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Parotid and Salivary Gland Center

The Parotid and Salivary Gland Center addresses the needs of patients who have developed salivary gland disorders, including benign and malignant parotid tumors.  The expertise and experience of our surgeons and medical staff, coupled with the cutting edge technology and research of our medical education program, provides patients with the most current diagnostic and surgical options available.

Services offered by the Salivary Gland Center include:

  • Surgery for Benign and Malignant Salivary Gland Tumors
  • Parotid Nerve Sparing Surgery
  • Salivary Gland Stone Extraction
  • Sialendoscopy and Minor Salivary Gland Surgery
  • Management of Dry Mouth due to Sjogren’s Syndrome, Radiation Therapy, and other Conditions
  • Reconstructive Surgery of the Facial Nerve
  • Reconstructive Surgery to Correct Parotid Surgery Facial Defects
  • Management of Traumatic Injury to the Salivary Glands
  • Fine Needle Aspiration (FNA) and other Biopsies, Diagnostic Testing, and Second Opinion Interpretations

Why a Parotid Surgery Specialist?

Surgery is the most commonly recommended course of treatment for parotid tumors, both benign and malignant. The nerves controlling facial movement run through the parotid glands and care is needed during surgery to avoid damaging the nerve, which would potentially impact facial movement and feeling. Our surgeons are experts in parotid surgery and utilize the most current surgical techniques and facial nerve monitoring systems in order to protect and preserve the function of the facial nerves as well as minimize any scarring or facial asymmetry. Included in our Salivary Gland surgery team is a Plastic and Reconstructive surgeon that will mitigate the affect of the parotid tumor and the surgical scar, helping to restore your original appearance. See examples of parotid surgery results.

Anatomy of the Salivary Glands

There are three major salivary glands located under and behind the jaw; the parotid, the sublingual, and the submandibular, with many other smaller ones located throughout the mouth and throat. The parotid glands are the largest of these salivary glands and are found on each side of the jaw, below the ear, and produce saliva that is secreted through the salivary ducts into the mouth in order to keep the mouth moist and facilitate the beginning of the digestive process.

All of the salivary glands can develop tumors but most often they occur in the parotid gland. The majority of parotid tumors are non-cancerous (benign) with approximately 20% being identified as cancerous (malignant). Surgery is the recommended course of treatment for almost all parotid gland tumors, whether benign or cancerous. Cancerous tumors may require additional treatment in addition to surgery.

What Are Parotid Tumors?

Parotid tumors are abnormal growths within the parotid salivary gland(s). Most of these growths are non-cancerous (benign) but in some cases they can be cancerous (malignant). In some cases the growth in the parotid gland can be the result of enlarged lymph nodes or tumors from other organs which have spread into the parotid glands. Symptoms of parotid gland tumors can include:

  • Changes in the symmetry of the face
  • Difficulty eating or swallowing
  • Difficulty opening the mouth
  • Fluid draining from the ear
  • Pain, numbness or weakness of the face
  • Swelling or lump in the cheek, jaw, mouth or neck

How Are Parotid Tumors Diagnosed?

If your primary care physician or other health care provider suspects a parotid gland tumor you will be referred to a Head and Neck surgeon for a complete examination of your salivary glands.  Patients who suspect a salivary gland problem can self-refer to the Parotid and Salivary Gland Center as well. As part of the examination a CT scan or MRI scan may be ordered to further determine the size and position of the parotid tissues. A Fine Needle Biopsy (FNA) procedure may also be ordered; this test will withdraw a small amount of tissue from the parotid gland to see if malignant cells are present.

What is the Best Course of Treatment for a Parotid Tumor?

For benign tumors that that are not enlarging and are causing no symptoms, regular observation may be an option, but in the majority of cases surgery is advised because benign tumors have the potential to grow or become cancerous, with treatment becoming more difficult the larger the tumor becomes. The most effective course of treatment for a parotid tumor is a parotidectomy, which is a partial or complete removal of the affected gland.

Parotid Surgery (Parotidectomy)

A parotidectomy is performed when there is a tumor or mass in the parotid gland, a chronic infection of the parotid gland, or an obstruction of the saliva outflow from the parotid gland that cannot be treated by other means.

Parotid surgery can be a challenge due to variations in tumor size and location, and requires a skilled Head and Neck Surgeon because the nerves that control facial movement run through the parotid gland. The amount of parotid gland that is removed is determined at the time of surgery based on the size and location of the tumor and a pathologist’s examination of the tissue removed during the surgery. Most tumors can be addressed with only a partial removal of the gland, avoiding interaction with the facial nerve, but advanced tumors often require removal of tissue located deep within the gland meaning that the surgery has the potential to impact the facial nerve unless the procedure is performed by a skilled surgeon. In some cases the advanced tumors may spread to the lymph nodes in the neck and require the removal of these nodes or, if the tumor is aggressive and has invaded into the surrounding structures, more extensive procedures may be required.

The surgeons of the Salivary Gland Center are specialists in parotid gland surgery and utilize the most current surgical techniques and nerve monitoring equipment in order to protect and preserve the function of the facial nerves as well as minimize scarring or facial asymmetry. Parotid surgery can be performed in conjunction with the services of a Plastic and Reconstructive surgeon who will restore your natural facial appearance and correct the facial depression (parotid defect) that results from the removal of the gland.

Sialendoscopy

Sialendoscopy is a minimally invasive procedure that is effective for both the diagnosis and management of obstructive salivary gland disorders, including the removal of salivary gland stones. Miniaturization of endoscopes and enhancements in fiber-optic video capability and computing technology has recently enabled the development of specialized equipment and procedures that allow the physician to visualize the salivary gland duct, identify obstructions or infections, and perform therapeutic measures. Sialendoscopy represents a significant advancement in the treatment of diseases and disorders of the salivary glands that were previously only able to be addressed through surgery.

This minimally invasive procedure offers numerous advantages over the traditional approach of surgically removing the affected salivary gland (sialendectomy) including no residual scarring, elimination of the possibility of facial nerve damage and paralysis, and lower complication rates. Because sialendoscopy procedures are performed on an outpatient basis under a local anesthetic (similar to a visit to the dentist) patients can go home the same day, and patients that are on anticoagulant or other medicine therapies that would be disrupted by surgery do not have to modify their regimes.

Sialendoscopy has shown itself to be a better diagnostic technique for salivary gland disorders than conventional radiology, ultrasound, computed tomography (CT),or magnetic resonance imaging (MRI), all of which are traditional and proven methods for evaluating salivary duct system problems. Sialendoscopy is appropriate for patients with sialolithiasis, salivary gland stones, infected salivary glands, stenotic disease, Sjögren's syndrome, radioiodine-induced sialadenitis, or children with recurrent parotitis.

Dr. Aslam is an experienced sialendoscopy user and can perform both diagnostic and therapeutic  sialendoscopy procedures.

Other Salivary Gland Procedures

Minor Salivary Gland Surgery
Tumors sometimes occur in the minor salivary glands. The surgeon will make an incision in the area where the gland is located and remove the tumor as well as any surrounding tissue and bone that may be affected.

Submandibular Sialoadenectomy
In the case of a Submandibular Sialoadenectomy the surgeon will make an incision in the neck, below the jawline, and the submandibular gland will be removed. If the purpose of the surgery is to remove a stone that has grown in the gland the stone will also be removed.

Sublingual Gland Surgery
Sublingual Gland Surgery is most often performed to remove a cyst (ranula). The sublingual gland is usually accessed through an incision in the mouth but if the cyst is large the surgeon may also need to make an incision in the neck.

Salivary Duct Stones
Salivary duct stones are crystallized minerals, primarily calcium, in the ducts that drain the salivary glands. When the ducts become obstructed and saliva cannot exit (sialolithiasis), it backs up into the excreting gland resulting in a dry mouth, discomfort, and swelling of the face or neck. Symptoms are the most prominent when eating or drinking. Risk factors associated with salivary duct stones include dehydration, malnutrition or eating disorders, alcoholism with cirrhosis of the liver, kidney failure or thyroid problems, or it can result from the use of certain medications.

Salivary duct stones may pass on their own but in most cases the stone will not come out by itself and needs to be removed in order to provide relief. Sometimes this can be accomplished by massaging the gland with heat or from inside the mouth with a thin blunt instrument (this procedure should be only be performed by your physician).

In some cases the stone needs to be removed by sialendoscopy, a process that utilizes small, lighted scopes that are inserted into the gland's opening in the mouth in order to visualize the salivary duct system and locate the stone. Once identified, the surgeon can retrieve the stone by using small, specially designed instruments. If a sialendoscopy cannot retrieve the stone a minor procedure (sialoadenectomy) may be necessary to remove it.

Sialodochoplasty
Sialodochoplasty is a procedure to repair an infected or traumatized salivary duct. It is often performed during a sialolithotomy in order to prevent re-stenosis (re-narrowing) of the salivary ductal system.

Make an Appointment

To make an appointment or schedule a second opinion consultation with our surgeons please contact our Patient Representative.

Head and Neck Surgery Specialists   504.988.1965   1.888.284.3726   headandnecksurgery@tulane.edu