Salivary Gland Surgery

The human body has three pairs of major salivary glands: parotid (in the cheeks), submandibular (under the jaw) and sublingual (under the tongue). These glands produce saliva which aids in digestion and lubricates the mouth to maintain oral health. There are several different types of salivary gland surgery, depending on which gland and what the problem is.  Removal of a portion or all of the parotid gland is called a Parotidectomy.  Removal of the submandibular gland is called a Submanidbular Gland Excision.  A newer, minimally invasive treatment of salivary stones and recurrent infections of either the parotid or submandibular glands is called Sialendoscopy.

What is a Parotidectomy?

Partoidectomy is a surgery that removes part or all of the parotid gland. Most commonly this is performed for a tumor, most of which are benign (non-cancerous), however this can be malignant (cancerous).

What is Submandibular Gland Excision?

Your submandibular glands are the second largest of your salivary glands. The submandibular gland is most commonly removed for tumors, stones lodged in the gland which block saliva from draining, or for recurrent infections of the gland that have failed medical management. Most tumors found in the submandibular gland are benign (non-cancerous), although they can be malignant (cancerous). 

What is Sialendoscopy ?

When salivary flow is blocked by salivary gland stones or scarring in the drainage pathway of the glands pain, swelling and infection of the salivary gland can result. Most salivary gland stones occur in the submandibular gland, although they can occur in the parotid glands as well.  Prior to sialendoscopy, treatment for salivary gland stones was limited to surgical removal of the affected gland through an open incision. Surgical removal of the gland, particularly for the submandibular gland, is effective but can result in rare serious complications, such as damage to the nerves affecting the lower face. For this reason, many patients choose to forgo surgery in favor of conservative management.  Sialendoscopy is minimally invasive technique that allows for stones and narrowed ducts to be treated without gland removal.  There are no incisions leading to less pain, faster recovery, less risk of nerve damage and most importantly gland preservation.

What to do BEFORE surgery

Here are a few things you can do before surgery to help things go more smoothly:

  • Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon.  Please see this list--Medications to Avoid Prior to Surgery
  • Stop smoking at least 3 weeks before your surgery date.
  • If you get a chest cold or fever during the 5 days before the surgery, please notify us. A cold may increase the risk from anesthesia.
  • Blood counts and clotting is checked before surgery to make sure you are not at risk of increased bleeding. Labs need to be drawn the week prior to surgery. Your insurance carrier may dictate the lab where the blood is drawn.
  • No food 8 hours prior to surgery.  No liquids for 4 hours prior to surgery.
  • Arrange for a ride home after the procedure

What to Expect During Surgery

Surgery is performed under general anesthesia. With general anesthesia, you will be asleep for the entire surgery.  Surgigal time varies according to the procedure being performed.  Parotidectomy typically lasts 1.5-3 hours.  Submandibular gland excision lasts 1-2 hours.  Sialendoscopy lasts 20 minutes to 1.5 hours.  During parotidectomy and submandibular gland excision intraoperative nerve monitoring (IOM) is performed.  Nerve monitoring is a technique used to monitor the function of a patient's nerves during surgery. Nerve monitoring helps prevent damage to the nerves, reducing the risk of surgery-related nerve damage. Prior to surgery electrodes are attached to your body to monitor nerve pathways. A special computer is used by a technologist to read these signals.    

During parotidectomy, an incision is made in front of the ear and carried down into the neck.  The facial nerve is then carefully identified. The mass in the parotid gland is then removed. A drain is then placed under the skin to prevent fluid or blood from accumulating. At the conclusion of surgery, a pressure dressing or jaw bra is placed to prevent fluid, blood, or saliva from building up underneath the skin.  

During submandibular gland excision an incision is made in a pre-existing crease in your neck below your jaw.  The gland is then dissected away from surrounding muscles, blood vessels and nerves. The salivary duct is tied off to prevent any communication from your mouth to your neck. After the gland has been removed a small drain will be placed in the wound. 

During sialendoscopy, the salivary duct is dilated to allow passage of the sialendoscope. The sialendoscope is a tiny lighted scope, about between 1.1-1.5 millimeters wide, that is attached to a camera and has a channel for tiny instruments.  Any stones that are identified are “lassoed” with a wire basket and then removed through the duct. Any narrowing in the duct can be dilated with a small balloon.  The duct is then examined and flushed if needed.  

When your surgery is over you will spend about an hour in the recovery area and then go home.

What to expect AFTER Surgery

  • For parotidectomy and submandibular gland excision:
    •  you can expect some swelling and discoloration around your incision. 
    • You will have some numbness around your incisions. The sensation will return within a few weeks to months. 
    • It is possible to have some temporary nerve weakness in your face after the surgery. Generally, this is very mild and returns within a few weeks. It is rare to have any permanent facial weakness.  After parotidectomy if you are unable to close your eyelids, notify us immediately. 
    • Most patients are out of work/school for 7 days following surgery.
    • Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 2 weeks following surgery to prevent bleeding.
    • A drain is placed prevent build-up of blood or fluid under your incision.  The nursing staff will teach you how to care for your drain and measure its output.  We recommend every 8 hours emptying the drain and recording the output. At the end of each 24-hour period total the output.  The drain must remain in place for a MINIMUM of 24 hours after surgery.  You will be given instructions about when the drain will be removed
    • You may not shower until the drain is removed.
    • You will have an appointment one (1) week after surgery to check your incision site and remove sutures.  If this has not been made please contact our office to schedule
    • Some pain is normal after surgery. If it worsens, it may be a sign of infection or bleeding.  Please notify us if pain is severe.  
    • Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain.   


  • For parotidectomy:
    • To reduce swelling, keep your pressure dressing in place until your drain is removed.  If possible, sleep with your head elevated on two pillows. Most of your swelling should subside over a week. 
    • The numbness around your ear lobe may be permanent but will improve slightly over time


  • For sialendoscopy:
  • Most patients experience minimal pain.  There may be mild soreness inside the mouth where the duct was dilated.
  • Swelling of the salivary glands is expected but resolves quickly
  • Most patients can return to work/school the following day.
  • Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding.
  • Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain.   

What are the risks of Surgery?

As with any surgical procedure, salivary gland surgery has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

BLEEDING: Bleeding is possible with any surgery. Minimal bleeding is expected during and after surgery.  A drain is placed to help prevent this from being a problem.  Any significant swelling of the incision can be a sign of bleeding and we should be notified.

INFECTION: Infection after surgery is uncommon but is most commonly treated with antibiotics or drainage.

SCARRING/POOR COSMETIC RESULT: Despite careful planning and closing of the incision it is possible to have undesirable scarring. If you are dissatisfied with your incision after it has completely healed, it is possible to do a scar revision. With removal of the gland there can be some loss of bulk and minor asymmetry on that side.

SEROMA/HEMATOMA: Occasionally fluid, blood, or saliva collects under the skin.  If this occurs this may need to be drained either by needle aspiration, or opening a small area in the incision.  Very rarely does further treatment need to be performed.

SIALOCELE/SALIVARY FISTULA:  Rarely a collection of saliva can form after surgery called a sialocele.  If this occurs it may be necessary to drain the saliva either by needle aspiration, opening a small area in the incision. A pressure dressing may also need to be placed to prevent re-accumulation.  If this tracts to the skin it is called a salivary fistula.

RETAINED STONE:  It is unlikely a stone will remain in the remnant of the salivary duct that is still connected to the mouth.  If this were to occur further surgery may be required.

NERVE DAMAGE:  

Most of the technical aspects of parotid surgery are designed to avoid injury to your facial nerve. The facial nerve controls the facial muscles that allow you to purse your lips, open your lips, close your eyes, and raise your eyebrows. Every effort is made to protect the nerve during surgery, including use of Intraoperative nerve monitoring. However, it is still possible for the nerve to be weak after surgery. Most often weakness is temporary.  Permanent injury to one or more of the branches of the facial nerve is rare. If the tumor is malignant and invading the nerve it may be necessary to intentionally cut the nerve to remove the tumor. This would result in permanent facial paralysis.

There are 3 important nerves near your submandibular gland:  the marginal mandibular nerve which moves your lip, the lingual nerve that supplies taste to that side of the tongue, and the hypoglossal nerve which moves the tongue on that side.  Injury to these nerves are rare and usually temporary.  Permanent injury can result in weakness of your lower lip or a crooked smile, decreased taste on one side, weakness in tongue motion on one side.

During sialendoscopy it is very rare for the lingual nerve (responsible for taste on one side of the tongue) to be injured.

ANESTHESIA COMPLICATION--Your operation will be carried out under a general anesthetic. There are rare but serious risks of anesthesia. Please feel free to discuss any specifics of the anesthesia with your anesthesiologist.

RISKS SPECIFIC TO PAROTIDECTOMY:

EAR LOBE NUMBNESS-- During parotidectomy the nerve that gives you feeling to the lower half of your ear is intentionally sacrificed to allow access to the facial nerve and facilitate tumor removal. This leaves you with permanent numbness to the lower half of your ear.

FREY'S SYNDROME (gustatory sweating)--The function of your salivary gland is to produce saliva to assist with chewing and digestion of food. Running through the salivary gland are nerves that direct the salivary gland to secrete saliva. Parotidectomy leaves some of these nerves exposed. These nerves can then connect to the sweat glands of the skin directing their signal to the sweat glands rather than to the salivary gland tissues. This can lead to sweating in the skin overlying the surgical site with eating. While all patients who have undergone parotidectomy have activation of their sweat glands, it is rare that patients notice it. We make attempts to avoid this problem by either making a thick skin flap or inserting a tissue layer between the elevated skin and the exposed remaining salivary gland. If this were to occur and it becomes problematic, you may put antiperspirants over this area to help prevent it.

RISKS ASSOCIATED WITH SIALENDOSCOPY: 

DAMAGE TO TEETH, LIPS, OR GUMS – Great care is taken to prevent injury to lips, teeth, and gum, however on rare occasion, one of more of your teeth might get chipped, cracked, knocked lose,  loss of crown, or the gums or lips could be cut.

DUCT INJURY/STENOSIS—Risk is low that the duct can be perforated or injured.  Injury to the duct can lead to scarring which can narrow the duct and may lead to the need for the gland to be removed.

FAILURE TO IMPROVE/NEED FOR FURTHER TREATMENTIt is possible that recurrent stone formation or scarring may occur.  In addition, there are patients whose problem is deeper in the gland itself than can be reached with a sialendscope (especially patients who have Sjogren’s or who have had Radioactive Iodine treatment).  Sialendoscopy may not be curative.


Contact Us

We have two locations!

Our main office is at 7851 S. Elati Sreet Suite 102 Littleton, CO, 80120. Our Southwest office is at 6179 S. Balsam Way Suite 120 Littleton, CO, 80123

Office Hours

We offer early morning appointments on select days starting at 7:15 am and late evening appointments until 5:45 pm.

Monday:

9:00 am-5:00 pm

Tuesday:

9:00 am-5:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

9:00 am-5:00 pm

Saturday:

Closed

Sunday:

Closed