The major salivary glands—the parotid, submandibular, and sublingual glands—produce saliva necessary for digestion and oral health. Saliva, a fluid composed of water, electrolytes, mucus, and enzymes, is secreted into the mouth through small ducts. When a gland develops a disease untreatable by medication, surgical removal becomes necessary to resolve the underlying medical issue.
Understanding the Medical Terminology
The umbrella term for surgical removal of a salivary gland is sialoadenectomy or salivary gland excision. This general term is rarely used in clinical practice, however, as the procedure is usually specified by the gland being removed. For the largest glands, located in front of the ears, the procedure is termed a Parotidectomy, signifying the removal of all or part of the parotid gland. Removal of the gland beneath the lower jaw is called a Submandibular Gland Excision or Submandibular Sialoadenectomy. This distinction is important because the anatomical structures, particularly the nerves near each gland, vary significantly, influencing the surgical approach and potential outcomes.
Reasons for Salivary Gland Removal
The most frequent reason for removal is the presence of a tumor. Most tumors, particularly those in the parotid gland, are benign. Even benign tumors are often surgically removed because some types have the potential to become malignant, and the procedure confirms the diagnosis and prevents future complications.
Malignant (cancerous) tumors are a definite indication for removal and often require excision of the entire gland and possibly surrounding lymph nodes to prevent disease spread. Another common trigger is the obstruction of the gland’s duct by calcified deposits, known as sialolithiasis or salivary stones. If a stone cannot be removed by less invasive techniques like sialendoscopy, the entire gland may need removal to resolve the painful blockage and chronic inflammation.
Recurrent or chronic infection of the gland, called sialadenitis, may also lead to surgery if it does not respond to antibiotic treatment or is linked to a blockage. This chronic inflammation causes recurring swelling and pain, severely impacting a patient’s quality of life. In rare instances, excessive drooling (sialorrhea), particularly in patients with certain neurological conditions, may be managed by removing the submandibular glands to reduce overall saliva production.
How the Surgery is Performed
The surgical process begins with the patient under general anesthesia for the major salivary glands, ensuring they are asleep throughout the procedure. The specific surgical approach is dictated by the gland’s location and the extent of the disease, though all procedures aim for the least visible incision possible. For a parotidectomy, the surgeon typically makes a curved incision starting in front of the ear and extending down into the neck, often following a natural skin crease.
The parotid gland is complex because the facial nerve, which controls all the muscles of facial expression, passes directly through it, dividing it into superficial and deep lobes. Preserving this nerve is the surgeon’s highest priority. Specialized facial nerve monitoring tracks the nerve’s function throughout the operation. A Superficial Parotidectomy removes only the outer lobe, typically for benign tumors, while a Total Parotidectomy removes the entire gland when the tumor is deeper or malignant.
For a submandibular gland excision, the incision is made just below the jawline, typically two to three centimeters in length. This location requires careful attention to nearby nerves, including the marginal mandibular nerve, which controls lower lip movement. Once the gland is separated from surrounding tissues and nerves, it is removed entirely. Procedure length varies widely, generally ranging from one to a few hours depending on the gland’s size, the disease’s nature, and the tumor’s proximity to delicate nerves.
Recovery and Potential Side Effects
Immediately following surgery, patients are typically monitored in the hospital for one night, though minor procedures may allow for same-day discharge. A small drainage tube is often placed in the wound to prevent fluid accumulation and is usually removed within the first day or two. Pain is managed with medication, and patients are generally advised to keep their head elevated to minimize swelling in the surgical area.
The primary concern following major salivary gland removal is potential temporary or permanent weakness of the facial muscles due to nerve manipulation. Temporary facial weakness is common and often resolves as the nerve recovers over weeks or months. Permanent paralysis is a less frequent outcome but is a known risk, particularly when a malignant tumor necessitates sacrificing a portion of the nerve.
A unique long-term complication, especially after parotidectomy, is Frey Syndrome, also known as gustatory sweating. This condition occurs when severed parasympathetic nerve fibers, which once stimulated saliva production in the gland, mistakenly regrow and attach to sweat glands in the overlying skin. The patient then experiences sweating and flushing on the cheek or temple area while eating or thinking about food. While it occurs in 30% to 50% of parotidectomy patients, it is often mild, and bothersome cases can be treated with botulinum toxin injections.