Salivary gland surgery can be an important part of treating tumors, recurrent infections, salivary stones, blocked ducts, and other conditions affecting the salivary glands.
Like any operation, however, it carries potential risks. The type and likelihood of complications depend partly on which gland is being treated, how much tissue needs to be removed, the reason for surgery, and the structures located close to the gland.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Understanding the possible salivary gland surgery risks and complications can help you know what to expect before and after the procedure. These risks are also an important part of discussing salivary gland surgery with your surgical team.
Are Complications Common After Salivary Gland Surgery?
Most patients recover without a serious complication, but some temporary effects are relatively common depending on the procedure. Others are less frequent but may require additional treatment or longer follow-up.
It is important to remember that “salivary gland surgery” covers several different operations. Removing a parotid gland, removing a submandibular gland, and operating on a sublingual gland do not carry exactly the same risks.
For example, the facial nerve runs through the parotid gland, while important nerves responsible for tongue sensation and movement lie close to the submandibular gland. This difference in anatomy explains why the potential nerve-related complications vary between procedures.
Common or Expected Effects After Surgery
Some changes after surgery are part of the normal healing process rather than signs that something has gone wrong. These can include:
- Pain or tenderness around the surgical area
- Swelling or bruising
- Tightness around the wound
- Temporary numbness around the incision
- A visible scar
- Mild difficulty with chewing or opening the mouth, particularly after some parotid procedures
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Important Salivary Gland Surgery Complications to Know About
1. Nerve Weakness or Nerve Injury
Nerve-related complications are among the most important risks associated with some types of salivary gland surgery. This is particularly relevant to parotidectomy because the facial nerve passes through the parotid gland and controls the muscles used for facial expression.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Manipulation of the nerve during surgery can sometimes result in temporary weakness of part or all of one side of the face. In many cases, postoperative facial weakness is temporary and improves as the nerve recovers. Permanent weakness is possible but is less common.
The risk can be influenced by factors such as the location and size of a tumor, whether the operation is a first or repeat surgery, and whether the facial nerve is closely involved with the disease.
2. Numbness Around the Ear or Face
Numbness or altered sensation around the ear, jaw, neck, or surgical scar can occur after salivary gland surgery. During parotid surgery, the greater auricular nerve may be affected because of its location near the gland.
This can cause numbness or tingling, particularly around the lower part of the ear. Sensation may gradually improve, although some patients can experience a persistent area of numbness.
3. Bleeding or Haematoma
Bleeding can occur after any operation. If blood collects beneath the skin, it can form a haematoma, causing swelling, discomfort, or pressure around the surgical site.
Significant bleeding after salivary gland surgery is uncommon, but a rapidly increasing swelling, substantial bleeding, or difficulty breathing requires urgent medical assessment.
4. Infection
A surgical wound can occasionally become infected. Signs may include increasing redness, warmth, swelling, pain, discharge, or fever.
Wound infections are generally uncommon after salivary gland surgery, but they may require antibiotics and, in some cases, drainage or additional treatment.
5. Salivary Leak, Sialocele or Salivary Fistula
Because the purpose of salivary glands is to produce saliva, surgery can occasionally lead to saliva collecting in the tissues or leaking through the wound.
A sialocele is a collection of saliva beneath the skin. A salivary fistula occurs when saliva finds an abnormal pathway to the skin surface.
These problems are particularly associated with surgery involving the parotid gland. Many salivary leaks settle with conservative treatment as healing progresses, although persistent cases may require further management.
6. Frey Syndrome
Frey syndrome is a recognised late complication of parotid surgery. It occurs when nerves that normally stimulate saliva production reconnect abnormally with sweat glands in the skin.
The typical symptom is sweating, flushing, or warmth over the cheek or around the ear when eating or thinking about food. Not everyone with evidence of Frey syndrome finds it troublesome. When symptoms affect quality of life, treatments such as topical therapies or botulinum toxin injections may be considered.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Because Frey syndrome has its own specific causes and treatment options, it is discussed in greater detail in our dedicated guide on Frey syndrome after parotidectomy.
7. Changes in Facial Contour
Removing part or all of a salivary gland can change the natural contour of the area. This may be noticeable as a small hollow or difference in facial fullness, particularly after parotidectomy.
The extent of any change depends on how much tissue is removed, the location of the surgery, the patient's natural facial structure, and how the tissues heal.
Some changes become less noticeable over time, while others may remain. In selected situations, reconstructive techniques may be considered during or after surgery.
8. Scarring
Skin incisions leave scars. Surgeons generally place incisions along natural skin creases or other areas where possible, but the final appearance varies between individuals.
Most scars gradually become less noticeable as they mature. Some people may develop a thicker or more prominent scar, particularly if they are prone to hypertrophic scars or keloids.
9. Dry Mouth or Changes in Saliva
Removing one major salivary gland does not usually cause significant permanent dry mouth because several other major and minor salivary glands continue producing saliva.
However, temporary changes in saliva, mouth dryness, or altered sensations may occur during recovery. More significant dryness may be more likely when multiple glands are affected or when salivary function is reduced for another reason, such as certain cancer treatments.
Persistent dry mouth can affect eating, speaking, swallowing, taste, and oral health, so ongoing symptoms should be discussed with a healthcare professional.
10. Problems Specific to Submandibular Gland Surgery
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The submandibular gland lies close to several important nerves. During surgery, these nerves can occasionally be bruised or injured. Possible effects include:
- Lower lip weakness: temporary weakness of the lower lip can occur if a branch of the facial nerve is affected.
- Tongue numbness: irritation or injury to the lingual nerve can cause altered sensation or numbness on one side of the tongue.
- Changes in tongue movement: very rarely, involvement of the hypoglossal nerve can affect tongue movement.
Most nerve-related effects caused by bruising improve over time, although permanent nerve damage is possible in difficult cases.
What Can Increase the Risk of Complications?
Complication risk is not the same for every patient. Several factors can make surgery more complex, including:
- A large or deeply located tumor
- Disease involving or close to an important nerve
- More extensive gland removal
- Repeat surgery in the same area
- Previous radiation treatment
- Significant inflammation or infection
- The need to remove surrounding tissues as part of cancer treatment
This is why complication statistics from one type of salivary gland operation cannot necessarily be applied to every patient or procedure.
How Are Salivary Gland Surgery Complications Managed?
Treatment depends entirely on the complication. Many postoperative issues can be managed without another operation. For example, temporary nerve weakness may simply require observation and follow-up while the nerve recovers.
A wound infection may be treated with antibiotics, while a fluid collection may sometimes require drainage or aspiration. Persistent salivary leakage can be managed with measures designed to reduce saliva production while the tissues heal.
More complex complications may require specialist treatment. The appropriate approach depends on the underlying cause, how severe the problem is, and whether it is expected to improve naturally with time.
The Bottom Line
Salivary gland surgery is generally performed with careful attention to the important nerves, blood vessels, ducts, and other structures surrounding the glands. However, complications can occur, ranging from temporary swelling and numbness to nerve weakness, infection, bleeding, salivary leakage, Frey syndrome, or changes in facial contour.
The specific risks depend on the type of salivary gland surgery and the condition being treated. Understanding these possibilities before surgery can help you have a clearer discussion with your surgical team about the expected benefits, individual risks, recovery, and follow-up.
