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Parotidectomy
Salivary glands distributed throughout the neck and oral cavity provide saliva to aid in digestion. Parotidectomy, excision of a major salivary gland of the cheek, is performed in order to remove swelling or tumors. These tumors can be benign, or a known or suspected tumor containing cancer. There are several reasons to consider a parotidectomy. Swelling from the tumor may cause damaging nerve compression on a facial nerve. Prevention of further spread of disease to other parts of the body is another.
The parotid gland is one of hundreds of salivary glands. Therefore, you will have more than enough saliva to compensate when your parotid gland is removed. Quality of life after parotidectomy is rarely significantly affected. Parotidectomy is a safe, effective procedure, however, as with any surgical procedure, certain risks may be involved.
Wound Infection
Infection can lead to a non-healing wound, skin breakdown, bleeding and leakage of saliva. You will be given antibiotics through your IV to prevent infection.
Bleeding
The need for a transfusion is rare but nevertheless could be a potential complication.
Skin Breakdown and Scar
Skin breakdown is most commonly a result of infection and can be managed with antibiotics. The potential exists for the salivary tract to exude saliva out the cheek of the operative side. This drainage can be managed with medications. The surgical incision will be placed in a natural skin fold, thus minimizing any scarring. Keloid or thick scarring is uncommon in surgery of the head and neck.
Nerve Injury
Injury to nerves controlling the face, the throat, and tongue, as well as skin sensation under the ear and jaw is a potential risk of this procedure. Depending on the involvement and proximity of the tumor to the facial nerve, one may experience temporary nerve damage, permanent nerve damage or both. If nerve damage is temporary (most commonly due to swelling) full function may take three to six months to return. Permanent damage (when the tumor has invaded the nerve, therefore making it necessary to remove part of the nerve) usually is in combination with temporary damage. Therefore, some improvement from the immediate postoperative period may still be anticipated. Every care will be taken, including monitoring throughout your procedure to minimize nerve damage. If you do experience facial palsy, a prescription for natural tears and eye protection will be give postoperatively. A consultation with an ophthalmologist may be indicated.
Anesthesia
Complications from anesthesia are known to exist. These, along with other complications, are mostly related to the risks of any major surgery in older or debilitated patients.
When you call the hospital on the business day before the procedure you will be given an arrival time that will be about an hour prior to the procedure. Upon arrival at the hospital you will talk with a nurse, who will also start an IV, an anesthesiologist and Dr. Coniglio before the procedure. The length of surgery depends on the extent of the tumor involvement, therefore the procedure could take anywhere from two to four hours. Dr. Coniglio will take care to place the incision along a natural skin crease to minimize any scarring. Recovery time takes about one hour, so your estimated arrival time to the hospital surgical unit is about four hours from the time of admission.
Pre-Operative Instructions
- Please call the hospital after 2:00 p.m. on the business day prior to scheduled surgery to confirm your arrival time.
- Do not have anything, to eat or drink after midnight prior to your surgery. This includes all food, all liquids, water, candy, mints and gum. Your surgery will be cancelled if you do not follow these instructions. You may brush your teeth.
- Please do not take aspirin or aspirin-containing products, ibuprofen or ibuprofen-containing products or Vitamin E for one week prior to your surgery. If you take any medications that affect your bleeding time (Coumadin or Warfarin, arthritis medications, muscle relaxants, to name a few) please let Dr. Coniglio's nurse know at this time.
- Please inform Dr. Coniglio's nurse at this time if you take routine medications.
- Prior to your arrival at the hospital, please be certain all make-up, nail polish or false nails are removed. This assists in monitoring your blood oxygen level.
- Please leave all valuables (money, credit cards, jewelry, watches) at home.
- During your surgery your family may wait in the Main Lobby on the first floor of the hospital. The nurses will provide directions. Dr. Coniglio will contact them there by telephone following your procedure.
- You will be admitted to one of the surgical units in the hospital. Your family may bring your belongings in at that time. It is recommended that you do not keep valuables with you while you are in the hospital.
Following surgery you will have a soft drain in the surgical incision. The drain will be removed the following morning prior to your discharge. Removal of this drain has been described by most patients as discomfort rather than pain. You will go home with steristrips along the incision line, which must be kept dry to remain in place.
After surgery it is not uncommon to have sensation of fullness or numbness of the side of the face, neck and lower ear on the affected side. Therefore hairdryer, curling irons, and extremely hot bath water should be avoided or used with the utmost care in the immediate postoperative period. Prior to your hospital discharge, the nurses will assist you to meet the discharge criteria; to drink liquids, walk with a steady gait, manage your discomfort, and to have any drainage under control. You will be asked to come to Dr. Coniglio's office for a two-week postoperative appointment for removal of steristrips.
You will be admitted to the hospital for observation for one to two nights. Pathology results may take anywhere up to two weeks but usually are available after one week to ten days. Our nurse will notify you as soon as the results are available. If you have not received the results after one week, please call our office at 256-3550.
Post-Operative Instructions
Sleep with head of the bed elevated, or use two to three pillows for one week. Absolutely no bending, lifting or straining or aerobic activity is allowed as this will promote swelling at the surgical site and delay wound healing. If you have little children who need urgent attention, bend at the knees or sit on the floor and let them come to you. Two to three weeks off work is recommended following parotidectomy.
Diet
Avoid extremely hot liquids or foods. Due to stiffness or difficulty opening your mouth, you may find soft foods and liquids easier to manage the first week following surgery. Please drink as much fluid as you can which will help you avoid becoming dehydrated. Advance diet from liquids to soft food to solids as tolerated.
Wound Care
Immediately following your surgery you will notice a drain placed in the surgical incision. This drain will be removed when the drainage subsides, prior to your discharge from the hospital. A dressing will be placed to manage any of the remaining drainage.
Medications
Use pain medication as directed and as needed. Significant pain is uncommon following parotidectomy. If your pain is not managed by the prescription provided please call the office. Start your antibiotic when you arrive home following hospital discharge. Take as directed.
Appointments
Your first follow-up appointment will be with our PA in approximately two weeks following surgery. Please call the office to arrange an appointment if you have not done so preoperatively.
Notify the office for any of the following:
- difficulty breathing or painful swallowing
- coughing up blood or persistent bleeding
- significant swelling of the neck or face.
- fever above 101° F
- pain not managed by pain medication
The sedative medication and/or general anesthesia may make you drowsy for as long as 24 hours. Therefore do not,
- drink alcoholic beverages for 24 hours. Also no alcohol while taking pain medication
- make major decisions, sign contracts, etc. for 24 hours.
For an emergency please call our professional answering service at 585-258-4840.
Please notify the office 585-256-3550 for any concerns. We are here to help in any way we can.
Dr. John U. Coniglio and Staff
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