The parotid gland is a major salivary gland, responsible for producing a significant amount of the saliva in the oral cavity.  It is located in front of the ear at the junction of the neck, and lies over the back portion of the jaw bone.  Saliva from the gland is released along the inner lining of the cheek on each side. The facial nerve, which moves most of the muscles of the face, runs through the parotid gland before branching out and innervating the facial muscles. The facial nerve is the main reason that surgery of the parotid gland, or parotidectomy, requires significant technical skill and expertise.  The two major categories of diseases that affect the parotid gland are infections and tumors.

Parotid gland infections (called parotitis) are usually caused by blockage of the drainage system of the gland. This can be due to salivary stones that block the drainage pathway or to dehydration which makes it more difficult for the gland to empty the saliva it has produced. Symptoms of pain (especially after eating), swelling and redness of the area can result.  Fortunately, the overwhelming majority of parotid gland infections can be successfully treated medically without need for surgery. In some cases, however, surgyer may be needed to remove large stones.  Very rarely, chronic infections may lead to a recommendation of parotidectomy to remove the gland. 

Parotid gland tumors are usually benign. However, approximately 15% can be malignant cancers. The possibility of cancer is the main reason that the majority of parotid gland tumors are surgically removed. All parotid gland masses need to be evaluated and properly worked up. This will likely include imaging (such as CT or MRI) and needle biopsy to try and determine the nature of the mass. Because needle biopsy is not 100% accurate all of the time, and because even benign parotid gland tumors may eventually become cancerous, most cases of parotid tumors usually lead to a recommendation of surgery. 

Parotidectomy:  Parotid surgery is extremely technically demanding. In virtually all cases, the goal of the operation is to remove the entire tumor without damaging the fragile branches of the facial nerve.  Also important is the secondary goal of performing the operation in such a way as to minimize facial scarring and deformity, thereby ensuring the best possible cosmetic outcome. Obviously, surgical experience and technical skill and expertise are most important in helping to achieve these goals.  However, recent advances in surgical technique and medical technology can also be used to help achieve the best possible outcome.  For example, the use of facial nerve monitors and stimulators to constantly monitor the activity of the facial nerve can help reduce the chance of nerve damage. To help improve cosmetic outcome, minimally invasive facelift incisions are used for exposure and muscle and soft tissue flaps are used to fill the defect left after the parotid tumor is removed.

Neck Dissection:  In the case of known cancer (or if cancer is diagnosed during the operation), there may be need to perform a neck dissection.  This procedure aims to remove all lymph nodes and soft tissue structures that the cancer may have spread to in the neck.  Like parotid surgery, neck dissection demands extreme technical skill.  Many critical nerves, arteries and veins have to be identifien and saved as the surrounding nodes, glands and soft tissues are removed.  Therefore, it is important that the surgeon have enough experience and expertise to offer and perform this operation if it becomes necessary.

Dr. Amini has significant experience operating on both benign and malignant parotid tumors.  In addition, Dr. Amini's experience in facial plastic and reconstructive surgery is extremely useful in ensuring the best possible cosmetic outcome with the least amount of scarring afterwards.  Finally, because Dr. Amini is routinely involved in the surgical treatment of other head and neck cancers, if more radical resection or neck dissection is necessary, you can rest assured that these will be performed with the the same high level of technical skill and expertise.