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Head and Neck Surgery Consultations
Kevin T. Brumund, M.D.
Appointments: (858) 822-6197
Consultation for Parotid Gland Tumor
This consultation is part of a series of consultations with Head and Neck Surgery specialists at the University of California, San Diego. The case is a hypothetical patient chosen to represent a composite of the usual and most common patients with this specific disorder. Where gender, age or race make a difference, these will be specifically cited. Where they do not make a difference, they may be omitted. The consultation is presented for purposes of general information. Specifics about an individual case and specific treatment must be discussed between the patient and the treating physician.
The patient can be young or old, male or female. The patient could even be you.
Doctor: Good morning, I’m Dr. Brumund. How are you today?
Patient: I am well, thanks for asking.
Doctor: How can I help you?
Patient: My primary care physician noticed that I have grown a bump or a lump on the side of my face, and he has asked me to see you to have it evaluated and treated.
Doctor: Prior to his pointing it out, is this something that you had noticed?
Patient: You know, I have noticed that there was sort of a little something there, but I really hadn’t paid much attention to it. Maybe it was there for a couple of weeks.
Doctor: Ok. And when were you seen by your primary care physician?
Patient: A week ago.
Doctor: So you noticed this about three or four weeks ago. Since that time, have you noted any change in its size or character?
Patient: I don’t think so.
Doctor: Ok. Is the mass giving you any pain or discomfort?
Patient: Mass means….?
Doctor: The bump.
Patient: Oh, the bump. No.
Doctor: Over the past month or so, have you noted any change in your eating, breathing, chewing, or swallowing?
Patient: No, I’ve been fine.
Doctor: Have you noted any change in your facial symmetry or change in the sensation or feeling in your face?
Patient: Those aren’t things that I pay attention to, but nothing that I have noticed.
Doctor: OK, very well. And are you otherwise healthy?
Patient: I am.
Doctor: I would like to examine you now, if I may.
Patient: That would be fine.
Dr. Brumund then performs a complete head and neck examination, including endoscopy, and returns to talk with the patient.
Doctor: On exam, I do feel the bump that you noticed a few weeks ago. This is likely a lump in your parotid gland. This is a gland that we all have on each side of the face in front of the ear. It produces saliva, often call spit; it is one of our salivary glands, and like other tissues in the body, it can get a growth in it, which is known as a tumor or a mass.
Patient: When you say tumor, are we talking cancer?
Doctor: Not likely. Tumor is a generic term for a growth. The majority of the tumors or masses that we see in the parotid gland are benign. In fact, about 80% are benign, meaning not cancer, and about 20% are cancerous.
Patient: So what do we do now, Dr. Brumund?
Doctor: Well, the best next step is to do what is called a fine needle aspiration biopsy.
Patient: What does that involve?
Doctor: That involves me putting a small needle into this lump and aspirating some of the cells contained within it. This is a procedure I do here in clinic. The pathologist will take a look at those cells under the microscope and hopefully be able to tell us what this growth is.
Patient: You say we can do that now?
Doctor: That is correct.
Patient: Then I can go back to work?
Doctor: You certainly can. It is a needle stick but it is well tolerated and you will be able to continue on with your day. The results usually take about a week, so I will see you back here in one week to discuss the results.
Patient: Sounds good to me.
It is now a week later, and patient returns.
Doctor: Hello, good to see you. Thanks for coming back to clinic. I have the needle biopsy results and they demonstrate what is called a pleomorphic adenoma.
Patient: That doesn’t sound good.
Doctor: The good news is, it is a benign tumor. If you recall what we talked about last week, the majority of tumors in the parotid gland are benign, and in fact, this is the most common benign tumor that we see in the parotid gland.
Patient: You keep using this word tumor. I just want to reaffirm that tumor is not cancer.
Doctor: That is correct. Tumor is a generic term for a growth, but indeed, yours is not a cancer; it is benign.
Patient: So I have a benign growth.
Doctor: That is correct.
Patient: So I don’t have to do anything with it.
Doctor: Well, that is not correct. Despite the fact that it is benign, it is still what we call a tumor, and it has a propensity to grow. If left untreated, there would be two concerns: 1) it would continue to grow and affect some surrounding structures just by its growth pattern, and 2) if left untreated, this type of tumor, although rarely, may turn into cancer.
Patient: So what, then, are my treatment options?
Doctor: The treatment option for this, and actually most tumors of the parotid gland, is surgery to remove it in its entirety.
Patient: And what exactly does that surgery involve?
Doctor: The surgery is done in the hospital under general anesthesia. The surgery itself usually takes about three hours, and it would require hospitalization for one to two days after surgery. The surgery involves an incision that begins in front of your ear and runs down into your neck.
Patient: Is that going to leave much of a scar?
Doctor: It does not leave much of a scar. It is placed in an area that is cosmetically favorable and usually heals quite well.
Patient: What else is involved in this surgery?
Doctor: The surgery is called a superficial parotidectomy. What that means is that we remove the tumor within the parotid gland, and we also take out some of the surrounding normal parotid gland tissue, to make sure that we remove it in its entirety.
Patient: Sounds simple.
Doctor: Well, there are risks involved with the surgery, just as with any surgery. The most pertinent with regard to any surgery on the parotid gland is potential damage to the structure called the facial nerve. The facial nerve controls all the movement of your facial muscles on that side of your face. It courses through the parotid gland.
Patient: So, why do we have to involve that?
Doctor: The safest approach to removing this type of tumor is to find the main trunk of the facial nerve and carefully dissect out all of these branches in order to preserve them while simultaneously dissecting and removing the tumor.
Patient: What is the chance of damaging that nerve?
Doctor: The risk to the individual nerve branch is less than 5% of your having a temporary or even possibly a permanent injury or weakness.
Patient: And when you say permanent injury, what does that mean?
Doctor: Permanent damage to a branch of the facial nerve means weakness in part of your face.
Patient: Does that mean like I can’t smile or something?
Doctor: That is one example, or your smile could be altered.
Patient: Could I get a real saggy face, like some people you see with Bell’s palsy?
Doctor: If the entire nerve were injured, meaning the main trunk of the facial nerve, and the entire face was paralyzed - that is a possibility.
Patient: Are there other risks?
Doctor: As with any surgery, there are also risks including the risk of general anesthesia and the risks of infection, bleeding, scarring, numbness to the surrounding skin or ear, and even death.
Patient: But those are less common?
Doctor: Correct.
Patient: You say I go home after one or two days. When can I go back to work, and when can I exercise?
Doctor: I usually tell people who have this type of surgery that they should plan on taking about one week off from work or from their normal activities, just as a safe period of time for recovery. And then I ask people to avoid strenuous activity such as exercise for three weeks after the surgery.
Patient: Are there alternatives to the surgical treatment?
Doctor: The only real alternative is just observation and not to do anything. But as I discussed, I don’t think that is appropriate, because it is likely this would continue to grow.
Patient: Well, this is something I have discussed with my wife, and of course, we looked it up on our computer. It is something I would like to have taken care of. So how do I get this scheduled?
Doctor: We can start processing the paperwork today. I’ll have you sign a consent form for the surgery, and I will get you in contact with my surgery scheduler. |