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COMMONLY ASKED QUESTIONS

How long does the surgery take to perform? A typical parotidectomy takes 2 hours. A total parotidectomy takes 3 hours.

What is the recovery time like? Typically patients are back to normal and feeling well after 4-5 days.

Will I need to stay overnight in the hospital? Most people are discharged the same day. Depending on the extent of dissection however, you may be required to stay overnight.

Any dietary restrictions after the surgery? None. You may eat and drink normally after your surgery.

Can I speak after surgery? You may use your voice immediately after the surgery.

Will I be sent home with any medications? You will be given pain medications and antibiotics.

What types of activities can I perform after surgery? I would not recommend heavy lifting or straining immediately after surgery. You can resume heavy lifting and straining 1 week after surgery.

When do I come in for my follow-up visit? You should be seen 1-2 weeks following surgery.

Will my stitches need to be removed? All the stitches will be dissolvable, and we do not need to remove any of them.

What are the risks of parotid surgery? Aside from possible bleeding and infection, the major risk of parotid surgery is weakness of the facial nerve and facial asymmetry. However, the risk of permanent injury in experienced hands is in the order of 3-5%. The vast majority of patients undergoing parotid surgery however, have no problems with their facial nerve after surgery. The possibility of facial nerve injury increases if all of the parotid has to be removed (total parotidectomy). This makes sense – the more nerve branches you dissect, the more chance you have to injure the nerve.

Other minor risks include sweating of the cheek while eating (called Frey Syndrome) or temporary salivary fluid collections under the skin (sialocele or salivary fistula). These are managed fairly easily.

Are there ways to minimize the injury to the facial nerve during parotidectomy?

During minimally invasive or traditional open parotid surgery, facial nerve monitoring can be used to identify the branches of the facial nerve and confirm facial nerve function.

 

 

 

 

 

 

 

Depending on the circumstances, the branches of the facial nerve can be hard to identify during surgery, especially if the patient has had prior parotid gland surgery. Patients can suffer temporary or permanent damage if a nerve is irritated or injured.

If there is a change in nerve function during the surgery, the facial nerve monitor alerts the surgeon and operating room staff. This helps reduce the risk of facial nerve damage and asymmetry.

What is the typical work-up of a parotid mass? A mass in the parotid gland is always abnormal.

The work-up usually involves a fine needle aspiration biopsy with or without ultrasound. If there is evidence of cancer on the needle biopsy, then surgery is usually recommended.

If there is no evidence of cancer on the needle biopsy, then the patient can be observed and will require a routine ultrasound examination every 9 months to 1 year.

There are several practitioners in my area who perform parotid surgery. How should I choose one? Are there questions I should ask during the consultation?

There are a few things to consider when deciding on a surgeon.

Ask how many parotid surgeries the surgeon has done during the past three months to get a sense of his/her experience. Dissecting the branches of the facial nerve safely is technically challenging. So make sure that you choose someone who has the requisite technical skills.

Ask if your surgeon is fellowship trained in head and neck surgery. There are many competent parotid surgeons who have not had fellowship training. Nevertheless, this is something that allows you as a patient to understand how up-to-date your surgeon is with new techniques. You can safely assume that a head and neck fellowship trained surgeon is doing parotidectomies on a regular basis.

Ask if your surgeon uses facial nerve monitoring. Successful parotidectomy does not always require the use of laryngeal nerve monitoring, but there has been a positive trend towards the use of monitoring during parotidectomy. If you are undergoing parotidectomy, you should have the state of the art technology available in order to minimize the chance of an injury to your facial nerve.

In the end, the decision to choose a surgeon is a very personal one. Don’t be rushed through the pre-operative consultation. Make sure that you can trust what your surgeon has to say, make sure that you have adequate time to get an answer to all of your questions, and make sure that you have been able to establish a rapport with the surgeon.