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Parotidectomy: what the operation involves | CION Cancer Clinics
A parotidectomy is an operation to remove a lump together with part or all of the parotid gland, the saliva gland just in front of and below the ear. You are fully asleep. The cut is hidden in the skin creases around the ear. The surgeon finds the facial nerve, which runs through the gland, and works around it. Most people have a short hospital stay. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What happens in a parotidectomy?
- What does the surgeon do, step by step?
- Why would a parotidectomy be advised?
- What do the words on the consent form mean?
- Who is it not suited to, and what can this page not tell you?
- What do families often believe about parotid surgery?
- Common questions about parotidectomy
The short answer
What happens in a parotidectomy?
A parotidectomy removes a lump together with part or all of the parotid gland, the large saliva gland in front of your ear. You are fully asleep, the cut runs in the skin creases around the ear, and the surgeon works carefully around the facial nerve that passes through the gland.
Where the parotid gland sits
You have two parotid glands, one on each side of the face. Each sits over the angle of the jaw, just in front of and below the ear. It makes saliva and drains it into the mouth near the upper back teeth. Losing one gland rarely causes a dry mouth, because the other saliva glands carry on working.
Why the facial nerve shapes the whole operation
The facial nerve moves your forehead, eyelids, cheek and lips. It enters the gland just below the ear and splits into branches inside it, like the fingers of a hand. The surgeon has to find the main trunk first, then follow each branch so the lump can be lifted away without cutting them. This is the slow, careful part of the operation, and it is why the surgery takes longer than people expect for a lump that looks small.
Your own surgeon will explain which part of the gland they plan to remove. That depends on where your lump sits.In the operating theatre
What does the surgeon do, step by step?
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You are put to sleep
The anaesthetist gives you a general anaesthetic. If nerve monitoring is being used, fine wires are placed in the muscles of your face after you are asleep, so you feel nothing.
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The cut
The cut starts in the crease in front of the ear, curves under the ear lobe and runs into a natural fold of the upper neck. The skin is lifted forward like the page of a book to show the gland.
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Finding the facial nerve
The surgeon uses fixed landmarks near the ear canal to find the main trunk of the nerve. Nothing is removed until the nerve has been seen.
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Removing the lump with gland around it
Each branch is followed and gently separated from the gland. The lump comes out with a layer of normal gland around it, so that nothing is left behind at the edges.
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Checking and closing
The surgeon checks the nerve, stops any bleeding and usually places a thin drain, a tube that carries away fluid. The skin is closed with fine stitches.
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Waking up
In recovery the team asks you to raise your eyebrows, close your eyes and smile. This is the first check of how the nerve is working.
Not sure whether this applies to you?
Ask an oncologistThe reasons
Why would a parotidectomy be advised?
Most lumps in the parotid gland are not cancer. The operation is still usually the way to remove them and find out exactly what they are.
A slow-growing benign lump
The most common reason. A benign lump is one that is not cancer. The commonest type, a pleomorphic adenoma, keeps growing slowly and can rarely change over many years, so removal is usually advised.
A lump that could be cancer
When a needle test or scan cannot settle the question, removing the lump gives the laboratory the whole piece to examine.
Signs that raise concern
- A lump that is growing quickly
- Pain in the lump
- Weakness of the face on that side
Cancer of the gland itself
For a salivary gland cancer, surgery is usually the main treatment. The team may also remove lymph nodes, the small glands in the neck where cancer can spread.
Skin cancer that has spread
Some skin cancers of the scalp, face or ear spread to the lymph nodes inside the parotid gland. Removing the gland clears those nodes.
On your consent form
What do the words on the consent form mean?
- Superficial parotidectomy
- Removal of the outer part of the gland, the part lying outside the facial nerve. This is the most common version.
- Total parotidectomy
- Removal of the whole gland, including the deep part that lies beneath the nerve.
- Facial nerve preservation
- The plan to keep every branch of the nerve whole. It is the aim in almost every operation.
- Frozen section
- A quick look at the tissue under the microscope while you are still asleep, to help guide the surgeon.
- Histopathology
- The full laboratory report on what was removed. This is the final answer on what the lump was.
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Did you know
The facial nerve moves your face but does not carry feeling. The numbness around the ear lobe that most people notice afterwards comes from a different, small skin nerve that is often cut to reach the gland.
Being straight with you
Who is it not suited to, and what can this page not tell you?
A parotidectomy is not the answer to every swelling near the ear. A swollen gland from an infection or a stone, or a swelling that comes and goes with meals, is usually treated in other ways first.
When the team may hold back
If you have serious heart or lung problems, the anaesthetic risk may outweigh the benefit of removing a small, slow-growing benign lump. Some older people with such a lump choose regular checks instead. Your team will weigh your general health, the type of lump and your own wishes. That decision belongs to you and them, not to this page.
What only your own reports can show
This page cannot tell you how large your operation will be, whether your nerve is close to the lump, or what the lump is. Those answers come from your scan, the needle test and, finally, the histopathology report.
Ask your surgeon to draw where the lump sits in relation to the nerve. Most are happy to do this.Commonly believed
What do families often believe about parotid surgery?
"If the lump does not hurt, it can be left alone."
Most parotid lumps do not hurt, including some cancers. Pain is not a reliable guide. A lump that is left grows larger, and a larger lump means more handling of the nerve when it is finally removed.
"The face will be crooked for life after this surgery."
Some weakness straight after surgery is common, because the nerve has been handled. In most people it settles over weeks to months. Lasting weakness is much less common and is more likely when a cancer has grown into the nerve.
"Only the lump will be taken out, not the gland."
Shelling out the lump alone leaves cells behind and makes a return more likely. Removing it with a layer of normal gland is safer, and your mouth still makes enough saliva.
"Opening the lump will make it spread."
A careful needle test before surgery does not spread the disease. It helps the team plan the right operation from the start.
Questions we are asked
Common questions about parotidectomy
How long does the operation take?
It usually takes a few hours, and longer when the lump is large, sits deep in the gland or the operation is being repeated. Much of the time goes into finding and following the facial nerve. Your family will be told roughly how long to expect, and someone from the team will update them if it runs longer.
Will I have a big scar on my face?
The cut is placed in the crease in front of the ear, under the ear lobe and into a fold of the neck. Once healed it is usually hard to see from the front. It looks red and firm at first, then softens and fades over the following months.
How long will I stay in hospital?
Most people have a short stay and go home once the drain is out, eating is comfortable and the wound looks healthy. The exact stay depends on your general health and how much fluid the drain collects. Ask the team before surgery so that the family can plan travel and time off work.
Will my face be weak when I wake up?
It might be. Some weakness of the lip, cheek or eyelid is common after the nerve has been handled, even when every branch is kept whole. It usually improves over weeks to months. If your eyelid does not close fully, the team will show you how to protect the eye before you go home.
Is the surgery very painful?
Most people describe soreness and tightness rather than severe pain. Chewing and opening the mouth wide can feel stiff for a while. Regular pain relief given by the team usually keeps it well controlled. Tell the nurses early if the pain is not settling, rather than waiting for the next round.
Will I still be able to eat and make saliva?
Yes. You have other saliva glands, including the parotid on the other side and glands under the jaw and tongue. Most people notice no lasting dryness. You can usually start eating soft food soon after waking, once the anaesthetic has worn off.
When will I know what the lump was?
The final histopathology report takes some days, and longer if special stains are needed. Your surgeon will go through it with you at a follow-up visit. If the lump turns out to be cancer, that report guides whether any further treatment such as radiotherapy is needed.
Is parotidectomy covered by Aarogyasri or insurance?
Often yes, when the surgery is approved under the scheme or policy. Aarogyasri, CGHS, ECHS, EHS and cashless insurance are all worth checking before admission. Coverage depends on your card, your policy and the diagnosis, so bring your documents and ask the helpline to check before you travel.
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Sources
- Cancer Research UK — Surgery for salivary gland cancer
- American Cancer Society — Surgery for salivary gland cancer
- Macmillan Cancer Support — Salivary gland cancer
- National Cancer Institute — Salivary Gland Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Superficial vs total parotidectomyWhich part of the gland is removed, and why it mattersThe facial nerve: the central risk of this operationWhy the nerve shapes the whole operationRecovery after parotidectomyThe drain, the wound and the first weeks at homeThe day of the operationFasting, arrival and what your family can expect
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