Parotid gland surgery

Author : Dr Maryam Mosleh

Salivary Gland Tumors

What causes tumors in salivary gland?

What are Salivary Gland Tumors?

Salivary gland tumors are growths of abnormal cells (tumors) that begin in the salivary glands. Salivary gland tumors are rare.

Salivary glands make saliva, which aids in digestion, keeps your mouth moist and supports healthy teeth. You have three pairs of major salivary glands under and behind your jaw — parotid, sublingual and submandibular. Many other tiny salivary glands are in your lips, inside your cheeks, and throughout your mouth and throat.

Salivary gland tumors can begin in any of your salivary glands. Most are noncancerous (benign), but sometimes they can be cancerous. Most salivary gland tumors occur in the parotid glands.

Treatment for salivary gland tumors is usually with surgery to remove the tumor. People with salivary gland cancers may need additional treatments.

Read more about: What is the submandibular gland?

What are Parotid Tumors?

Parotid tumors are abnormal growths of cells (tumors) that form in the parotid glands. The parotid glands are two salivary glands that sit just in front of the ears on each side of the face. Salivary glands produce saliva to aid in chewing and digesting food.

There are many salivary glands in the lips, cheeks, mouth and throat. Tumors can occur in any of these glands, but the parotid glands are the most common location for salivary gland tumors. Most parotid tumors are noncancerous (benign), though some tumors can become cancerous.

Parotid tumors often cause swelling in the face or jaw that usually isn't painful. Other symptoms include numbness, burning or prickling sensations in the face, or a loss of facial movement.

Parotid tumor treatment is usually with surgery to remove the tumor. If the tumor contains cancer cells, additional treatments might be recommended.

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Before Salivary Gland Tumors Surgery

Symptoms of salivary gland tumor

Signs and symptoms of a salivary gland tumor may include:

. A lump or swelling on or near your jaw or in your neck or mouth

. Numbness in part of your face

. Muscle weakness on one side of your face

. Persistent pain in the area of a salivary gland

. Difficulty swallowing

. Trouble opening your mouth widely

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When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

Having a lump or an area of swelling near your salivary gland is the most common sign of a salivary gland tumor, but it doesn't mean you have cancer. Most salivary gland tumors are noncancerous (benign). Many other noncancerous conditions may lead to a swollen salivary gland, including an infection or a stone in a salivary gland duct.

Causes of salivary gland tumors

Salivary gland tumors are rare. Their cause isn't clear.

Salivary gland tumors begin when some cells in a salivary gland develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do.

The changes tell the cells to grow and divide rapidly. The abnormal cells go on living when healthy cells would die. The accumulating cells form a tumor.

If additional changes happen in the DNA, the abnormal cells may become cancerous. Cancer cells can invade and destroy nearby tissue. They can also break away from the tumor and spread (metastasize) to distant areas of the body.

Types of salivary gland tumors

Many different types of salivary gland tumors exist. Doctors classify salivary gland tumors based on the type of cells involved in the tumors. Knowing the type of salivary gland tumor you have helps your doctor determine which treatment options are best for you.

Types of noncancerous (benign) salivary gland tumors include:

. Pleomorphic adenoma

. Basal cell adenoma

. Canalicular adenoma

. Oncocytoma

. Warthin tumor

. Types of cancerous (malignant) salivary gland tumors include:

. Acinic cell carcinoma

. Adenocarcinoma

. Adenoid cystic carcinoma

. Clear cell carcinoma

. Malignant mixed tumor

. Mucoepidermoid carcinoma

. Oncocytic carcinoma

. Polymorphous low-grade adenocarcinoma

. Salivary duct carcinoma

. Squamous cell carcinoma

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Risk factors

Factors that may increase your risk of salivary gland tumors include:

. Older age. Though salivary gland tumors can occur at any age, they most commonly occur in older adults.

. Radiation exposure. Radiation treatments for cancer, such as radiation used to treat head and neck cancers, may increase the risk of salivary gland tumors.

. Workplace exposure to certain substances. People who work with certain substances may have an increased risk of salivary gland tumors. Jobs associated with salivary gland tumors include those involved in rubber manufacturing, asbestos mining and plumbing.

Salivary gland tumors diagnosis

Tests and procedures used to diagnose salivary gland tumors include:

. Physical exam. Your doctor will feel your jaw, neck and throat for lumps or swelling.

. Imaging tests. Imaging tests, such as magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET), ultrasound or X-ray, may help your doctor determine the size and location of your salivary gland tumor.

. Collecting of a sample of tissue for testing (biopsy). To collect a sample of tissue, your doctor may recommend a fine-needle aspiration or a core needle biopsy. During the biopsy, the doctor inserts a thin needle into the salivary gland to draw out a sample of suspicious cells. Doctors in a lab analyze the sample to determine what types of cells are involved and whether the cells are cancerous.

Determining the extent of salivary gland cancer

If you're diagnosed with salivary gland cancer, your doctor will determine the extent (stage) of your cancer. Your cancer's stage determines your treatment options and gives your doctor an idea of your prognosis.

Cancer stages are identified by Roman numerals, with stage I indicating a small, localized tumor and stage IV indicating an advanced cancer that has spread to the lymph nodes in the neck or to distant parts of the body.

Parotid tumor diagnosis

Tests and procedures used to diagnose a parotid tumor may include:

. A physical exam. Your doctor will feel your jaw, neck and throat for lumps or swelling.

. Collecting a sample of tissue for testing (biopsy). Your doctor may recommend a needle biopsy procedure, such as fine-needle aspiration or core needle biopsy, to collect a sample of tissue for testing. During a needle biopsy, the doctor inserts a thin needle through your skin and into the affected parotid gland. The needle is used to draw out a sample of cells or fluid.

In the lab, doctors can determine what types of cells are involved and whether they're cancerous. Your doctor uses this information to determine your prognosis and which treatments are best for you.

. Imaging tests. Your doctor may recommend imaging tests of your parotid gland to help understand the size of your tumor. If your parotid tumor is cancerous, you may need tests to look for signs that the cancer has spread. Tests may include ultrasound, MRI and CT.

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During Salivary Gland Tumors/ Parotid Tumors Surgery

Salivary Gland Tumors Treatment

Treatment for salivary gland tumors is usually with surgery to remove the tumor. People with salivary gland cancers may need additional treatments, such as with radiation therapy and chemotherapy.

Surgery

Surgery for salivary gland tumors may include:

. Removing a portion of the affected salivary gland. If your tumor is small and located in an easy-to-access spot, your surgeon may remove the tumor and a small portion of healthy tissue that surrounds it.

. Removing the entire salivary gland. If you have a larger tumor, your doctor may recommend removing the entire salivary gland. If your tumor extends into nearby structures — such as the facial nerves, the ducts that connect your salivary glands, facial bones and skin — these also may be removed.

. Removing lymph nodes in your neck. Your surgeon may recommend removing some lymph nodes from your neck if your salivary gland tumor is cancerous and there's a risk that the cancer has spread to the lymph nodes. The surgeon removes the lymph nodes that are most likely to contain cancerous cells.

. Reconstructive surgery. After surgery to remove the tumor, your doctor may recommend reconstructive surgery to repair the area. If bone, skin or nerves are removed during your surgery, these may need to be repaired or replaced with reconstructive surgery.

During reconstructive surgery, the surgeon works to make repairs that improve your ability to chew, swallow, speak, breathe and move your face. You may need transfers of skin, tissue, bone or nerves from other parts of your body to rebuild areas in your mouth, face, throat or jaws.

Salivary gland surgery can be difficult because several important nerves are located in and around the glands. For example, a nerve in the face that controls facial movement runs through the parotid gland.

Removing tumors that involve important nerves may require stretching or cutting the nerves. This can cause partial or complete paralysis of your face (facial droop) that can be temporary or, in some situations, permanent. Surgeons take care to preserve these nerves whenever possible. Sometimes severed nerves can be repaired with nerves taken from other areas of your body or with processed nerve grafts from donors.

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Radiation therapy

If you're diagnosed with salivary gland cancer, your doctor may recommend radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing high-powered beams at specific points on your body.

A newer type of radiation therapy that uses particles called neutrons may be more effective in treating certain salivary gland cancers. More study is needed to understand the benefits and risks of this treatment. Neutron radiation therapy isn't widely available in the United States.

Radiation therapy can be used after surgery to kill any cancer cells that might remain. If surgery isn't possible because a tumor is very large or is located in a place that makes removal too risky, your doctor may recommend radiation alone or in combination with chemotherapy.

Chemotherapy

Chemotherapy is a drug treatment that uses medications to kill cancer cells. Chemotherapy isn't currently used as a standard treatment for salivary gland cancer, but researchers are studying its use.

Chemotherapy may be an option for people with advanced salivary gland cancer. It's sometimes used in combination with radiation therapy.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Parotid Tumor Treatment

Parotid tumor treatment usually involves surgery to remove the tumor. If the tumor contains cancer cells, your doctor may recommend additional treatments, such as radiation therapy and chemotherapy.

Surgery

Operations used to remove parotid tumors include:

. Removing part of the parotid gland. For most parotid tumors, surgeons may cut away the tumor and some of the healthy parotid gland tissue around it (superficial parotidectomy).

. Removing all of the parotid gland. Surgery to remove all of the parotid gland (total parotidectomy) might be recommended for larger tumors and those that affect the deeper parts of the parotid gland.

. More extensive surgery for larger cancers. If parotid cancer has grown into nearby bone and muscles, a more extensive operation may be necessary. Surgeons try to remove all of the cancer and a small amount of the healthy tissue that surrounds it. Then they work to repair the area so you can continue to chew, swallow, speak, breathe and move your face. This may involve transferring skin, tissue, bone or nerves from other parts of your body to make repairs.

To access the parotid gland, surgeons make an incision near the ear. During the operation, special care is taken to avoid damage to nearby structures, such as the facial nerve that runs through the parotid gland. The facial nerve controls facial movement, so stretching or cutting the nerve can cause partial or complete paralysis of the face that can be temporary or permanent.

If the facial nerve must be cut in order to remove all of the tumor, surgeons can repair it using nerves from other areas of your body or processed nerve grafts from donors.

Radiation therapy

Radiation therapy uses powerful beams of energy, such as X-rays, protons or neutrons, to kill cancer cells. If your parotid tumor is cancerous, radiation therapy might be recommended after surgery to kill any cancer cells that remain. Radiation therapy is sometimes used as an initial treatment when surgery isn't an option.

Chemotherapy

Chemotherapy is a drug treatment that uses medications to kill cancer cells. It's not routinely used to treat parotid tumors. But sometimes it's combined with radiation therapy to treat parotid cancers that have a high risk of spreading or cancers that can't be removed completely with surgery. Chemotherapy might also be an option for people with advanced parotid cancers that have spread to other parts of the body.

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After Salivary Gland Tumors/ Parotid Tumors Surgery

Recovery

Parotidectomy is the removal of the parotid glands, located below the ears. They make saliva, which enters the mouth through a tube (duct) near the back teeth. Most tumours that grow in the parotid glands are benign, meaning they are not cancer.

You may leave the hospital with stitches in the cut (incision) the doctor made. Your doctor will tell you if you need to come back to have these removed. You may still have a tube called a drain in your neck. Your doctor will take this out a few days after your surgery.

You may have some trouble chewing and swallowing for several days after you go home. You may have numbness in your earlobe and weakness in your face. For most people, these problems get better within 3 to 4 months. But it can take as long as a year. In some cases, problems with facial movement are permanent.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

. Activity

. Rest when you feel tired. Getting enough sleep will help you recover. When you lie down, raise your head with two or three pillows.

. Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.

. Avoid strenuous physical activity and lifting heavy objects for 3 weeks after surgery or until your doctor says it is okay.

. Do not over-extend your neck backwards for 2 weeks after surgery.

. Ask your doctor when you can drive again.

. You may take a shower, unless you still have a drain near your incision. Pat the incision dry. If you have a drain, follow your doctor's instructions to care for it.

. Diet

. If it is painful to swallow, start out with cold drinks, Popsicles, and ice cream. Next, try soft foods like pudding, yogurt, canned or cooked fruit, scrambled eggs, and mashed potatoes. Avoid eating hard or scratchy foods like chips or raw vegetables. Avoid orange or tomato juice and other acidic foods that can sting the throat.

. If you cough right after drinking, try drinking thicker liquids, such as a smoothie.

. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

. Medicines

. Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.

. If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.

. Take pain medicines exactly as directed.

   . If the doctor gave you a prescription medicine for pain, take it as prescribed.

   . If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.

. If you think your pain medicine is making you sick to your stomach:

   . Take your medicine after meals (unless your doctor has told you not to).

   . Ask your doctor for a different pain medicine.

. Your doctor may prescribe calcium to prevent problems after surgery from low calcium. Not having enough calcium can cause symptoms such as tingling around your mouth or in your hands and feet.

. Your doctor may have prescribed antibiotics. Take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

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. Incision care

. If your doctor told you how to care for your incision, follow your doctor's instructions. If you did not get instructions, follow this general advice:

   . After the first 24 to 48 hours, wash around the incision with clean water 2 times a day. Don't use hydrogen peroxide or alcohol, which can slow healing.

. You may have a drain near your incision. Your doctor will tell you how to take care of it.

Lifestyle and home remedies

Coping with dry mouth

People who undergo radiation therapy to the head and neck area often experience very dry mouth (xerostomia). Having a dry mouth can be uncomfortable. It can also lead to frequent infections in your mouth, cavities and problems with your teeth, and difficulty eating, swallowing and speaking.

You may find some relief from dry mouth and its complications if you:

. Brush your teeth several times each day. Use a soft-bristled toothbrush and gently brush your teeth several times each day. Tell your doctor if your mouth becomes too sensitive to tolerate gentle brushing.

. Rinse your mouth with warm salt water after meals. Make a mild solution of warm water and salt. Rinse your mouth with this solution after each meal.

. Keep your mouth moistened with water or sugarless candies. Drink water throughout the day to keep your mouth moistened. Also try sugarless gum or sugarless candies to stimulate your mouth to produce saliva.

. Choose moist foods. Avoid dry foods. Moisten dry food with sauce, gravy, broth, butter or milk.

. Avoid acidic or spicy foods and drinks. Choose foods and drinks that won't irritate your mouth. Avoid caffeinated and alcoholic beverages.

Tell your doctor if you have dry mouth. Treatments may help you cope with more-severe signs and symptoms of dry mouth. Your doctor may also refer you to a dietitian who can help you find foods that are easier to eat if you're experiencing dry mouth.

Alternative medicine

No complementary or alternative medicine treatments can cure salivary gland tumors. If you're diagnosed with salivary gland cancer, complementary and alternative medicine treatments may help you cope with the side effects of cancer treatment.

Complementary treatments for fatigue

Many people undergoing radiation therapy for cancer experience fatigue. Your doctor can treat underlying causes of fatigue, but the feeling of being utterly worn out may persist despite treatments.

Complementary therapies can help you cope with fatigue. Ask your doctor about trying:

. Exercise. Try gentle exercise for 30 minutes on most days of the week. Moderate exercise, such as brisk walking, during and after cancer treatment reduces fatigue. Talk to your doctor before you begin exercising, to make sure it's safe for you.

. Massage therapy. During a massage, a massage therapist uses his or her hands to apply pressure to your skin and muscles. Some massage therapists are specially trained to work with people who have cancer. Ask your doctor for names of massage therapists in your community.

. Relaxation. Activities that help you feel relaxed may help you cope. Try listening to music or writing in a journal.

Author : Dr Maryam Moslehshirazi
 

10 common questions about Parotid gland surgery in Iran

1How long does it take to recover from parotid gland surgery?
Incisions take approximately 6 weeks to heal, however they continue to remodel for one to two years after surgery. Initially during the first 6 weeks scar creams should be used to hasten the initial healing.
2What happens when parotid gland is removed?
Cosmetically there may be a dent in the skin around the area of the parotid gland, if all or a large part of the gland is removed. ... The facial nerve, which makes the muscles of the face work, runs through the parotid gland. Damage to the nerve or its branches usually occurs as a result of bruising.
3Can parotid gland be removed?
Surgery to treat parotid gland tumors is very precise. This is because your facial nerve needs to be protected during surgery. The goal is to remove the entire tumor without harming your facial nerve. ... Once they do, they will make an incision (surgical cut) in the front of your ear, down into your neck.
4Do all parotid tumors have to be removed?
Parotid glands In most cases, surgery to remove all or a part of the parotid gland (parotidectomy) is the preferred treatment for parotid tumors. Special care must be taken to avoid damaging the facial nerve that runs through the parotid gland
5Is Parotidectomy major surgery?
Parotidectomy. A parotidectomy is the surgical excision (removal) of the parotid gland, the major and largest of the salivary glands. The procedure is most typically performed due to neoplasms (tumors), which are growths of rapidly and abnormally dividing cells
6How long does parotid surgery take?
approximately two hours Removal of all or part of the parotid gland is a complicated operation which takes approximately two hours.
7Do benign parotid tumors have to be removed?
BACKGROUND: Parotid tumors are mostly benign, but their evaluation and treatment require a thorough knowledge of the relevant anatomy and pathology. Surgical treatment of benign tumors is aimed at complete removal of the mass with facial nerve preservation
8Do parotid cysts have to be removed?
A rare condition, parotid cysts account for approximately five percent of salivary gland tumors and are typically not attached to the facial nerve. Because parotid cysts continue to grow over time and are prone to infection, it is important to have them surgically removed to prevent long-term complications.
9How common are parotid gland tumors?
You have three pairs of major salivary glands under and behind your jaw — parotid, sublingual and submandibular. ... Salivary gland tumors most commonly occur in the parotid gland, accounting for nearly 85 percent of all salivary gland tumors. Approximately 25 percent of parotid tumors are cancerous (malignant).
10What type of surgeon does Parotidectomy?
Parotidectomy (Parotid Gland Tumor Surgery) MSK's parotid gland surgeons, including Ian Ganly, have extensive experience in using precise techniques that help preserve the facial nerve. For many people with parotid gland tumors, surgery performed by a head and neck surgeon is the main treatment

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