Salivary gland surgery

The main salivary glands are located in the face, in front of the ear for the parotid gland, and under the jaw for the submaxillary gland. Their main function is to synthesize and produce saliva.

The most frequent reason for consultation is the casual discovery, by the doctor or the patient, of a lump located in front of the auricle, behind or under the jaw. Additional symptoms may include local pain, recent asymmetry of the mouth when miming, or increasing difficulty in closing the eyelids completely on one side of the face.
 Complementary examinations will initially involve ultrasound, followed by MRI.

There are different types of salivary gland tumour: benign, more adenoma-like, or malignant, notably carcinomas.

The procedure is performed via a “face lift” incision for the parotid gland, i.e. concealed in front of and behind the auricle, or under the jaw for the submaxillary gland.
The first step is to locate the facial nerve and its branches, assisted by monitoring for more efficient nerve identification.

A histological examination may be requested during the operation to assess the type of lesion.

Chirurgie des glandes salivaires

The most frequent lesions are pleomorphic adenomas or mixed tumors, which can degenerate in around 15-20% of cases. This type of lesion requires sub-total or total parotidectomy to limit the risk of future recurrence. 

In the case of a cancerous lesion, a second stage of surgery may be required to clarify the histological nature of the lesion and inform the patient of the possibility of nerve sacrifice of the face nerve, with repair at the same time by a nerve graft taken from a peripheral nerve in the leg.

In this type of situation, lymph node removal may be associated within the various lymphatic chains of the neck. Closure is performed using a drain, which is kept in place for two to three days.

Hospitalization rarely exceeds three to four days.

The post-op period is associated with edema, which gradually fades in the days following the operation.

In about 30% of cases, there is trouble closing the eyelids completely during occlusion, or asymmetry of the corner of the lip during mimicry, with recovery taking between two and eight weeks, depending on the dissection difficulties encountered during the operation.

This paralysis of one half of the face must be treated as soon as possible by a physiotherapist, without electrical stimulation.

Secondary facial paralysis may occur permanently, particularly in the presence of cancer, or with specific difficulties in the context of inflammatory adenomatous tumors.

The monitoring and prognosis of this type of paralysis will be the subject of secondary electrical examinations such as electromyography.
In this type of situation, there are additional possibilities for aesthetic enhancement through muscle transfers or nerve grafts, in order to ease gradual rehabilitation in a socially acceptable manner.

Another side-effect may arise from abnormal sweating of the cheek during chewing movements.

This syndrome, known as FREI, occurs in around 3% of cases, and can be treated with botulinum toxin in the case of persisting discomfort.

The downtime required for parotid or submaxillary surgery is around three to four weeks.

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