The general medical term for the surgical removal of a salivary gland is Sialoadenectomy. This procedure targets one of the three major pairs of glands: the parotid, the submandibular, and the sublingual glands. The parotid glands are the largest and are located in front of the ears. The submandibular glands sit beneath the jaw, and the sublingual glands are under the tongue. While Sialoadenectomy is the overall term, surgeons typically use a more precise name specifying the gland being removed.
Defining the Procedure
The umbrella term Sialoadenectomy categorizes the excision of a salivary gland. In clinical practice, however, the name of the operation is tailored to the specific gland involved. This allows for clear communication regarding the anatomical location and expected surgical complexities.
For the parotid gland, the procedure is called a Parotidectomy. This procedure is classified based on the extent of the gland removed. A superficial parotidectomy removes the portion of the gland outside the facial nerve, which is the most common approach. A total parotidectomy involves removing the entire gland, usually reserved for larger or more aggressive tumors.
The removal of the submandibular gland is termed a Submandibular Gland Excision, sometimes called a submandibulectomy. The removal of the sublingual glands is called a Sublingual Gland Excision. These specific terms reflect the unique surgical anatomy and potential complications associated with each gland’s location.
Primary Reasons for Gland Removal
The most frequent reason for removing a salivary gland is the presence of a mass or tumor. Approximately 65% of all salivary gland tumors are benign, but their continued growth often necessitates removal to prevent complications or malignant transformation. The parotid gland accounts for the majority of all salivary gland tumors, with the most common benign type being a pleomorphic adenoma.
The likelihood of a tumor being malignant changes significantly depending on the gland involved. While roughly 80% of parotid tumors are benign, the chance of malignancy increases for the submandibular and sublingual glands. Tumors in these smaller glands have a higher probability of being cancerous, sometimes estimated between 50% to 80% of cases. The most common form of malignant salivary gland cancer is mucoepidermoid carcinoma.
Beyond tumors, the most common non-neoplastic cause for removal is the formation of salivary stones, known as sialolithiasis. These calcified masses block the flow of saliva, causing painful swelling and infection (sialadenitis). Sialolithiasis occurs in the submandibular gland in 80% to 90% of cases. This is due to the gland’s more viscous saliva and its duct’s upward path against gravity.
Recurrent or chronic sialadenitis that is unresponsive to conservative measures is a common indication for gland removal. Conservative measures include hydration, antibiotics, and gland massage. When obstruction or infection causes irreversible damage and scarring, excision provides a definitive treatment. The decision to remove the gland is made only after less invasive procedures, such as sialendoscopy, have been unsuccessful.
Navigating the Surgical Process
The surgical process depends highly on the gland’s location, with the Parotidectomy being the most anatomically complex. The parotid gland is intimately interwoven with the facial nerve (Cranial Nerve VII), which controls facial movements. The facial nerve separates the gland into its superficial and deep lobes, making its preservation the primary technical challenge of the surgery.
To prevent permanent facial paralysis, surgeons use Facial Nerve Monitoring (FNM). This involves placing electrodes into the facial muscles. This technique allows the surgeon to identify and track the nerve and its branches by applying a weak electrical current during the dissection. The monitoring system provides immediate feedback, alerting the surgeon if the nerve is being stretched, compressed, or injured.
The submandibular gland excision is considered less challenging than a parotidectomy, but it still requires meticulous dissection. The procedure risks injury to the marginal mandibular nerve, a branch of the facial nerve controlling the lower lip depressor muscle. Surgeons also work close to the lingual nerve (sensation to the tongue) and the hypoglossal nerve (controls tongue movement).
For both major procedures, the patient is placed under general anesthesia. An incision is typically made in a natural skin crease, such as below the jawline for the submandibular gland or in front of the ear for the parotid gland. A small drain is placed in the surgical bed before the incision is closed to prevent fluid accumulation. The drain is typically removed within a day or two post-operation.
Post-Operative Recovery and Long-Term Adjustments
Initial recovery involves managing temporary swelling, bruising, and pain at the incision site. Patients are encouraged to rest and limit strenuous activity for several weeks to allow tissues to heal. Temporary bruising of nearby nerves, particularly branches of the facial nerve, can cause transient facial weakness or numbness. This usually resolves over a few weeks or months.
A unique long-term adjustment following a Parotidectomy is the potential for Frey Syndrome, often called gustatory sweating. This condition results from the misdirected regeneration of severed parasympathetic nerve fibers. These fibers, originally intended to stimulate saliva production, instead grow to innervate the sweat glands in the skin over the cheek.
When a person eats or thinks about food, the cheek on the side of the surgery sweats and may become flushed. While clinical symptoms are only noticeable in a smaller subset of patients, 30% to 50% of patients show signs of Frey Syndrome when tested. Treatments like topical antiperspirants or botulinum toxin injections can effectively manage the sweating.
The removal of one major salivary gland rarely results in permanent Xerostomia, or chronic dry mouth. The remaining salivary glands compensate by increasing saliva production to maintain oral moisture. Patients may experience a temporary reduction in saliva flow. The indication for removing more than one major gland is always carefully considered due to the increased risk of permanent dry mouth.