons (MRCS) Edinburgh and a Master of Medicine in Otolaryngology from NUS. Committed to continuous learning, she actively participates in international and regional conferences to stay updated on the development of ENT, Head and Neck Surgery.
For eligible patients, Dr Ker Liang offers a minimally invasive technique known as micro-parotidectomy. This approach allows for:
- Same-day discharge when possible.
- Smaller incisions, resulting in minimal scarring and reduced pain.
- The use of high-magnification and fine instruments for the delicate nature of ENT procedures.
What Are The Common Complications of a Parotidectomy?
If you are wondering whether removing your parotid salivary gland will affect your saliva production, the answer is no. You still have several main salivary glands as well as smaller ones to compensate for this. It is common to experience temporary swelling, pain or occasional saliva leak after a parotidectomy, which can resolve on their own.
Common complications of parotidectomy are similar to those of any surgery:
- Pain and swelling
- Discomfort at the surgical site
- Wound Infection, though unlikely with proper intra- and post-operative care
- Mild facial movement weakness, usually temporary, lasting for a few days to weeks
- Salivary fistula, saliva collection and leaking through the incision (very rare)
These side effects typically last for a few weeks after surgery. Less common but more serious complications that could occur after a parotid gland tumour removal include:
Facial Nerve Injury
Given the position of the parotid gland and facial nerve, damage to the nerve is possible. As such, the surgeon’s skill in this case is important. The head and neck, parotid surgeon will need to identify the position of the facial nerve and trace its branches, to the parotid tumour.
Nerve monitoring during surgery can help identify and protect the facial nerve. If the tumour has surrounded or invaded the facial nerve, that nerve may have to be removed along with the tumour. This highlights the need for early detection and treatment to minimise complications as much as possible.
Facial Weakness
Temporary facial nerve weakness may occur immediately after surgery, primarily due to the dissection and repositioning of the nerve during the procedure. This weakness typically improves over time but may take several weeks to months or up to a year for full recovery. Permanent facial nerve weakness is far less common and depends on factors such as the size, location, and type of mass, as well as the extent of surgery required for its removal.
The severity and duration of side effects vary based on the specifics of the surgery, the portion of the gland removed, and the patient’s individual response.
What Can Patients Expect When They Undergo a Parotid Gland Tumour Surgery?
Before Surgery
Pre-operative planning emphasises the importance of accurate diagnostic imaging, which can help your surgeon to map out the tumour’s location and its relation to the facial nerve.
During Surgery
How do ENT Head and Neck Surgeons Preserve Facial Nerves During a Parotidectomy?
Preserving the facial nerve during a parotidectomy is crucial to maintaining facial movement and function. There are several ways in which a surgeon can optimise preserving facial nerves when removing a parotid salivary gland tumour:
- Facial Nerve Monitoring: Also known as intraoperative nerve monitoring (IONM), the technique provides real-time feedback on nerve function and reduces the risk of accidental damage.
- Careful Dissection Using Nerve Identifiers: The main section of the facial nerve can be identified using a reference point near the ear. Branches of the facial nerve are then carefully dissected away from the tumour using gentle techniques.
- Microsurgical Techniques: Fine instruments, magnification (surgical loupes or microscopes), and micro-scissors are used to carefully dissect the tumour from the facial nerve. This is the technique used in a micro-parotidectomy.
Nerve Monitoring for Parotidectomy
The rate of facial weakness and nerve injury varies from one study to another. However, common observations include:
- Temporary facial weakness is more common than permanent facial weakness.
- Damage to the facial nerve is more likely after a total parotidectomy, which is often performed to remove a malignant parotid tumour.
- Most cases of temporary facial weakness improve within a few weeks to months, with full recovery typically occurring within six months.
To prevent the above from happening, most surgeons will use a nerve monitor during parotidectomy. This involves the setup of:
- Small electrodes are placed on the patient’s face before surgery.
- These electrodes are positioned to monitor muscle activity linked to different branches of the facial nerve.
- The surgeon uses a nerve stimulator to send mild electrical impulses.
- When the facial nerve is stimulated, the corresponding facial muscles twitch.
- This helps the surgeon identify the nerve and its branches to avoid accidental injury.
- Throughout the procedure, the nerve monitoring system provides real-time feedback.
- If there is excessive stretching, compression, or irritation of the nerve, the system alerts the surgical team.
By continuously tracking nerve function, the surgeon can make adjustments to prevent injury. This reduces the risk of temporary and permanent facial weakness after surgery.
After Surgery
Physiotherapy can help to restore nerve function in patients who experience facial weakness after parotidectomy. In some cases, nerve transfer can be done as part of a correction surgery.
How Much Does Parotid Gland Tumour Surgery Cost in Singapore?
In Singapore, parotid gland tumour surgery can cost from $10,000 to $27,000 in a private clinic. A parotidectomy is usually covered by insurance providers. Our experienced and friendly team is committed to addressing any financial concerns, enabling patients to focus on their recovery with peace of mind.
Consult Dr Ker Liang, an Experienced Head and Neck, Parotid Surgeon in Singapore for Parotid Gland Tumour Surgery
In Singapore, you can schedule a consultation with Dr Ker Liang, an experienced ENT head and neck, parotid surgeon, at Aglow ENT Centre for any ear, nose, throat, head and neck conditions, including salivary gland lumps.
Advocating for minimally invasive procedures and fewer post-surgical complications, Dr Ker Liang strives to put her patients’ interests first. If you are looking for tailored care and an experienced surgeon, our team at Aglow ENT Centre is ready to support you.
References
- Cleveland Clinic. Parotid Tumor. Cleveland Clinic. Accessed March 3, 2025. https://my.clevelandclinic.org/health/diseases/parotid-tumor.
- Mayo Clinic. Parotid Tumor: Symptoms & Causes. Mayo Clinic. Accessed March 3, 2025. https://www.mayoclinic.org/diseases-conditions/parotid-tumor/symptoms-causes/syc-20578986.
- Cleveland Clinic. Parotidectomy (Parotid Gland Tumor Surgery). Cleveland Clinic. Accessed March 3, 2025. https://my.clevelandclinic.org/health/treatments/24057-parotidectomy-parotid-gland-tumor-surgery.
- Ministry of Health Singapore. Salivary Gland Bill Information. MOH Singapore. Accessed March 3, 2025. https://www.moh.gov.sg/managing-expenses/bills-and-fee-benchmarks/cost-financing/tosp-sf814p-salivary-gland-bill-information.
- National Center for Biotechnology Information. Salivary Gland Tumors. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2023. Accessed March 3, 2025. https://www.ncbi.nlm.nih.gov/books/NBK538340/#:~:text=Benign:%20Pleomorphic%20adenoma%2C%20Warthin%20tumor,epithelial:%20Haemangioma%2C%20lymphangioma%2C%20neurofibromas.
- Johns Hopkins Medicine. Parotid Gland Tumors. Johns Hopkins Medicine. Accessed March 3, 2025. https://www.hopkinsmedicine.org/health/conditions-and-diseases/parotid-gland-tumors.
- O’Brien CJ, Malka V, et al. Facial nerve function after parotidectomy for benign disease. Arch Otolaryngol Head Neck Surg. 1997;123(10):1091-1096. doi:10.1001/archotol.1997.01900100059010. https://pubmed.ncbi.nlm.nih.gov/9339986/.
