SALIVARY GLAND LESIONS
There are 4 groups of salivary glands in the Head and Neck region:
The largest. Paired salivary glands in front of the ear
Paired salivary glands under your jaw
Paired salivary glands under your tongue
Minor Salivary Glands:
Numerous. Located throughout the oral cavity
Benign and malignant lesions can occur in any of the salivary glands. Salivary glands may also harbour stones (sialoliths).
Salivary gland lesions usually present as a painless, firm swelling that gradually enlarges. Depending on the underlying cause, some salivary gland swellings can be rapidly-growing. The lesions can cause pain.
If the lesion is aggressive, it can cause facial paralysis (parotid gland) or lip paralysis (submandibular gland).
Initial assessment may require imaging such as a CT or an MRI. A fine-needle aspiration or a core biopsy may be performed under image-guidance to aid in diagnosis.
Once the diagnosis has been established, Dr Tan-Gore will discuss the treatment options with you so that you can make an informed decision regarding your surgery.
PAROTID GLAND SURGERY
Parotidectomy involves the removal of the part of the parotid gland which contains the lesion. A key part of the surgery is to identify branches of the facial nerve which controls the movement of the facial muscles on the corresponding side of the face.
Parotidectomy requires an overnight stay. You will wake from surgery with a small drain in your neck which is attached to a reservoir. If the drain amount is minimal overnight, you will be discharged the next day. Occasionally you will be required to stay a few days if the drain amount is significant or if you require substantial pain relief.
Most patient will require 1-2 weeks off work.
The main risks of parotid gland surgery are:
Injury to the Facial Nerve:
Dr Tan-Gore utilises a combination of intra-operative nerve monitoring and magnification loupes to guide her during surgery. Surgery to the parotid gland carries a moderate risk of temporary facial nerve palsy (approximately 20%) but a very low risk of permanent nerve injury (<1%).
The incision for parotid surgery is placed in the crease in front of your ear and can sometimes extend into the mid-portion of your neck. Dr Tan-Gore is careful to keep most of the incision in natural crease lines to ensure that the scar is minimally visible. However, in patients with a history of keloid scarring, this can be noticeable.
Saliva Leak (Sialocoele):
Saliva can leak from the cut surface of the parotid gland and this travels to the skin, causing a leak through the incision. The sialocoele usually settles in 2-4 weeks. If this does not settle, treatment to stop the leak ranges from pressure bandaging to injection of botox into the gland.
The great auricular nerve supplies the earlobe area and may be transected to facilitate exposure of the parotid gland. This results in permanent numbness to the earlobe region.
The parotid gland contributes to the shape of the side of your face (cheek area) and removal of part of the gland can cause flattening of the facial contour.
Frey’s Syndrome/Gustatory Sweating:
A late complication (months) is the development of a condition where eating causes sweating on the face. This is an unusual complication that sometimes requires further intervention.
SUBMANDIBULAR GLAND SURGERY
Excision of a submandibular gland may be indicated for treatment of a lesion or management of submandibular gland stone (sialolithiasis). If the submandibular gland stone has caused an infection, you will be treated with antibiotics and surgery to remove your submandibular gland is postponed until your infection is settled.
Surgery on the submandibular gland usually requires an overnight stay. You will wake from surgery with a small drain in your neck which is attached to a reservoir. If the drain amount is minimal overnight, you will be discharged the next day. Occasionally you will be required to stay a few days if the drain amount is significant or if you require substantial pain relief.
Most patients will require 1-2 weeks off work.
The main risks of submandibular gland surgery are:
Injury to the facial nerve:
The marginal mandibular branch of the facial nerve controls movement of the lower lip and can be injured due to its proximity to the submandibular gland. Nerve injury is usually temporary and permanent nerve injury is rare. This would result in an asymmetrical smile and drooping of the lower lip on the affected side.
Injury to the lingual nerve:
The nerve which supplies sensation to your tongue is located near the upper part of the gland. Dr Tan-Gore utilises magnification loupes to minimise the risk of injury to any vital structures. Injury would result in numbness to the affected side of the tongue and a change in taste.
Dr Tan-Gore is careful to keep the incision contained within a neck crease. However, in patients with a history of keloid scarring, the incision can be noticeable.