Salivary gland removal is a surgery that aims to remove all or part of the salivary gland. It is a common operation in Turkey that can be performed with the latest technology and without leaving a scar.
A person may need a salivary gland removal if a cancerous tumor forms in the gland. It is removed to prevent the tumor from spreading and harming important nearby tissues or structures, such as the facial nerve.
In patients with malignant salivary gland tumors, surgery to remove the salivary gland is usually the primary treatment. In addition, the surgeon may recommend radiotherapy, chemotherapy, or a combination of the two, depending on the characteristics of the tumor and the stage of the tumor.
Reconstructive surgery, dental care, and rehabilitation may also be part of your recovery plan.
In this article, you will learn about salivary gland removal surgery available in Istanbul, its types, and when you need it.
What is salivary gland removal?
The salivary gland removal surgery aims to remove one of the salivary glands, which are responsible for secreting saliva in the mouth. The person has small secondary glands in addition to three main pairs of glands:
- Submandibular glands
- Sublingual glands
- Parotid glands
The type of anesthesia required for this surgery depends on the gland to be removed. If it is one of the minor secondary salivary glands, then local anesthesia will suffice, while surgery for large major salivary glands such as the parotid gland requires general anesthesia.
When do you need salivary gland removal surgery?
Salivary gland resection is usually performed to remove tumors that grow in these glands or due to blockage of their ducts. Statistical studies indicate that more than approximately 70% of salivary gland tumors are benign (non-cancerous). However, any mass that is detected must be examined and usually Both types of tumor require removal.
A person may need to have a salivary gland removed in order to remove benign tumors because they sometimes grow large and press on and harm nearby tissues, and certain types of benign tumors can turn into salivary gland cancer.
Malignant (cancerous) tumors cause damage to surrounding tissues and are characterized by their ability to spread to other areas of the body. Cancer cells break away from the original tumor and spread to more distant parts of the body through the bloodstream or lymphatic system.
may spread salivary gland cancer to nearby lymph nodes in the neck and then to other parts of the body.
Additional treatments for cancer may include: Radiotherapy and additional surgeries including lymph node removal and reconstructive procedures.
Inflammation and infection
Many diseases can affect the salivary glands, the most important of which are:
salivary gland stones
Obstruction and inflammation of the salivary glands due to the presence of calcified stones. Salivary gland stones are formed due to the accumulation of calcium deposits in the glands, preventing saliva flow in the mouth. This can cause repeated swelling of the glands and infection.
There are several ways to remove thesalivary stones Such as salivary gland endoscopy, but in some cases calcifications are located inside the gland, which must be removed.
salivary gland inflammation
You may also need to remove the gland when you have an infection of the salivary glands, which can be caused by a stone in it or caused by a virus or bacteria.
Before recommending surgery, the head and neck surgeon may order imaging studies such as a CT scan to see the submandibular gland and learn more about what obstructs saliva flow.
Your doctor may consider removing your salivary gland to control excessive salivation (excessive salivation).
This condition can occur in people with nerve problems that impair control of the mouth and face muscles, such as Parkinson's disease or stroke.
Some medications help control the condition, but if the medication is not effective, the doctor may discuss surgical removal of the salivary gland to control excessive salivation, especially if there is difficulty swallowing and there is a risk of inhaling saliva and suffocation.
For some patients, we may not have to remove the gland and just surgically line one of the salivary ducts to control the excess saliva.
Preparing for salivary gland removal
Before the surgical intervention on the case, the specialist will conduct a physical examination, confirm the medications that should be prescribed before the operation, and explain the medications that cannot be taken.
The surgeon will perform a thorough physical examination before surgery and review your past and current medical conditions. The face, neck, jaws, and inside of the oral cavity will be examined for stones, masses, or lesions.
This also includes examining facial symmetry and the function of the nerves that move the corners of the mouth and asking about any medications you take, including herbal medicines and nutritional supplements.
Examination may require tests using CT of the head and neck or MRI to plan the surgery and locate the tumor, if the tumor is close to the facial nerve. These diagnostic images help the surgeon plan the best way to remove it without causing injury Damage to the facial nerve.
If the specialist suspects a tumor, he or she may order a diagnostic biopsy using a fine needle (FNA) to remove a small sample of cells and help diagnose the type of tumor.
The presence of a carcinoma of the salivary gland will require a different treatment plan.
A procedure used to examine the ducts of the salivary glands by inserting a miniature telescope called a speculum into the opening of the salivary gland duct to explore it, and small instruments can be inserted through the microscope to remove any stones present.
Determine the date of salivary gland removal
Once the condition is diagnosed and the person's consent is obtained, the surgery date will be set.
You will receive instructions about preparing for a salivary gland removal, including what medications to take or stop taking, when to stop eating or drinking before surgery, and so on.
You may also receive instructions about stopping smoking. Smoking increases your risk of breathing problems during surgery and can slow recovery.
Salivary gland removal: What happens during the surgery?
The surgery itself takes about an hour and a half but the whole process including pre-operative preparations and post-operative recovery takes about six hours. You will be given either local or general anesthesia to make sure you are comfortable throughout the surgery.
The surgeon makes an incision (cut) in the crease of the skin in the neck below the jaw, where the scar is less visible. The length of the incision may be 2 to 3 cm.
The surgeon and the team then locate the salivary gland and carefully free it from the surrounding tissues and structures. The gland is then completely removed, and the incision is closed.
Once you are awake from the anesthesia and examined by your surgeon, you may spend the night in the hospital before you are discharged. You will be given pain medication while you recover at home.
Parotid salivary gland removal surgery
Parotidectomy is the name of the surgery used to remove a benign or cancerous tumor in the parotid glands. This procedure requires care and expertise on the part of your surgical team to ensure that the facial nerve and other structures near this gland are intentionally damaged.
You'll have the procedure in a hospital or surgery center. You usually need to stay one to two nights when the parotid gland is removed.
During the procedure:
- You will be given an intravenous sedation to keep you asleep during the surgery.
- The surgeon will make an incision that starts in front of your ear and extends back and down to the natural crease at the top of your neck. The cut pattern will help hide the wound once it has healed.
- The parotid gland is exposed and the facial nerve identified. To be careful and avoid damaging it during surgery, a facial nerve monitor may be used to ensure proper facial nerve functioning during surgery.
- Part or all of the gland and nearby lymph nodes in your neck are removed if cancer cells have spread there.
- Finally suture the incision.
The surgeon may insert a small tube called a drainage tube to catch any blood or fluid that may collect at the surgical site.
Submandibular salivary gland removal
The surgeon removes the affected gland to treat a benign or cancerous tumor of the submandibular glands.
The submandibular glands are located just below the jaw. The surgeon will make an incision below the jawline to remove the gland and surrounding tissue. The extent of the surgery depends on the size and type of tumor being treated.
The operation to remove the salivary gland under the lower jaw requires precision and skill due to the presence of important nerves close to it:
- The mandibular nerve that helps you smile
- The lingual nerve, which allows sensation in the tongue
- The hypoglossal nerve, which allows movement of the part of the tongue that helps with swallowing and speech
During surgery, your surgeon will try to preserve these and other structures whenever possible, depending on the extent and location of the tumor.
Sublingual salivary gland removal
A hypoglossal glandectomy involves removing the entire gland. These glands are located under your tongue on either side of the floor of your mouth.
The surgeon will cut your mouth to remove the gland and some surrounding tissue. The surgical area is often repaired either by closing the gap with stitches or by using a skin graft technique.
Excision of the sublingual salivary gland requires precision from the surgeon to avoid damage to the lingual nerve located in this area.
The lingual nerve is responsible for sensation and taste on the side of the tongue. A feeling of numbness may occur on the affected side of the tongue. It is usually temporary anesthesia that goes away after a few weeks to two months.
Minor salivary gland cancer surgery
Cancer can occur in one of the small secondary salivary glands found in the lips, tongue, palate, inner cheeks, throat, larynx, nose and sinuses.
Surgery depends on the size and location of the tumor. Usually, the surgeon removes some of the surrounding tissue.
Lymph node excision
Salivary gland cancers often spread to the lymph nodes in the neck first before spreading anywhere else.
This is why cervical lymph nodes that appear to contain, or are likely to contain, cancer are often removed along with some other adjacent tissues during the removal of the cancer.
Complications and risks of salivary gland removal
Salivary gland eradication is not a high-risk surgery. However, some precautions must be taken during eradication due to its accompanying and proximity to critical anatomical places. The most important of these precautions are:
There are many important nerves near the salivary glands that the surgeon is careful to avoid bruising or damaging during this operation.
Nerves that must be protected during salivary gland removal include:
- facial nerve
- The lingual nerve, which controls sensation in the tongue
- The hypoglossal nerve, which allows movement of the tongue
Damage to these nerves during salivary gland removal can lead to temporary changes in the movement of the facial muscles or loss of sensation in the areas they control, especially if extensive surgical dissection around the facial nerve is required.
Permanent damage to these nerves is a rare complication and usually results only in highly complex parotidectomy, while ear numbness is fairly common.
In some people, the condition may begin several months after surgery. People with this syndrome experience excessive sweating on the side of the face when eating.
Antiperspirants and Botox injections are suggested treatments for Frey syndrome.
First bite syndrome
The first-bite syndrome involves severe pain with the first bite of food after surgery, lessening with each subsequent chew.
Botox injections can relax the nerve causing the pain.
Complications in addition to those described above are possible after salivary gland removal, including:
- Fluid buildup under the skin that can form a cyst or mass
Other risks that apply to most surgeries, including salivary gland removal, include:
- An allergic reaction to pain medications
- Injury to a nearby organ during surgery
- Fluid collection at the surgical site
- Collection of blood at the site of surgery (hematoma)
- infection, bleeding, or scarring
The survival of scars after removing the salivary glands, especially the parotid glands, is usually minimal because of the incisions that fit the neck wrinkles so that they are difficult to see when the wound heals.
Recovery after removal and resection of the salivary gland
After salivary gland removal, the specialist will observe the patient's facial movements and ask him to smile or make facial gestures.
Once home, following your surgeon's instructions about wound care and hygiene routines is important.
The patient may return to the clinic to have the sutures removed a few days after the surgery, and you may notice some slight bruising there. Once removed, the area should be washed with mild soap and water.
He will be asked to follow wound care instructions, including keeping the wound site clean and dry and not straining or lifting any heavy objects.
You may have to get used to feeling less of a sensation in your face. This change is usually temporary.
Discuss with your doctor how the surgery will affect your daily activities during recovery, what changes you should expect, and how to plan for them before you remove the salivary gland.
When should I see a doctor?
Do not delay in contacting your doctor if you notice any of the following:
- Pain that cannot be controlled with medication
- Your face feels increasingly numb or weak
- You notice pus, fluid, or blood leaking from the wound
- Your wound feels swollen and painful
- Foul smell at the wound site
Salivary gland removal is a common surgery to remove all or part of the salivary gland due to a different gland disease. Most people have to adjust their daily routine after surgery, such as choosing foods that are easy to chew and swallow and avoiding stress.