The parotid gland is a primarily serous salivary gland that is located high in the neck in front of the ear – extending towards the cheek. The facial nerve branches pass through the parotid gland and supply the muscles of facial expression, as well as to the postauricular muscles, the posterior belly of the digastric muscle, and the stylohyoid muscles. The motor branches to the face are divide to supply the muscles of the mouth and neck and the muscles of the forehead and eye (there is some overlap in the nasal region).
About parotid gland surgery
There is no anatomic feature that formally separates the parotid gland into superficial and deep lobes, but the plane of the facial nerve generally serves for demarcation of the superficial and deep portions of the gland.
A superficial (or lateral) parotidectomy involves removing all of the gland superficial to the facial nerve, whereas a partial superficial parotidectomy involves removing only the portion of the gland surrounding a tumour or mass.
In a partial superficial parotidectomy, only some branches of the facial nerve are usually dissected, whereas in a formal superficial parotidectomy, the entire cervicofacial and temporofacial divisions of the facial nerve are dissected.
For a total parotidectomy, the superficial gland is dissected free of all of the facial nerve branches to the extent feasible, and the branches are then completely mobilized and the deep portion of the gland removed.
Many deep lobe or parapharyngeal parotid tumors can be approached transcervically rather than by means of parotidectomy.
Indications for parotid gland surgery
- Tumours are the most common indication for parotidectomy
- The vast majority of primary parotid tumours are benign, but approximately 20% are found to be malignant
- In addition, regional and distant disease can metastasize to the parotid and necessitate removal for diagnosis or cure.
- Inflammatory processes (eg, chronic parotitis, deep salivary calculi, or parotid abscess) are occasionally treated with total parotidectomy, with the recognition that surgery in an inflamed gland probably carries a higher risk of postoperative facial nerve dysfunction