Parotid Tumor & Cancer Reconstruction(Salivary Gland Malignancy)
Restoring your smile and facial function after life-saving oncologic surgery.
The Parotid Gland & The Facial Nerve
The parotid glands are the largest salivary glands, located just in front of and below your ears. Uniquely, the facial nerve (7th cranial nerve) exits the skull and runs directly through the center of the parotid gland, splitting into five main branches that control all of your facial expressions.
When a benign or malignant (cancerous) tumor develops in the parotid gland, it can entangle or press against the facial nerve. During a "parotidectomy" (surgery to remove the tumor), the primary goal of your oncologic surgeon is to safely remove the disease. In cases of advanced or aggressive cancer, the facial nerve must sometimes be intentionally sacrificed to ensure all cancer cells are removed and save your life.
Like traumatic injuries, surgical sacrifice of the facial nerve results in immediate facial paralysis. However, modern reconstructive techniques allow us to rebuild the neural pathways at the time of your tumor removal or shortly thereafter.
Coordination is Key: Immediate Reconstruction
If you have been diagnosed with a parotid tumor and are scheduling a resection, it is highly recommended to consult with a facial reanimation specialist before your surgery.
Dr. Jowett frequently coordinates with head and neck oncologic surgeons to perform "immediate reconstruction." This means that in the same operation where the tumor is removed, Dr. Jowett steps in to graft and repair the cut facial nerve before you even wake up. This prevents muscle atrophy and offers the best possible chance for regaining facial movement.
Symptoms of Nerve Involvement
Symptoms can appear before surgery if the tumor is invading the nerve, or immediately after surgery if the nerve was manipulated or removed.
Pre-Surgical Weakness
If a parotid mass is accompanied by a gradually worsening facial droop or twitching before surgery, it is a strong indicator that the tumor is malignant and invading the nerve.
Post-Surgical Flaccid Paralysis
If the nerve is sacrificed, you will wake up with profound loss of muscle tone on that side of the face, causing a drooping mouth, flattened cheek, and difficulty speaking or eating.
Inability to Close the Eye
Like other forms of facial paralysis, the inability to blink or close the eye (lagophthalmos) is a medical emergency that requires immediate protective measures.
Reconstructive Surgical Options
Post-oncologic reconstruction often must account for missing tissue, large nerve gaps, and the effects of post-operative radiation therapy.
If a segment of the nerve is removed with the tumor, leaving a gap, Dr. Jowett can harvest a sensory nerve (usually from the leg or neck) to act as a "cable graft." This bridges the gap between the main facial nerve trunk and the peripheral branches, allowing the nerve to slowly grow back into the face over 6-12 months.
Why Choose Revitalis?
Dr. Nate Jowett is a world-renowned expert in facial reanimation. With dual fellowship training in Germany and at Harvard Medical School, he brings a unique engineering and microsurgical background to treating complex facial nerve disorders.
Whether you are days into a diagnosis or have lived with incomplete recovery for years, Dr. Jowett offers the full spectrum of care, from medical management to cutting-edge surgical reconstruction, to help you regain your smile and confidence.
Selected References
- Free Gracilis Muscle Transfer for Smile Reanimation after Treatment for Advanced Parotid Malignancy. Faris C, Heiser A, Hadlock T, Jowett N. Head Neck. 2018 Mar; 40(3):561-568. doi: 10.1002/hed.25022. PMID: 29155463.
- A General Approach to Facial Palsy. Jowett N. Otolaryngol Clin North Am. 2018 Dec;51(6):1019-1031. doi: 10.1016/j.otc.2018.07.002. PMID: 30119926.
- A Contemporary Approach to Facial Reanimation. Jowett N, Hadlock TA. JAMA Facial Plast Surg. 2015 Jul-Aug;17(4):293-300. doi: 10.1001/jamafacial.2015.0399. PMID: 26042960.