The parotid gland plays an essential role in producing saliva which helps to lubricate the food we eat. This helps in facilitating swallowing of food. The parotid glands are located on either side of the face, in front as well as beneath the ears. These parotid glands can occasionally have abnormal growths of cells or tumours. Tumours can occur in any salivary gland found on the cheeks, throat or mouth. However, the most widely found salivary gland tumours are those of the parotid gland. Not all parotid tumours are cancerous, most are benign. The parotid tumours induce a pricking sensation in the face and can cause facial nerve damage, leading to loss of facial movement. This is the key reason why it is necessary to not neglect parotid tumours. However, it is important to have these tumours assessed by an ear, nose and throat specialist to rule out any malignancy.

What are the causes of parotid gland tumours?

The most common cause of salivary gland tumours is mutations occurring in the salivary gland DNA. Such mutations can be induced due to radiation exposure, smoking and dehydration. When a mutation occurs in the DNA of salivary glands, it can cause an abnormal increase in cell division due to the accumulating cells forming a tumour. Benign tumours can become malignant if additional changes occur in the DNA. If a malignancy is present, then the cancer tissues can destroy the surrounding oral tissues and even spread across distant areas of the body. Tumours can lead to blockages in salivary ducts resulting in slow drainage of saliva.

What are the symptoms of a parotid gland tumour?

When a salivary gland tumour is present, then the following signs and symptoms are observed:
● A swelling in the jawline, neck or mouth
● Facial numbness
● Facial muscle weakness
● Discomfort and pain in the salivary gland area
● Trouble swallowing food
● Difficulty in opening the mouth widely

When should you see an ENT doctor?

If any of the above symptoms persist and you are worried, then you should make a consultation with an ENT specialist Who are at a high risk of getting parotid tumours?

While parotid tumours can occur at any age, the elderly are at a higher risk. In addition, exposure to radiation increases the risk of parotid tumours. If an individual undergoes radiation therapy for head and neck cancer treatment, then there is a chance of getting a parotid tumour. Occupational hazards include being constantly exposed to certain chemicals, for instance during manufacture of rubber, plumbing and mining.

How does an ENT doctor diagnose parotid gland tumours?

The ENT physician will first perform a physical examination to identify any lumps or swelling in the neck and throat. Then, the head and neck cancer specialist might suggest collecting a biopsy for testing. This is a simple procedure, where a needle is inserted into the affected parotid gland to collect cells and tissues for testing. Once the sample is sent to the laboratory, testing will be done to identify if there are any malignant cells present. In addition, imaging tests such as a CT scan or a MRI scan would be done to understand the size of the tumour in the parotid gland. In case of a malignancy, the ENT doctor will do additional tests to check for signs of metastasis of the cancer.

What are the treatment options available?

Benign tumours may be routinely monitored by your ENT doctor to see if they turn cancerous. Permanent treatment for parotid tumours involve surgical removal of the outgrowth. In case of a malignancy, additional treatment will be required which includes chemotherapy and radiation therapy.The kind of surgeries done to remove parotid tumours include:

● Partial removal of parotid gland: The ENT surgeon may remove the parotid gland partially along with the tumour and some of the healthy tissue. This is called superficial parotidectomy
● Complete removal of the parotid gland: Total parotidectomy involves the complete removal of the parotid gland. It is recommended for large tumours and tumours affecting a deeper section of the parotid gland.
● Extensive surgery for metastasized cancers: If a parotid gland malignancy has spread to nearby muscles and bone, then the ENT surgeon will remove the entire gland and surrounding tissues leaving only a small portion of healthy tissue. The ENT surgeon will work to repair with grafted skin from other parts of the body to help with swallowing and other facial movements.

Parotidectomy is a surgery which needs expert hands. Special care is needed to avoid damage to the facial nerve which runs across the parotid gland. This nerve is responsible for facial movement and any damage to it, can lead to partial or total paralysis of the face temporarily or even permanently.

During this surgery, the ENT surgeon may need to trim small branches of the nerve if the gland is large and it is difficult to be removed. The parotid gland consists of two lobes, the superficial lobe and the deep lobe, while the facial nerve runs across the lobes. The parotid gland can generally be removed without causing permanent damage to the facial nerve and usually a nerve monitoring machine helps the ENT surgeon to monitor the nerve during the surgery. Superficial lobe removal occurs in benign tumour removal, but if the tumour is located deep within the gland then partial or complete removal of the parotid gland may be needed. In case of malignancy, the entire gland is removed generally, and the surgeon will decide on how much tissue to remove during the surgery.

Following the surgery one might experience weak facial muscles and numbness of the ear lobe and incision site. It may lead to decreased facial muscle movement, while the facial nerve recovers gradually following surgery. Rehabilitation may be needed if there is a disturbance to facial movements. Rare complications include a salivary fistula causing saliva to leak through the skin.

The ENT Clinic in Singapore performs parotid gland tumour removal and other ENT procedures. The otolaryngologists have deep experience and patients feel comfortable with the doctors and the modern clinic. Located in Mt. Elizabeth Novena Specialist Center and Gleneagles Hospital, the ENT clinic offers care par excellence.

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