Parotid Lump

Lumps occur in the parotid due to abnormal overgrowth of some part of the salivary glands (a parotid gland tumour). The majority of these tumours are benign, which means that they are not cancerous and do not spread to other parts of the body. Occasionally, malignant tumours can occur in the parotid. Your specialist may recommend performing a fine needle aspirate (needle biopsy) of the lump to find out what sort of tumour you have. Sometimes a malignant lump in the parotid gland may represent a secondary cancer from cancer of the skin of the head or face.

Although 80% of these lumps are benign, in most cases we recommend that they be removed since they generally continue to grow and can become unsightly, and after many years a benign lump can turn malignant. Also the bigger the lump, the more difficult it is to remove. Lastly, the diagnosis suggested following needle biopsy is sometimes wrong. There is always some concern regarding the exact cause of the lump until it is removed and analysed in the pathology laboratory by specialists. Known malignant parotid lumps are best treated by surgery, and in some cases, radiation treatment is recommended after surgery.

Parotidectomy is the surgical removal of part or all of the parotid gland. The operation is performed under general anaesthesia, which means that you will be asleep throughout. The incision runs from in front of your ear and down into your neck. This incision heals very well, and in time the scar is likely to be minimal. At the end of the operation the surgeon will place a plastic tube through the skin to reduce the risk of blood clot (haematoma) collecting under the skin. You will require 24 to 48 hours in hospital after the operation before the drain can be removed and you can go home. In some cases your surgeon may arrange for you to recuperate at home with the drain soon after the surgery. You will require 1 to 2 weeks off work, and you will be advised to take a bland diet and avoid rich, creamy and spicy foods to minimise saliva stimulation in the remaining parotid gland.

• Infection: Occasionally, the wound may become swollen, red, tender and warm to touch (cellulitis). This is treated with antibiotics. Rarely there pus may collect under the skin (abscess), which is best treated by surgically draining the pus
• Blood clot: A blood clot (haematoma) may collect under the skin. This occurs in about 5% of patients and it is sometimes necessary to return to the operating theatre and remove the clot and replace the drain
• Salivary collection: The cut surface of the parotid gland leaks a little saliva, which may collect under the skin or drain through the skin. If the saliva collects under the skin, it can be removed with a needle. Your surgeon will recommend a bland diet for several days following surgery to minimise salivary collection
• Seroma: This is build up of bodily fluid occurring at the site of surgery
• Numbness of the face and ear: The skin of the side of the face will be numb for some weeks after the operation, and often you can expect your ear lobe to be numb permanently
• Frey's syndrome: Some patients find that after this surgery their cheek can become red, flushed and sweaty whilst eating. This is because the nerve supply to the parotid gland can regrow to supply the sweat glands of the overlying skin, instead of the parotid. This can usually be treated easily by the application of a roll-on antiperspirant
• Facial weakness: There is a very important nerve, the facial nerve, which passes right through the parotid gland. This makes the muscles of the face move and, if damaged during the surgery, there may be a weakness of the face (facial palsy). In most cases the nerve works normally after the surgery. However, occasionally when the tumour has been very close to the nerve, a temporary weakness of the face can occur that can last a few weeks. In 1% of cases there is a permanent weakness of the face following this sort of surgery for benign tumours
• Tumour recurrence: Occasionally the parotid tumour may recur at any time after the surgery, regardless of the diagnosis