Surgery for Salivary Gland Cancer
Overview of salivary gland cancer surgery
Surgery is the most common treatment for many people with salivary gland cancer. Your surgeon will talk with you about which salivary gland surgery is best for you, based on the:
- Type of salivary gland cancer
- Stage
- Location of the tumor
- Tumor’s characteristics, including its genetic information
Surgeons may be able to use minimally invasive methods that:
- Do less harm to the body
- Reduce side effects
- Improve recovery
Salivary gland surgery may sometimes be used along with other therapies.
At MSK, salivary gland tumor removal surgery and reconstructive surgery often are done at the same time. Your surgeon may also remove lymph nodes in your neck that have or may have cancer. A lymph node removal procedure lowers the chance of salivary gland cancer coming back.
Surgery or other treatments may affect other parts of your mouth and how you look and speak. Our experts in dental procedures make prosthetics (replacement parts) to repair teeth, jawbone, or tongue.
Talk with an MSK Care Advisor. We're here 24 hours a day, 7 days a week.
Types of salivary gland cancer surgery
There are a few types of salivary gland surgeries, depending on which gland has a tumor. Salivary gland tumors can be in the parotid, submandibular, or sublingual glands. But parotid gland tumors are the most common salivary gland tumor.
Your surgeon will talk with you about which type of salivary gland surgery you’ll have.
These surgeries treat salivary gland tumors:
- Parotidectomy: This is parotid gland removal surgery. A superficial parotidectomy removes a tumor in the superficial lobe (part) of the parotid gland. A total parotidectomy removes a tumor from the deep lobe or both the deep and superficial lobes.
- Submandibular gland excision: Removes the submandibular gland with the tumor.
- Sublingual gland excision: Removes the sublingual gland with the tumor.
- Minor salivary gland cancer surgery: Removes tumors that are from these glands.
- Lymph node removal: Removes lymph nodes in the neck that may have cancer.
- Reconstructive surgery: Rebuilds parts of the body affected by salivary gland tumor surgery.
Parotidectomy
A parotidectomy (puh-RAH-tih-DEK-toh-mee) is parotid gland tumor removal surgery. A parotidectomy removes a tumor in the parotid glands that’s cancer or benign (not cancer). You may need all or part of the parotid gland removed.
Parotidectomies are complex and must be done by a very experienced surgery team. Surgeons must remove the tumor without harming the facial nerve. The parotid glands are near the facial nerve, which controls facial movements, such as smiling and closing your eyes.
Our surgeons use advanced imaging such as MRI or CT scans and a facial nerve monitor. We try to remove all of the tumor while preserving the facial nerve and reducing surgery side effects.
Your surgeon may also do a neck dissection to remove the lymph nodes that have or may have cancer. This procedure can be done during parotid gland surgery.
Each parotid gland has 2 lobes (parts). The type of parotid gland surgery depends on which part of the parotid glands is affected.
Parotid gland tumors often start in the outside part of the gland, called the superficial (SOO-per-FIH-shul) lobe. A superficial parotidectomy removes all or part of the superficial lobe.
Your surgeon may recommend a superficial parotidectomy when the tumor starts in the superficial lobe.
During a superficial parotidectomy, your surgeon makes an incision (cut) from the front of the ear and down the neck. Facelifts use a similar cut.
Your surgeon removes the tumor whiles trying to protect the facial nerve, which controls facial movements. They also may remove some nearby lymph nodes.
A total parotidectomy removes the entire parotid gland. A total parotidectomy is for tumors that affect the deep lobe. The deep lobe is the inside part of the parotid gland.
During a total parotidectomy, your surgeon makes an incision (cut) from the front of the ear and down the neck. Facelifts use a similar cut.
Your surgeon removes the tumor whiles trying to protect the facial nerve, which controls facial movements. They also may remove some nearby lymph nodes.
A total parotidectomy is a very complex surgery. It takes a surgeon with a lot of experience to completely remove the tumor while preserving the facial nerve.
Parotid gland surgery is complex and must be very precise. The parotid gland is near your facial nerve, which controls the muscles in your face. The facial nerve lets you smile, blink, and raise your eyebrows.
MSK experts use precise methods to protect the facial nerve during salivary gland surgery. We also try to preserve the nerves that let your ears feel sensation.
At MSK, we use advanced nerve monitoring to find the facial nerve and its many branches during surgery. We’re experienced in working around the facial nerve during parotid gland removal surgery. We do everything possible to avoid injury.
Parotid gland tumor removal surgery can cause facial paralysis (puh-RA-lih-sis). This means you cannot make facial movements on that side of your face. Movements include smiling, closing your eyes, or raising your eyebrows.
MSK surgeons are experts in treating facial paralysis with a procedure called facial reanimation. We transfer or transplant muscles and nerves from other parts of the body to restore facial movement in a few months. We may do this during, or sometimes after, the parotid gland surgery.
We also can rewire nerves from both the tongue and one of the biting muscles to help restore facial movements.
Submandibular gland excision
The submandibular glands are below your jaw. A submandibular gland excision is surgery to excise (remove) tumors in the submandibular glands.
In a submandibular gland excision, your surgeon makes a cut under your jaw to remove the gland and the tumor. Sometimes they also remove the lymph nodes next to the gland. The amount of surgery depends on the tumor’s size and type.
The submandibular glands are near important nerves and muscles in your face and neck. Your surgeon will remove all of the tumor while protecting these nerves to keep them safe.
The submandibular glands are near the:
- Marginal mandibular nerve, which helps move the lower lip.
- Lingual nerve, which lets your tongue feel.
- Hypoglossal nerve, which moves part of your tongue.
MSK has experts in surgery to remove submandibular gland tumors. MSK surgeons do everything possible to keep your salivary glands working the way they should after surgery.
MSK has more than 70 head and neck cancer experts. We see more people with rare types of head and neck cancer than many other cancer centers. We’re experts in diagnosing and treating rare salivary gland, mouth, and thyroid cancers. That’s why many people with rare head and neck cancers come to MSK each year.
Sublingual gland excision
A sublingual gland excision excises (removes) the tumor in your sublingual gland. Your surgeon also removes part of the sublingual gland to make sure they remove all of the tumor.
Sublingual glands are in the floor of the mouth, below either side of the tongue. Your surgeon will make an incision (cut) inside your mouth to remove the gland. Your surgeon will close the incision with sutures (stitches), a skin graft, or a biologic dressing.
The sublingual glands are near the lingual nerve, which controls feeling and taste on the side of the tongue.
MSK surgeons do everything possible to protect the lingual nerve during sublingual gland surgery. Sublingual gland tumors are rare, and this complex surgery is best done by surgeons experienced in this procedure.
You may have some facial changes after your surgery. The types of changes depend on the surgery you had. Your care team will talk with you about what to expect.
Surgery of minor salivary gland cancers
Surgery often is the best option to treat cancer in your minor salivary glands. Minor salivary gland cancer can start in your:
- Lips
- Tongue
- Palate (roof of the mouth)
- Inner cheek
- Throat
- Larynx (voice box)
- Nose
- Sinuses
Surgeons often remove some nearby tissue along with the cancer. They may also remove nearby lymph nodes. The type of surgery depends on the cancer’s type, size and location.
What are the types of lymph node removals (neck dissection)?
Head and neck cancer often spreads first to the lymph nodes in the neck. A neck dissection surgery removes lymph nodes that have or may have cancer. Lymph nodes are small, bean-shaped structures that filter out waste products from your lymphatic system.
The type of neck dissection depends on the tumor’s type, stage, location, and whether cancer has spread. Your surgeon only will remove lymph nodes that have cancer or are at risk for having cancer. They’ll preserve other parts that are not affected by cancer, including nerves and blood vessels.
During salivary gland tumor removal surgery, we remove lymph nodes if there’s a risk the cancer has spread to them.
Reconstructive surgery for salivary gland cancer
Some people may need reconstructive surgery after salivary gland cancer surgery. Removing the tumor can mean taking out some skin, muscle, or nerves near the salivary glands. This can change how your face looks or moves, or how you speak, swallow, or chew.
Reconstructive surgery at MSK can help restore your look and how the area works and feels.
MSK plastic and reconstructive surgeons are experts in rebuilding parts of the body affected by head and neck surgery. A reconstructive surgeon is a doctor with special training in cosmetic and reconstructive surgery.
MSK reconstructive surgeons use methods such as:
- Flap surgery: We transfer healthy tissue from a part of your body to repair the affected area. Types of flap surgery include a local flap or a free tissue transfer, also called a free flap.
- Facial reanimation: Surgery to remove salivary gland tumors may affect the facial nerve, which controls your facial movements. We move muscles and nerves from other parts of the body to restore facial movements. We can do this during parotid gland removal surgery or years after, in some cases.
Reconstructive surgery is often done at the same time as surgery to remove the salivary gland tumor. MSK’s experts do everything possible to keep your looks and your ability to move your face. Our speech therapy, physical therapy, and dental experts have special training to help you sound and look your best.
Your caregiver is a very important part of your care team. They need support, too. Our nurse liaisons are here to help your caregiver when you have surgery. They’ll offer updates about your progress during and after surgery. We also have a Caregivers Clinic to help your loved ones cope with cancer.
Common questions after salivary gland surgery
You may have some facial changes after salivary gland cancer surgery. Changes depend on the surgery you had and can include:
- Some weakness in your facial muscles. This may affect your smile, and how you blink and raise your eyebrows. Facial weakness after salivary gland cancer surgery is often mild and gets better over time.
- Some numbness of the earlobe, cheek, and upper neck on the side where you had parotid gland surgery. This often gets better as time passes.
You’ll fully recover from salivary gland cancer surgery in a few weeks to a few months. Recovery time and when you can return to your normal life depend on a few things such as:
- Your age
- Your general health.
- The type of salivary gland cancer surgery you had
As you recover:
- The swelling will slowly go away.
- Your face will start to look more natural, and scars will be less noticeable.
- You’ll be able to talk more easily and eat many of the foods you like.
- You’ll have more energy to do the activities you enjoy.
Head and neck cancer treatment can affect your digestion (how your body breaks down the food you eat). It can change your taste, how you eat, and how hungry you are.
Our clinical dietitian nutritionists can answer your questions about what you can and should eat. They can help with:
- Planning healthy meals at home.
- Advice about special diets.
- Working around food allergies.
- Managing symptoms such as weight loss or gain.
You may have radiation after surgery for salivary gland cancer. Learn more about getting enough nutrition before, during, and after radiation treatment.
Not everyone feels pain or discomfort the same way or for the same amount of time. In the first days after surgery, you may still have some pain when you go home. Most often, you’ll be taking pain medicine that we’ll prescribe.
After the first week, the pain often gets much better. Most people can stop taking pain medicine after salivary gland surgery in 2 to 3 weeks.
Some people can have soreness, tightness, or muscle aches around their incision (cut) for up to 6 months. This does not mean something is wrong. You’ll have less pain and need less pain medicine as your incision heals.
You’ll likely see your head and neck surgeon 7 to 10 days after you leave the hospital. They’ll check your incision and make sure you’re healing well.
If your pathology test results are ready, your surgeon will go over them with you during your first follow-up visit. This includes details about the cancer that was removed. Future surveillance visits will be arranged.
If you had advanced salivary gland cancer, you may need radiation therapy, chemotherapy, or both after surgery. We may talk with you about rehabilitation exercises.
