Partial Parotidectomy for Pleomorphic Adenoma Tumor Removal – My Experience and What to Expect
Well that title is certainly a mouthful! I wanted to take a little time to share my experience and knowledge about a partial parotidectomy so others who are faced with the procedure can feel more comfortable about undergoing this type of surgery.
It was about 10-12 years ago when I was in high school that I first began to feel a small lump behind my right ear near where my earlobe ends just above and to the rear of my jaw bone. It pretty much appeared out of nowhere as I didn’t really notice anything “growing” there before that time. The lump was about the size a large marble, slightly oval, but smooth and firm yet slightly movable. It wasn’t really painful but occasionally it would ache. When pressed, it would be very uncomfortable and somewhat painful. Actually, what it really felt like was just a lot of pressure in that area.
Over the next few years, I had about two or three doctors check it out and they said it was probably just an undrained lymph node, since as a teenager, I had very bad acne. I accepted this explanation until about a year and a half ago when it started to get really irritating. It seemed that the pressure was increasing and often verged on the border of being painful. So I finally went to see a specialist.
My first ENT was a total quack so I quickly ditched that guy (Robert Jacobs, if anyone is interested). My second ENT was very good. He ordered a fine needle aspiration (FNA) of the lump along with an ultrasound. The FNA is a pretty simple procedure. The doctor numbed the area before inserting another needle designed to capture some of the cells in the mass. It wasn’t necessarily painful, rather it just felt like a lot of pressure in the area. Slightly uncomfortable yes, but that’s about it.That FNA did not grab any of the cells in the mass. Unfortunately, I had to move to Arizona before any further tests could be done.
Once arriving in Arizona, I found another ENT (James Chuang) who again ordered a FNA of the mass. He suspected it was a tumor in the parotid gland. The second FNA was a bit different. The needle was much smaller and it was done in the hospital (Banner Desert). The doctor performing the procedure didn’t need to numb me since the needle was so much smaller. After inserting the needle, he slowly worked the needle back and forth a few times in order to grab as many cells as possible. This was only slightly uncomfortable. After the procedure, he immediately took the sample to the lab to confirm he got enough cells and to identify the cell type. He was back in about 10 minutes. It was positively identified as a pleomorphic adenoma tumor; a non-cancerous tumor of the parotid (salivary) gland.
Back at Dr. Chuang’s office, I was presented with my options: leave it alone since it was not cancerous, or take it out since there is a 20% chance of it turning into cancer. Well 20% seemed like a terribly high number when dealing with cancer so I decided to have it removed.
There are a number of complication that can happen with any surgery but when doing this type of surgery, there is the very real risk of facial nerve damage because the five facial nerves that control facial movement lie directly on/near the parotid gland (on each side of the face of course).
So in other words, there was a risk that I could have partial or complete facial paralysis if anything went wrong. Again, that vs. cancer…not really an option. Dr Chuang explained that these days they use special nerve detection techniques which involve placing electrodes on the face and using a probe to locate and protect the nerves.
Regarding the procedure and hospital stay, Dr Chuang said that I would be in the hospital overnight. Not all people end up with overnight stays but he wanted to be on the safe side. Also, he said that I would have a small tube hanging out of the incision area to collect any pooled blood in the gap left by removing the tumor. The incision itself was to be almost a Harry Potter like lightning scar beginning at the front of the ear, going directly down and behind the earlobe then down the neck to just about the jaw line. The incision is supposed to be done such that scarring is minimized.
The surgery took about 3 hours because my tumor was actually growing in between two of the branched nerves and it took a bit longer than he had expected to remove. I woke up to find a small tube taped from my ear, down my neck, ending in a sort of compressed bulb like plastic container which collected any draining blood. This device was attached to my hospital gown so that it wouldn’t swing around or fall off when I walked and moved. Overall, I really didn’t feel any pain. My neck was a bit stiff but I just had the usual post-op things like sleepiness and some nausea.
The next day my doctor arrived to check the incision and remove the collection bulb thing. Removal of the tubing was rather uncomfortable but was very quick. You might think that the tube is only in there maybe an inch or so but it is actually placed in there a good three+ inches. Pulling it out was very weird and a little painful. The good thing is that once you realize that it feels uncomfortable and painful, it’s already out.
Post-Surgery and Recovery
There are a number of things that you should know about what to expect during recovery. First, your neck will be stiff. You won’t be able to turn your head very well and sleeping will be a bit of a pain. You need to try and keep your head elevated to reduce swelling and chances of bleeding. When I tried to lay flat, I felt a lot of pressure in my head and the incision started to bleed. You won’t be able to safely drive for about two weeks.
Second, you will have trouble eating. I was unable to open my mouth very wide due to the swelling in the jaw area and thus could not fit much in my mouth. Even for the things that I was able to fit in there, chewing was a pain, literally. You will want to stick with soft foods like soups, rice, pudding, jello, etc. As things heal, you will be able to chew larger and longer without pain and stiffness. It took me about two to three weeks to start eating semi-normal meals in satisfying quantities. Also, avoid bitter/sour and spicy foods that promote saliva production. On my first day home, I made the mistake of eating fish with lemon and every time I would get that sour smell or taste, the area would hurt.
Your doctor will almost certainly give you narcotic pain killers like vicodin or percocet. My advice is to use them…you will need them. It’s not super painful but it is uncomfortable enough to require pain killers for a good 3 days or so. Avoid blood thinners like ibuprofen (Advil and Motrin) as these will make it more likely that you will bleed.
Finally, a note about bleeding. Avoid everything you can that might start your wounds from bleeding. This means no straining (exercise, lifting, etc.) and blood thinners. If your incision starts to bleed, then it’s not that big of a deal but if the area starts to bulge out and or bleed through the incision you need to go back to the doctor. This could mean that the bleeding could be internal and they may need to surgically go back in to stop the bleeding…not something you will want to do again! So take it easy for a while and heal up.
Overall, the experience was not too bad. Yes, there was pain and it was a pain in the ass but it was not the end of the world and it is definitely something that everyone can cope with. One of the other things that you should be aware of is that you may (probably will) experience some numbness in your ear and lower jaw. This is normal but takes some getting used to. They say that the feeling may come back but after three months, I’m still experiencing a good amount of numbness in the area. One of the more annoying things about the numbness is that the area will itch but you can’t feel yourself scratching so you can’t really satisfy the itch. Annoying but relatively minor.
Well I hope that my experience was helpful in helping you understand the process. Good luck and be safe.
UPDATE – 10-13-09
Hi everyone. Well this blog post is by far my most popular and since it has been slightly over a year since I had this procedure done, I though that an update would be good! Thanks to everyone who has commented about their experiences. The more people who contribute their thoughts the better.
Anyway, so its been a little over a year and there’s only a few things that I wanted to say. First of all, a lot of the numbness has gone away. I started to notice more normal feeling in the ear and jaw line after about 6 months. However, there is still some numbness and even slight tenderness closer to the incision area. Not an annoying amount…but then again I’m probably just used to it already.
The scar seems to be healing alright. It’s definitely not as noticeable as before but it’s not exactly invisible either. One thing about the healing process that I experienced was that there tends to be a lot of dead skin buildup around the incision. When cleaning your face in the shower, I would recommend taking some sort of exfoliating pad and maybe once a week or so gently scrub the area well with soap. I would imagine that this would promote healing as well since removing the dead skin should promote the creation of new skin…but I’m not sure that’s how it works. Of course, don’t do this right after the surgery. I would say wait until 3-6 months after the surgery and once the incision has well healed.
I do still notice some annoying itchiness in the area but since the numbness has begun to fade, scratching usually works…but not always.
And finally, I have noticed that whenever I eat something, be it hot or cold, spicy or bland…my cheeke sweats. Now, that may sound strange but I was told by my doctor that this is a relatively common occurrence. Apparently, when the skin is laid back on the face during surgery, it has a tendency to heal in such a way that whenever you eat something, it triggers the sweat glands in your skin near the incision area to being to sweat. Don’t worry, it’s not saliva or anything like that, it’s just sweat, like you were eating something really spicy. It does not sweat a lot (you probably won’t be dripping) but it is enough for you to have to wipe it off with a napkin or something. Nothing hurts and it’s only in a small area right where the skin was peeled back during surgery…but it can be embarrassing if anyone notices…though that is pretty unlikely. This didn’t begin happening until probably 4-6 months after the surgery.
Well, that’s really about all the updates I have. I hope the story and comments are helpful to those of you who have or will be having the surgery. Thank you and good luck.