Saliva is produced by three pairs of large glands (the parotid in front of the ear, the submandibular under the jaw and the sublingual under the tongue) and by hundreds of minor glands in the lining of the mouth and throat. Tumours can grow in any of them. Most are benign, some are malignant, and almost all are treated by surgery.
What it is
Salivary gland surgery removes a tumour together with the part of the gland around it. In the parotid gland this is a superficial or total parotidectomy, performed around the branches of the facial nerve, which passes through the gland and controls the muscles of facial expression. In the submandibular gland the whole gland is removed. Malignant tumours may also require removal of the lymph nodes of the neck and, in selected cases, radiotherapy afterwards.
Who it is for
Adults with a slowly growing lump in front of the ear, under the jaw or in the mouth; adults whose needle biopsy has shown a tumour; and people with a salivary gland cancer diagnosed elsewhere who need surgical treatment.
Symptoms and diagnosis
A painless, slowly enlarging lump is the usual sign. Pain, rapid growth, numbness, weakness of the face, or a lump that is fixed to the skin or the deeper tissues raise concern for a malignant tumour. Diagnosis involves examination, ultrasound of the gland and neck, a fine-needle biopsy (cells taken with a thin needle) and MRI to show the extent of the tumour and its relation to the facial nerve.
How the operation is done
Parotid surgery is performed under general anaesthesia through an incision in front of the ear that continues into a skin crease of the neck, so that it heals discreetly. The main trunk of the facial nerve is found first, and the gland tissue with the tumour is lifted away from its branches; facial nerve monitoring may be used to confirm that the branches are working during the operation. Submandibular gland surgery uses an incision below the jaw, protecting the nerve to the lower lip and the nerves to the tongue. Minor salivary gland tumours in the palate or lip are removed through the mouth. The tissue goes to the pathologist, whose report confirms the type of tumour.
Recovery
Most people go home the day after surgery, with a small drain removed before discharge. Numbness of the earlobe and the skin of the cheek is common after parotid surgery and improves over months. A temporary weakness of part of the face may occur and usually recovers. Sweating of the cheek skin while eating (Frey’s syndrome) can appear later in some people and can be treated. Normal activities are resumed within one to two weeks.
How Prof. Hafız works
Salivary gland tumours are among the focus areas of Prof. Hafız’s practice, within his wider work in head and neck cancer surgery. Before the operation he explains the likely nature of the tumour, the course of the facial nerve and how it will be protected, and what the pathology report will mean for any further treatment.