About the Procedure
Parotidectomy is surgery to remove part or all of the parotid gland, the largest salivary gland, located in front of and below the ear. It is most often performed for a parotid tumor, which is frequently benign but is usually removed to confirm the diagnosis and prevent growth or future problems.
The facial nerve, which controls movement of the face, passes directly through the parotid gland. A central focus of the operation is identifying and protecting this nerve, which is why parotid surgery is performed by surgeons experienced with this anatomy, often using nerve monitoring.
Norelle Health approaches parotidectomy with careful preoperative evaluation, including imaging and often a needle biopsy, and with attention to facial nerve preservation and appearance. The right plan depends on the size, location, and type of the gland problem, imaging findings, and the patient's goals.
How we approach the decision
Parotid surgery is planned around the diagnosis and around the facial nerve that runs through the gland. A consultation helps clarify several points.
- What does imaging and a needle biopsy suggest about the parotid tumor, and is it likely benign or malignant?
- How much gland needs to be removed, and where does the tumor sit relative to the facial nerve?
- If salivary gland cancer is suspected, do the neck nodes or reconstruction need to be addressed?
The plan depends on the size, location, and type of the problem.
Considering parotidectomy? The next step is a quiet, unhurried conversation.
What happens next
Care usually follows a sequence.
- Evaluate the mass with examination, imaging, and often a fine-needle biopsy.
- Plan the extent of surgery, from partial or superficial to total parotidectomy.
- Identify and protect the facial nerve, often with nerve monitoring, and address neck nodes when cancer is present.
- Plan reconstruction and, when a nerve segment must be removed, reanimation options.
- Use pathology to guide any further treatment and follow-up. Other salivary gland surgery options are considered when the diagnosis points elsewhere.
When to seek urgent care
After parotid surgery, some symptoms need prompt attention.
- Emergency: significant bleeding or a rapidly expanding swelling at the surgical site needs emergency care.
- Same-day: new or worsening facial weakness, inability to close the eye, fever, or spreading redness should prompt a same-day call to the surgical team.
- Routine: numbness near the ear, a firm feeling along the incision, and mild swelling can be reviewed at a scheduled visit.
The online consultation form is not an emergency service.
Who may be a candidate
Surgery may be recommended for several parotid gland problems.
- A mass or lump in or in front of the ear
- A tumor that is enlarging, symptomatic, or suspicious on imaging or biopsy
- Confirmed or suspected salivary gland cancer
- Chronic infection or stone disease that does not respond to other treatment
Imaging and often a fine-needle biopsy help plan the operation.
How it is performed
Parotidectomy is performed under general anesthesia through an incision near the ear that extends into the neck, designed to be hidden in natural creases when possible. The surgeon identifies the facial nerve and carefully dissects the gland away from it.
A superficial parotidectomy removes the portion of the gland outside the nerve, while a total parotidectomy removes deeper tissue when a tumor requires it. Facial nerve monitoring is often used to help protect movement, and when cancer is present, nearby lymph nodes may also be addressed.
Recovery and aftercare
Many patients go home the same day or after an overnight stay. A small drain may be placed and removed within a day or two.
Temporary numbness of the ear and cheek is common, and some patients have temporary facial weakness from handling the nerve, which usually improves. Swelling and a firm feeling along the incision are expected early on. Most patients resume light activity within one to two weeks.
Risks and alternatives
Risks may include temporary or, less commonly, lasting facial weakness, numbness near the ear, bleeding, infection, salivary leak or collection, scarring, and Frey syndrome, in which the cheek sweats or flushes with eating. Risk depends on the size and location of the tumor relative to the nerve.
Alternatives depend on the diagnosis and may include observation for selected small benign-appearing masses, repeat imaging or biopsy, or, for cancer, additional treatment such as radiation. The plan is individualized after evaluation.
Types of parotidectomy
The extent of surgery is matched to the tumor's size, location, and depth within the gland.
- A partial or superficial parotidectomy removes tissue from the outer portion of the gland
- A total parotidectomy removes both the superficial and deep portions while preserving the facial nerve when possible
- More extensive operations are reserved for tumors that involve the nerve or adjacent structures
Terminology varies among surgeons, so the focus is on what tissue will be removed and why rather than on a single label.
Facial nerve identification and monitoring
Because the facial nerve and its branches pass through the gland, the surgeon identifies the nerve and carefully separates it from the gland and tumor. Nerve monitoring may assist with identification and provide feedback during the operation.
Temporary weakness can result from stretching or inflammation even when the nerve remains intact. A tumor that surrounds or invades the nerve can make preservation unsafe, and when a segment must be removed, grafting, nerve transfer, or other facial reanimation options may be considered. If weakness affects eye closure, the eye is protected promptly.
Long-term considerations
Numbness around the ear may improve slowly and may not fully return. Scar and contour changes evolve over months, and when facial weakness is temporary, recovery can take time.
Malignant tumors and selected benign tumors require ongoing surveillance. Rehabilitation may include facial therapy, eye care, scar management, or treatment of Frey syndrome if it develops.
Results and follow-up
Removing the gland tissue allows a definitive pathology diagnosis. For benign tumors, surgery usually resolves the problem, while for cancer, pathology guides whether additional treatment is recommended.
Follow-up includes wound and facial nerve checks, scar care, and surveillance when the diagnosis is cancer. Frey syndrome and other late effects can be managed if they develop.
Clinical perspective
Our head and neck surgeons plan the extent of parotid surgery around the tumor while making facial nerve identification and protection central to the operation. Factors that influence the plan include the size, depth, and location of the tumor relative to the nerve, the likely diagnosis from imaging and biopsy, signs of malignancy, and overall health. Temporary facial weakness can follow handling of the nerve even when it stays intact, while a tumor that invades the nerve can make preservation unsafe and may call for grafting or reanimation. The right extent requires individualized specialist review.
What to bring to your consultation
For a focused review, gather prior imaging, any biopsy or pathology results, a current medication list, and a written timeline of how the mass has changed. A consultation can clarify the likely diagnosis, the planned extent of surgery, the steps taken to protect the facial nerve, and what to expect during recovery. For urgent symptoms, follow the guidance above rather than using the routine form.
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Specialists who perform parotidectomy
Dr. Moustafa Mourad
MD, FACS
Double Board-Certified Head & Neck and Facial Plastic & Reconstructive Surgeon
Dr. Moustafa Mourad is a double board-certified head and neck and facial plastic and reconstructive surgeon who cares for the full range of cosmetic and complex conditions affecting the face, head, and neck.
- Facial plastic and reconstructive surgery
- Head and neck cancer surgery
- Microvascular free-flap reconstruction
- Facial trauma and reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
A superficial parotidectomy removes the portion of the gland outside the facial nerve, while a total parotidectomy also removes the deeper portion when a tumor requires it, with the nerve preserved when possible.
Temporary weakness from handling the nerve often improves over weeks to months. When a nerve segment must be removed, grafting, nerve transfer, or other reanimation options may be discussed.
It is surgery to remove part or all of the parotid salivary gland, located in front of and below the ear, most often to treat a tumor while protecting the facial nerve.
The goal is usually to preserve the nerve, but a tumor that directly involves it may require removing a segment to treat the disease. The surgeon discusses this possibility and reconstructive options before surgery.
Many patients do, although practice varies. A small drain helps remove fluid and is removed based on the surgeon's protocol and how much fluid is draining.
The incision and extent depend on the tumor's location and on safety. Smaller or modified incisions may be possible in selected cases, but complete treatment and nerve safety take priority over incision length.
Most parotid tumors are benign, but removal is commonly recommended to confirm the diagnosis and prevent growth, since some can change over time.
The facial nerve runs through the gland, so protecting it is central to the operation. Temporary facial weakness can occur from handling the nerve and usually improves; lasting weakness is less common.
The incision is placed near the ear and extends into the neck, designed to follow natural creases so it heals less noticeably.
Frey syndrome is sweating or flushing of the cheek during eating that can develop after parotid surgery. It is manageable if it occurs, and the team can discuss options.
A fine-needle biopsy is often done before surgery, along with imaging, to help determine the type of tumor and plan the operation.
Many patients resume light activity within one to two weeks. Numbness near the ear and a firm feeling along the incision can take longer to settle.
If cancer is present or suspected, nearby lymph nodes may also be addressed at the same operation, depending on the diagnosis and imaging.
Clinical References
These independent resources from medical and professional organizations offer further reading. They are provided for general education and do not replace a consultation with a clinician.
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