Medical Questions » Neck Questions » Question No. 716
| Question: | My wife has had a slowly enlarging lump below and in front of her ear for months. After numerous X-rays and an ultrasound scan, she has been told that she has a tumour of the parotid gland, and it will have to be removed. Is this a dangerous procedure? Are there any complications of the operation? |
| Answer: | The parotid gland is one of three glands on each side of the face that produce saliva, which is discharged into the mouth through a duct that opens at the back corner of the tongue. The parotid glands are the ones that usually swell up with a mumps infection.
Rarely, a tumour can arise in the parotid gland. These tumours are usually relatively benign (not cancerous), and are called mixed parotid tumours. Their cause is unknown, but they slowly enlarge with minimal symptoms other than a vague discomfort. Eventually, they start to break down and ulcerate, at which stage they cause severe pain. If left for a long period, the tumour may press on the facial nerve to cause permanent paralysis, or become malignant.
The only treatment is removal of the affected parotid gland. This is not a serious operation, but a very technically difficult and tedious operation. The gland is not easy to reach as it is tucked underneath the angle of the jaw, and more importantly, the facial nerve runs through the gland.
As it leaves the brain, the facial nerve divides into nine smaller nerves that supply the muscles of the face, the tear gland in the outer corner of the eye, and some of the taste glands and sensation of the tongue. During the operation to remove the parotid gland, the surgeon must dissect out these tiny nerve fibres from the gland and tumour, because if any of the fibres are cut, the area of the face supplied by that nerve will be permanently paralysed.
Even if the operation is completely successful, the irritation to the nerve caused by the operation will cause temporary paralysis to the face for a few weeks. During this time, the patient will not be able to smile, close the eye, suck, whistle, frown, puff out the cheeks or produce tears on the affected side of the face.
After removal of the gland, a recurrence of the tumour is uncommon, provided it has not been left to develop into a cancer.
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