Salivary Gland Surgery

Procedures & Operations

Salivary Gland Surgery – Submandibular Gland

What is Submandibular Gland Surgery and Why Might You Need It

The Submandibular Gland is one of the salivary glands that is situated under your jaw. Approximately 60% of lumps in the submandibular gland are benign (not cancerous) and the rest can be cancerous. They occur as a result of overgrowth of the cells in the gland. Swelling can also arise as a result of stones blocking the duct draining the gland. This often leads to pain and infection, restricting routine activity.

Treatment depends on the nature of the lump and the results of the tests. Removal of the swelling is usually recommended because the exact nature of the swelling is often ascertained after removal and analysis of the whole lump. Additionally, if the lumps are not removed, the majority of them will grow further, often becoming cosmetically unacceptable and potentially even becoming cancerous. Large, cancerous lumps are difficult to remove and complicate surgery.

The Surgery Explained

The operation involves removing the whole of the gland. This is performed under general anaesthetic, which means that you will be asleep throughout the procedure. An incision is made well below the jaw line in the neck. The cut is usually placed along a skin crease so that over a period of time the scar is barely visible. At the end of the operation, a drain (plastic tube) is placed through the skin in order to prevent any blood or fluid collecting under the skin. This tube is usually removed the next day when you will be able to go home.

What to Expect Following Your Surgery

Weakness of the corner of the mouth: The nerve that moves the corner of the mouth lies in close proximity to the gland and is at risk during surgery. Damage to this nerve results in weakness of the corner of the mouth. This deformity is more obvious when one smiles. One may also experience drooling of saliva on the affected side. In most cases, the nerve works normally after surgery, although occasionally (about 10% of cases) you may notice a temporary weakness of the corner of the mouth. This usually lasts for a few weeks before full recovery takes place.

Numbness and stiffness of the neck: Stiffness and numbness of the neck are common and this resolves spontaneously over a period of few months. Use of moisturisers and creams to supple the scar and skin is very useful.

Blood and saliva collection: Blood and/or saliva can collect beneath the skin. Occasionally, it may be necessary to return to the operating theatre to remove this clot. Usually, this collection is minor and our body mops it away completely.

Altered Taste: The nerve which helps us appreciate taste runs very close to the duct of the submandibular gland. This nerve may get bruised or damaged resulting in altered taste in the mouth. Usually, the altered taste sensation recovers fully over a period of few weeks.

Weakness of the tongue: Very rarely, the nerve that moves the tongue may get bruised or damaged during surgery. Usually this recovers fully over a period of a few weeks.

Salivary Gland Surgery – Parotid Gland and Parotid Surgery

Candidacy

During the initial consultation, a detailed history is taken and also an assessment of your problem. This is usually followed by an ultrasound scan, which is performed by an expert radiologist. During the ultrasound scan, a needle may be inserted into the lump to collect a sample of cells. These cells are then analysed under the microscope by the pathologist who will often determine the nature of the swelling. Rarely, other tests such as a plain X-ray, CT scan, MRI scan or a sialogram may be required. These will be discussed with you and further action considered where necessary.

What is Parotid Surgery and Why Might You Need It

The Parotid Gland is the gland that is affected by Mumps. Lumps (tumours) in the parotid gland are common and are seen in all age groups. They are the result of an abnormal growth of cells within the gland, though the exact reasons for this are not clear. The vast majority (approximately 90%) of these tumours are not cancerous and are called benign tumours. Rarely, however, some tumours can be cancerous.

Other causes of lumps in the gland include stones in the duct of the gland, which often block the flow of saliva. This blockage often gives rise to infections, which can sometimes be troublesome. Whatever the cause, however, it is prudent to establish the exact nature of the swelling.

Treatment depends on the nature of the lump and the results of the tests. Removal of the swelling is usually recommended because the exact nature of the swelling is often ascertained after removal and analysis of the whole lump. Additionally, if the lumps are not removed, the majority of them will grow further and often become cosmetically unacceptable and even turn cancerous. Large, cancerous lumps are difficult to remove and complicate surgery.

The Surgery Explained

The surgery to remove the parotid lump is called a parotidectomy. This involves removing either part or all of the parotid gland. The operation is usually performed under a general anaesthetic, which means that you will be asleep throughout the procedure. A skin incision (cut) is made, which runs from the front of the ear curving towards the back of the ear just to the level of the hair line. Most surgeons differ in making the skin cut and tend to extend the cut into the neck. This is nearly the same incision as that used in face-lift surgery and has excellent cosmetic results. At the end of the operation a small drain (plastic tube) is placed through the skin to facilitate drainage of blood and tissue fluids. The skin cut is closed with stitches and the drain is removed in 24-48 hours, when you will be able to go home. Stitches will be removed usually after 6 days.

What to Expect Following Your Surgery

In the following section some of the common and serious risks of parotidectomy are discussed briefly. Please note that the chances of these happening are very low.

Weakness (paralysis) of the face: The facial nerve that moves the muscles which help the eyes to close and the mouth to smile and eat runs through the parotid gland. We always diligently identify and preserve the nerve. We also use a specialised nerve monitoring technique which adds further safety to the procedure. In most cases, the nerve works normally after surgery. Occasionally, however, (about 15-20% of cases) where the lump has been very close to the nerve, a temporary weakness of the face may occur. This usually lasts for a few weeks and then recovers back to normal. Permanent damage, resulting in permanent weakness of the face, is rare in surgery of benign (non-cancerous) tumours.

Bleeding and leakage of saliva:Rarely, blood can collect beneath the skin resulting in swelling in the operated area. It is also normal for small quantities of saliva to leak from the cut surface of the gland and cause it to swell. Most often this blood and saliva is mopped up by our body and therefore the swelling is self-limiting. Occasionally, however, it may be necessary to return to the operating theatre to rectify the problem.

Numbness/altered sensation of the face and the ear: The nerves that are responsible for appreciating sensation on the face, side of the neck and the ear lie just under the skin and are damaged to a variable degree. This transpires as numbness of the ear, particularly felt in the ear lobe and to a variable degree on the side of the face and neck. One is more likely to be aware of it when wearing earrings and whilst shaving in men. Generally speaking, with time the numbness and altered sensation improves.

Cosmetic deformity: You may notice some hollowing under the skin at the back of the jawbone from where the gland and swelling has been removed. This is usually mild and is not a concern to the majority of patients. There are various ways of treating this should it become troublesome.

Skin changes – sweating and flushing (Frey’s Syndrome): You may notice that the cheek skin on the operated side becomes flushed and sweaty, particularly associated with eating or thought of food. Should this occur and become troublesome, it can generally be treated by the application of simple roll-on antiperspirant and very occasionally further surgery or injections with botulinum toxin may be required.

Pain and stiffness: You may notice pain and stiffness in the area of the neck and shoulder. This recovers quickly. Gentle daily massage with your regular skin cream starting two to three weeks after surgery helps to supple the scar and eases the discomfort.

To view and/or download further information relating to this procedure, please go to the Patient Information Leaflets section of this website.