Postoperative Instructions for Parotidectomy
The Parotid Gland: The parotid gland is a gland that produces saliva. You have two glands, one on each side of your face. The gland rests on the muscles of chewing in front of the ear canal. The gland may extend below the earlobe. The gland may need to be removed for several reasons.
- The parotid gland may develop tumors, the majority of which are benign.
- The parotid gland may become repetitively blocked with stones and subsequently infected. Most of these stones cannot be seen on X ray films.
- Six to ten lymph nodes reside in the parotid gland. These lymph nodes drain the skin of the cheek, temple, and ear.
- Some skin cancers in these areas may spread to the lymph nodes in the parotid gland.
The Facial Nerve: The facial nerve starts in the brain, exits the skull just under the ear canal, splits into 5 thin branches, and runs through the parotid gland. This nerve controls the muscles of facial expression: forehead wrinkling, eyebrow raising, eyelid squinting and blinking, lip puckering, and smiling.
Parotidectomy: Removal of some or all of the parotid gland is termed a parotidectomy. The incision starts in front of the ear canal, runs down under the earlobe, and curves slightly forward in the upper neck. Much of the procedure involves separating the parotid tissue from the fine branches of the facial nerve. After the gland is removed, the incision is closed. A small drain is often placed at the bottom of the incision to remove fluid that commonly forms after surgery.
Incision: Please keep the incision dry for 2-3 days, and then gently wash the incision with soap and water 2-3 times a day as needed. You may use Q-tips dipped in peroxide to remove any dried blood over the incision. After washing, please apply a thin film of an antibacterial ointment (e.g. Polysporin). Please avoid any activity that pulls across the incision such as shaving across the incision for at least 2 weeks. (The rest of the face may be shaved.) The staples and stitches will be removed 1-2 weeks after surgery.
Drain: Some patients are discharged with a thin drain tube and oval collecting reservoir called a grenade. When the grenade looks half full or at least 2 times a day, please record the amount of fluid and then empty the grenade. Discard the fluid in the sink or toilet.
Head of Bed: Please elevate the head of your bed 30-45 degrees or sleep in a recliner at 30-45 degrees for the first 3-4 days to decrease swelling. The skin above the incision may look swollen after lying down for a few hours.
Activity: Please avoid any activity that raises your blood pressure for one week, e.g. heavy lifting, strenuous exercise, etc.
Eye care: The nerve controlling the closure or blink of the eye may be weak for several weeks to months. The cornea or surface of the eyeball is moistened with tears by the blinking action of the eye muscles. The eyelids also close and cover the corneas while you sleep. If the blink is slow or eye closure is incomplete, then the cornea may dry out and become infected. This can lead to scarring of the cornea and blindness. If the blinking action is weak or slow, then please apply a thin film of Lacrilube to the eye before sleeping, whenever going outside on a windy or dry day, and whenever the eye feels dry or itchy. The Lacrilube will distort the vision in that eye while the ointment is present. Please do not scratch or rub a dry or itchy eye. Please call your eye doctor or us if you have vision problems after the surgery.
Diet: You may eat your regular diet after surgery. If the oral “pucker” muscles are weak, you may drool slightly when drinking or have trouble with very sticky foods like peanut butter. You may notice a slight increase in fluid from your incision while eating; this is normal and usually resolves by a few weeks.
Pain: Pain can be mild to moderate the first 24 – 48 hours, but usually declines thereafter. The sooner you reduce your narcotic medication use, the more rapid your recovery. As your pain lessens, try using extra-strength acetaminophen (Tylenol) instead of your narcotic medication.
Pain Management: A realistic goal is to reduce the patient’s pain to a manageable level, and not to eliminate the pain. One cannot predict either a patient’s pain level or the necessary dose of pain medicine in all patients. One must approach each patient in a stepwise fashion for pain management. Specifically, please start at an intermediate dose of narcotic, and increase the dose if pain remains uncontrolled, or decrease the dose if the medications’ side effects are too severe. Close monitoring of the patient for side effects of each medication is essential.