Top 6 Things to Know About Parotid Surgery

The facial nerve starts from the brain and travels out of the skull and passes through the parotid gland to get into the muscles of the face that it controls. Once the facial nerve enters the parotid gland, it generally divides into two branches, which are called the upper and lower division, and then into 5 other main branches, which further divide into many smaller branches that connect to the facial muscles. Facial nerve branching is like a tree in that no two facial nerve branch systems are the same and your surgeon won’t be able to see your facial nerve branch system until surgery begins. It is very important to understand this and appreciate that great expertise is required to be able to dissect the nerve, find all of the branches, and protect them throughout the parotidectomy.

A cutting-edge nerve integrity monitor should be used throughout the entire parotid surgery to observe and protect the facial nerve. Once the parotid tumor is removed, your surgeon should confirm the facial nerve’s function by stimulating its branches and main trunk to ensure the associated muscles are moving properly. If everything is moving properly, the incisions will be closed and the surgery will be deemed a success.

However, in some complicated cases (usually in rare and advanced cancer patients), the location and scope of the disease may prohibit the preservation of the facial nerve. In these instances, it is critical to have a facial nerve expert present for the parotidectomy so that the facial nerve can be repaired immediately, by repairing the damage with a nerve graft or other advanced techniques.

Now that you understand the close relationship of the parotid and the facial nerve, it is important that one of your top criteria for choosing a parotid surgeon is expertise in the facial nerve, so that not only is your tumor removed, but also your smile is saved!

Once the entire tumor has been removed and the facial nerve function has been checked, it is time to reconstruct the face to fill in the hollow divot left behind from the tumor. Your surgeon should reconstruct the area using muscle flaps, grafts, or a combination of both, depending on your unique needs, to fill in the divot and make both sides of the face symmetrical and balanced. When the reconstruction is performed by a facial plastic surgeon, specifically, patients are left with a beautiful aesthetic outcome and minimal scarring.

However, facial reconstruction following parotidectomy is not always the standard for surgery. Many surgeons will remove the tumor and then just close the incision. Not only will this leave you with a divot on the side of your face and an asymmetrical appearance, it also will increase your risk of future facial nerve damage and Frey’s syndrome.

Frey’s Syndrome is a preventable complication of parotid surgery. Frey’s Syndrome occurs when the nerve branches that aid in saliva production inside the parotid gland grow from the cut surface if the parotid gland into the skin and attach to the sweat glands. As a result, this causes excessive sweating on the side of the face when one is hungry or eating. This is obviously an unwanted complication of a parotidectomy, and luckily is easily preventable when a true parotid expert performs your surgery. As mentioned before, performing facial reconstruction in conjunction with your parotid tumor removal not only provides you with a positive aesthetic outcome, but it also prevents Frey’s syndrome.

When the surgeon reconstructs the face by using muscle flaps and/or grafts, it adds a layer of protective tissue on top of the facial nerve. This layer of protection stops branches of the parasympathetic nerve from being able to attach to the sweat glands. When having parotid surgery with a specialist, your risk of Frey’s Syndrome should be reduced to less than 1%.

Once you have found a team of surgeons that have the expertise necessary to provide you with a micro-parotidectomy incision, facial nerve preservation, complete tumor removal, facial reconstruction and Frey’s Syndrome prevention, it is important that you feel 100% comfortable with them. There are many surgeons out there who have the credentials to perform your parotidectomy, but we recommend finding a team of surgeons in which you can create a very positive and trusting inter-personal relationship with as well.

At the CENTER for Advanced Parotid & Facial Nerve Surgery our multi-specialty team approach to minimally invasive parotidectomy ensures patients have access to specialists for every aspect of their parotid disease. With expertise in head & neck surgery, the facial nerve, and facial plastic & reconstructive surgery, our parotid surgery team delivers superior surgical outcomes. Complimenting this unparalleled medical expertise with a dedication to compassionate patient care, makes the CENTER for Advanced Parotid & Facial Nerve Surgery a highly sought after destination for patients from around the world.

Dr. Babak Larian, Director of The CENTER for Advanced Parotid & Facial Nerve Surgery, is internationally renowned for his expertise in parotid surgery. Dr. Larian is highly respected in his field, as he has published numerous scientific articles, is the Chief of Head & Neck Surgery at Cedars-Sinai Medical Center, has presented new techniques to physicians from around the world, and has been featured on The Doctors TV Show multiple times. Along side Dr. Larian, his partner Dr. Babak Azizzadeh, provides expertise in facial nerve preservation and facial reconstruction, both of which are crucial components in delivering a successful parotid tumor removal surgery in regards to function and aesthetics.

Dr. Azizzadeh is the most highly respected doctor in his field and has penned five textbooks, contributed to hundreds of medical journals, and has been featured in many media outlets, including The Oprah Winfrey Show. For the most complex parotid tumor removal cases, Dr. William Slattery, an otology and neurotology specialist from the world-renowned House Ear clinic, joins Dr. Larian and Dr. Azizzadeh in the patient’s care. In addition to their individual achievements, our team of surgeons has collaborated on top-selling textbooks. Together Dr. Azizzadeh and Dr. Slattery co-edited and authored the definitive book for facial nerve disorders called “The Facial Nerve,” and Dr. Larian and Dr. Azizzadeh are authors of the book entitled “Parotid Surgery” for Elsevier’s Clinics in Otolaryngology.

It is the combination of our multi-specialty team of surgeons’ expertise and their dedication to providing compassionate care that ensures all of our patients the best parotid treatment available.