Problems with the parotid gland, and how they are treated

Written by: Professor Neil Tolley
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 has an international reputation in thyroid and robotic head & neck surgery. He is an ENT expert that pioneered 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, along with being 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. Robotic surgery is used in selected patients to avoid a scar in the neck with an equivalent hospital length of stay. He has a national reputation in education, training and research and lectures widely at national and international meetings. He has in excess of 160 peer-reviewed publications. He serves as lead for ENT training in North Thames, Chairman of the London Consultants’ Association and an executive board member of the British Association of Endocrine and Thyroid Surgeons.

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