ParotidectomyThe parotid gland is a major salivary gland located just in front of the ear beside the jawbone. It is important in producing the watery saliva necessary during mealtime to assist in the swallowing and digesting solid food. Common reasons to need part or all of the parotid gland removed include chronic infections, growths or tumors, or enlargement due to chronic obstructions. Only 20% of tumors of the parotid are malignant. If a malignancy is identified, the majority of the gland is removed in addition to surrounding lymph nodes in the neck (neck dissection). Special mention is made to another important structure, the facial nerve. This nerve is one of the cranial nerves and is responsible for moving the muscles of one side of the face. It travels right through the substance of the parotid gland and has to be kept safe throughout the procedure. However, the nerve is always at risk during the procedure. Rarely, the nerve is intentionally cut because of malignancy involving the nerve. If this were to be necessary, nerve grafting can be considered. In order to avoid fluid collections at the surgical site, a drain is place under the skin and will be removed in a day or two. If after removing the gland a significant defect along the facial contour is left, soft tissue augmentation with dermal grafts can be performed as reconstruction. You should discuss this option with Dr. Speyer prior to scheduling the surgery. Dr. Speyer will discuss the risks, benefits, and alternatives to this procedure with you in detail. Listed below are some of the disclosed risks of undergoing a parotidectomy. By reading and signing below, you are stating that you indeed understand the nature of the procedure, the risks as listed, and alternatives to undergoing the procedure. Risks of parotidectomy include, but are not limited to, bleeding, infection, facial nerve weakness or paralysis, which may be temporary or permanent requiring additional treatment and/or surgery. Parotidectomy risks also include fluid collections (seroma or sialocele) and Frey’s syndrome or gustatory sweating (sweating at mealtime due to nerve endings regenerating into the sweat glands of the face skin). Malignancies carry the risk of recurrence, failure to clear all of the margins with residual tumor left behind, the need for additional treatment such as radiation. If a neck dissection is performed as well, this carries with it additional risks of nerve injury, shoulder dysfunction, chyle leak, damage to surrounding veins and/or arteries. All incisions carry the risk of scarring or keloid formation, which will be minimized by hiding the incision in a skin crease and using fine sutures to result in the most acceptable cosmetic outcome. Lastly, since you are undergoing a general anesthetic, this alone carries its own risks regardless of the surgery considered. The risks of general anesthesia include, but are not limited to, the risk of heart attack, stroke, drug reactions, and even death. You should discuss your specific risks assessment with the anesthesiologist during your preoperative anesthetic appointment.
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