Problems with the parotid gland, and how they are treated

Written by: Professor Neil Tolley
Published:
Edited by: Jay Staniland

The parotid gland is a major salivary gland, positioned in front of the ears and wedged between the jaw and the skull base on either side of the head. The name parotid means 'close to the ear'.

 

What is the parotid gland for?

 

We produce 1.5 litres of saliva per day and the parotid glands are responsible for around 25% of the daily salivary secretion.

Saliva contains an enzyme that begins to break down complex carbohydrates such as starch. It is also rich in immunoglobulin A which helps fight infection. The saliva is important in keeping the mouth moist, facilitating the chewing of food and making it easier to swallow and digest food.

 

What problems can occur in the parotid gland?

 

The parotid gland is the gland that becomes painful and swollen during an attack of mumps (paramyxoviridae viruses).
 

Tumours can also occur where 80% are benign with pleomorphic adenoma being the most common form. This is known as an intermediate tumour with a 1% rate of transformation into cancer each year. Leaving this tumour for 20 years therefore would result in a 20% chance of it becoming cancerous. 20% of parotid lumps are cancerous.

 

How do I know I have a parotid gland tumour?

 

Most present as a painless lump which should be investigated by an ultrasound scan (USS) and fine needle aspiration biopsy (FNA). Occasionally an MRI scan may be additionally requested.


Most lumps within the parotid gland require surgery as the accuracy of FNA is only 90%. An exception is an adenolymphoma or Warthin’s tumour seen most commonly in male smokers over 50 years of age.


The parotid gland's main duct (Stensen’s duct) may develop a stone (calculus) which can cause pain and swelling of the gland. An autoimmune disease such as Sjögren’s syndrome, of which 50% of cases are associated with rheumatoid arthritis is another condition that can affect the parotid gland.

 

How is parotid gland surgery performed?

 

The most common procedure performed on the parotid gland is a superficial parotidectomy. This is an operation that can be performed with minimal scarring and low permanent risk to the facial nerve. Patients suffering from stones can have these removed using endoscopic basket retrieval techniques performed as a day case.


If you are concerned about lumps in your glands, make an appointment with a specialist here.

By Professor Neil Tolley
Otolaryngology / ENT

Professor Neil Tolley is an internationally respected consultant ENT (head and neck) surgeon based in London. He has earned worldwide acclaim for his pioneering work with head & neck robotic surgery in the UK and was the first surgeon in the UK to use the Da Vinci Robot for head & neck cancer, obstructive sleep apnoea and thyroidectomy. Additionally, he was the first surgeon in the world to perform robotic parathyroid surgery. Professor Neil Tolley treats a wide range of ENT conditions and has a special interest in surgery of the thyroid and parathyroid glands.

Professor Tolley completed his initial medical training in Cardiff in 1982 and his MD in nasal physiology in 1988. He then went on to complete specialist training at the Royal National Throat, Nose & Ear Hospital and Great Ormond Street Hospital amongst others. Professor Tolley has undertaken a number of international fellowships in San Diego, California, Cape Town and Perth and Sydney, Australia. The Royal College of Surgeons of Edinburgh appointed him a fellow in 1988 and the following year he was also appointed a fellow of the Royal College of Surgeons of England. He was accredited as an ENT surgeon in 1992. In 1994, he joined St Mary’s and Ealing Hospitals as a consultant ENT surgeon and has since been appointed lead clinician of ENT, head and neck surgery, audiology and oral surgery.

In 2010, Professor Tolley made pioneering use of telerobotic equipment to perform surgery to remove an overactive parathyroid gland and its use in selected patients to avoid scarring and lenghty hospital stays is now widely practised. His work in the field has earned him international renown and as such he is regularly invited to contribute to training programmes and conferences. Professor Tolley has twice presented his work at the World Congress of Robotic Surgery held in Orlando in 2010 and in Miami in 2011. He also visited Hamburg to assist in the first robotic thyroidectomy in Germany in 2012. Additionally, he developed the first integrated simulation training programme for ENT healthcare providers in England, which has gone on to be shared and used in the US, Sweden, Australia and Egypt.

Professor Tolley imparts his knowledge in a number of educational roles for medical trainees. He is a programme and simulation course director for ENT training in North Thames and has supervised a number of MSc, MD and PhD students in his role as Professor at Imperial College, London. Additionally, Professor Tolley is a surgical tutor at St Mary’s Hospital. In addition, he is course organiser for the Imperial MSc in Surgical Innovation - ENT and runs a twice yearly DOHNS course. Professor Tolley has published in excess of 200 peer-reviewed publications. He is a regional adviser to the Royal College of Surgeons (England) for North Thames West. He is also secretary and president elect to YCOHNS (Young Consultants Otolaryngology-Head and Neck surgery). Professor Tolley is also chairman of the London Consultants’ Association and an executive board member of the British Association of Endocrine and Thyroid Surgeons.

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