Salivary gland removal

About salivary gland removal

You may need to have a salivary gland removed if you have a growth in the gland (a tumour), or if a duct has become blocked. Blockages are usually caused by salivary duct stones or a narrowing of your salivary duct. 

Depending on how much of the gland is affected, you may have all or part of the gland removed.

Your salivary glands produce saliva to keep your mouth moist. It also allows you to swallow, helps keep your teeth healthy and breaks down your food as part of digestion.

There are three major pairs of salivary glands in your mouth.

  • Parotid glands. These are the largest of your salivary glands and are located on either side of your face between your cheekbone and your jawbone in front of your ears.
  • Submandibular glands. These are smaller than the parotid glands and are located under each side of your jawbone.
  • Sublingual glands. These are the smallest of the three types and can be felt as two small lumps on the floor of your mouth underneath your tongue.

As well as these major glands, there are many other tiny salivary glands throughout your mouth and throat. These are called your minor salivary glands.

Diagnosis of a salivary gland condition

Salivary gland problems are usually first noticed as either a swelling of the whole gland or as a smaller lump within the gland. When you see your GP, he or she will ask about your symptoms and examine you. Your GP may then refer you to a surgeon with a specific interest in salivary gland diseases. This will usually be an ear, nose and throat (ENT) surgeon or an oral and maxillofacial surgeon (a doctor who specialises in the surgical treatment of conditions that affect the head, neck, face and jaw).

You may need to have a blood test and an ultrasound, CT or MRI scan. If your doctor thinks you might have a tumour, you will have a biopsy taken from the affected gland. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous. Most salivary gland tumours are benign.

What are the alternatives to salivary gland removal?

Salivary gland tumours are usually treated with surgery. This is because the tumour needs to be removed to both confirm its type and to cure the problem. If you have a salivary duct stone, you can sometimes have it removed with a procedure known as a sialoscopy or with a small operation inside your mouth. In sialoscopy your surgeon uses a flexible tube (endoscope) to remove the stone.

Preparing for salivary gland removal

Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The operation is done under general anaesthesia. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during salivary gland removal?

Depending on which salivary gland you have removed, the procedure may take between 30 minutes and four hours. 

Your surgeon will make a cut into your skin. The position of the cut will depend on the type of salivary gland being removed.

  • If you have a parotid gland removed, your surgeon will make a C-shaped cut that runs from the bottom of your ear and around the edge of your jawbone. The cut is sometimes continued up the skin crease in front of your ear.
  • If you have a submandibular gland removed, your surgeon will make a cut in the upper part of your neck, just below your jawline.
  • If you have a sublingual gland removed, your surgeon will make a cut inside your mouth, under your tongue.

If there is a stone blocking a salivary duct, your surgeon may also make a cut inside your mouth to remove it.

After the affected gland is removed, the cut is closed with stitches.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may have a fine tube running out from your wound. This will drain fluid into a bottle and is removed once there is very little coming out. For submandibular gland removal this is usually the day after surgery, but for parotid gland removal it can be between two and three days later.

You will usually need to stay in hospital until your drain is removed. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your salivary gland removal.

General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Before you go home, you will see your surgeon to discuss the outcome of the procedure and whether you need any further treatment. Your nurse will advise you about caring for your healing wounds and may arrange a date for a follow-up appointment.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about two to three weeks. Non-dissolvable stitches and skin clips are removed about a week after your operation.

Recovering from salivary gland removal

It usually takes about one week to make a full recovery from salivary gland removal, but this varies between individuals, so it’s important to follow your surgeon’s advice. You may find eating and drinking uncomfortable for the first few days. Start with soft or pureed foods as they are easier to eat.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If the cuts were made outside your mouth, try to keep your wound dry for the first week after the procedure. Take care when washing and shaving your face.

What are the risks?

As with every procedure, there are some risks associated with salivary gland removal. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

You’re likely to have some bruising, pain and swelling below your jawline. You may find it painful to chew or swallow at first, and may have some loss of taste and sensation, but this is uncommon.

You will have a scar, but this will fade over time.

Complications

Complications are when problems occur during or after the procedure. General complications of salivary gland removal are listed below.

  • Infection. If you feel a burning sensation when you touch your wound, or it looks red, inflamed or swollen, contact your GP. You may have an infection and need antibiotics.
  • Nerve damage. This can be permanent and cause changes to your face or alter the movements of your tongue.
  • Frey’s syndrome. This happens when nerves that are cut during surgery reconnect abnormally with sweat glands. Your cheeks become red, flushed and you feel sweaty when you eat.
  • Build-up of saliva under your skin. If only part of a gland has been removed, saliva can leak out from the cut edge of the remaining gland into the wound and cause it to swell up. Sometimes the saliva leaks out of the wound, particularly when you eat. This usually clears up without treatment, but can take several months.

Can nerves be damaged during salivary gland removal and if so, what symptoms will this cause?

Answer

Yes, nerves can be damaged during salivary gland removal, but this is uncommon. The symptoms you have will depend on which nerves have been damaged. 

Explanation

Nerve damage is usually only temporary. However, it can sometimes be permanent and cause changes to your face or alter the movements of your tongue.

The nerves that may be damaged depend on which salivary gland is removed. Removal of a parotid gland can cause damage to your facial nerve. Your facial nerve runs through your parotid gland and controls the movement of the muscles in your face. Damage usually results in weakness in the muscles on one side of your face. This is usually temporary, but it can take up to three months or more for you to fully recover. Permanent damage is very rare.

The nerve that supplies feeling to your ear lobe (greater auricular nerve) sometimes needs to be divided or removed so that your surgeon can get to the parotid gland. This can cause a numb or tingling feeling in your ear lobe. It can take over 18 months for you to recover, but some people will be left with permanent numbness of the ear lobe, which can be a problem if you wear earrings.

Removal of a submandibular gland can cause damage to a lower branch of your facial nerve. If this happens, you may have weakness in your lower lip, which can give you a slightly crooked smile. However, this is usually only temporary. There are also two other nerves travelling near the submandibular gland that can be damaged during salivary gland removal, but this is very rare. These are the lingual nerve which, if damaged, can cause one side of your tongue to feel tingly or numb, and if the hypoglossal nerve is damaged, can cause problems with moving your tongue.

Removal of a sublingual gland can also damage your lingual nerve. If this happens, you may have a tingling or numb feeling in your tongue.

If you have any of these symptoms after salivary gland removal, speak to your surgeon.

Will my mouth be drier than it was before the operation?

Answer

No, your mouth shouldn’t become drier than it was before salivary gland removal. 

Explanation

There are three major pairs of salivary glands in your mouth. These are your parotid glands, sublingual glands and submandibular glands. As well as these major glands, there are many other tiny salivary glands throughout your mouth and throat. These are called your minor salivary glands.

If you've had a salivary gland removed, you will produce less saliva, but the other glands produce enough to prevent your mouth being dry. Your other salivary glands will still be working and the saliva from these glands will keep your mouth moist.

Will I be able to eat as I did before salivary gland removal?

Answer

Yes, you can eat as you would usually after your operation. However, eating and drinking may be difficult to begin with. 

Explanation

After your operation, your mouth may feel sore and you may have some difficulty eating. It may help if you eat soft foods to start with and gradually return to a normal diet once your mouth feels less sore. Some ideas for soft foods you can eat to begin with are soups, omelettes, noodles, casseroles, stews, yoghurt, jelly and ice cream.

Once your wound has healed, you should be able to eat as you would normally.

Will I be able to taste as well as I could before salivary gland removal?

Answer

Yes, your taste buds won't be affected by the operation. 

Explanation

Your tongue and the roof of your mouth are covered in tiny taste buds that allow you to taste. If you have a salivary gland condition, your surgeon will only remove the affected salivary glands. Your taste buds won't be affected and you should be able to taste normally after the operation. The only time you might see some change in taste is if the lingual nerve has been damaged.

If you have cancer of your salivary glands and are having chemotherapy or radiotherapy, this may affect your taste buds. You may notice some changes in the way that your food tastes. Ask your surgeon whether your treatment is likely to affect your taste.

Is cancer of the salivary glands common?

Answer

No, cancer of salivary glands is very rare. 

Explanation

About 550 people are diagnosed with cancer of the salivary glands in the UK each year. Seven out of 10 salivary gland cancers start in the parotid glands. Around two out of 10 start in the submandibular glands. Cancer of the sublingual glands is rare. It’s often very difficult to be sure a lump in a salivary gland is not cancerous without removing it surgically, so your doctor will usually suggest this to determine what type of tumour it is.