Salivary Gland Surgery

Introduction

If you have been told you need salivary gland surgery, you are probably already past the stage of wondering what is causing your swelling, lump, or repeated infections. A scan or biopsy has likely been done, a diagnosis has been discussed, and surgery is now part of the plan. This guide is written for that moment — when you understand broadly what is wrong but want to know what the operation actually involves, what the recovery will feel like, and what to expect afterwards.

Salivary gland conditions are common, but surgery on these glands is a careful, specialised area of ear, nose and throat (ENT) and head and neck practice. The glands sit close to important facial nerves, so the operation is as much about protecting those nerves as it is about removing the problem tissue. This article walks you through the different types of salivary gland surgery, how the operation is planned and performed, recovery and risks, and the practical questions most patients ask before going ahead.

What Is Salivary Gland Surgery?

Salivary gland surgery is a group of operations performed on the glands that produce saliva. Saliva helps you chew, swallow, taste, speak, and protect your teeth and gums from infection. When a gland becomes blocked, infected, or develops a growth, surgery is one of the ways doctors restore comfort and rule out or treat serious disease.

• Parotid glands — the largest pair, sitting in front of and below each ear. The facial nerve, which controls the muscles of facial expression, passes directly through the parotid gland.
• Submandibular glands — sitting just under the lower jaw on each side. They produce most of the saliva you make at rest.
• Sublingual glands — smaller glands lying under the tongue, on the floor of the mouth.
• Minor salivary glands — hundreds of tiny glands scattered through the lips, cheeks, palate, and throat.

Depending on the problem, surgery may mean removing a stone, opening a blocked duct, taking out part of a gland, removing the whole gland, or removing a tumour together with surrounding tissue. The goal is to settle symptoms, confirm or treat a diagnosis (especially if a tumour is involved), and preserve the nerves and tissues around the gland as far as possible.

Why Is Salivary Gland Surgery Performed?

Surgery is usually considered only after a clear diagnosis has been made through clinical examination and imaging, sometimes supported by a fine needle biopsy. The most common reasons for salivary gland surgery include:

Salivary Stones (Sialolithiasis)

Stones can form inside the duct of a salivary gland, most often the submandibular gland. They block the flow of saliva, causing pain and swelling that get worse around mealtimes. Small stones near the opening of the duct can sometimes be removed in clinic, but larger or deeper stones, or stones that keep coming back, may need surgery.

Benign Tumours

The most common benign salivary gland tumour is a pleomorphic adenoma, which usually forms in the parotid gland. Even though it is not cancerous, doctors generally recommend removal because it can slowly grow, become harder to remove safely over time, and in a small number of cases change into a cancer many years later.

Salivary Gland Cancer

Cancers of the salivary glands are uncommon but do occur. The parotid gland is the most frequent site, although cancers can arise in any salivary gland. Surgery is usually the main treatment, sometimes followed by radiation therapy depending on the tumour type and stage.

Chronic or Recurrent Infection

When a gland has been damaged by repeated infections, scarring, or autoimmune disease, it may stop functioning properly and continue to cause swelling and pain. Removing the affected gland can settle long-standing symptoms.

Cysts and Other Lesions

Ranulas (mucous cysts in the floor of the mouth), mucoceles, and other cystic lesions sometimes need surgical removal, particularly if they keep returning after simple drainage.

Blocked Ducts Not Caused by Stones

Scar tissue, narrowing (strictures), or mucus plugs can block saliva flow in the absence of stones. These can sometimes be treated with sialendoscopy, a procedure described below.

Who Is a Candidate?

Whether you are a candidate for salivary gland surgery depends on what is wrong, how much it is affecting you, and your overall fitness for an operation. ENT and head and neck surgeons typically consider surgery in the following situations:

• A lump or mass in a salivary gland that needs to be removed for diagnosis or treatment, especially if imaging or biopsy suggests a tumour
• Repeated episodes of pain or swelling that have not responded to medication, hydration, gland massage, or duct procedures
• Large or deeply placed stones that cannot be removed through the mouth or by sialendoscopy
• Confirmed or suspected cancer of a salivary gland
• Cysts or ranulas that keep coming back
• Chronically damaged glands causing ongoing symptoms

Before surgery, your surgeon will review your medical history, current medications (particularly blood thinners), other health conditions, and the results of your scans and biopsy. People with significant heart, lung, or bleeding problems may need additional assessment to make anaesthesia as safe as possible.

Alternatives to Surgery

Not every salivary gland problem needs surgery. Depending on the diagnosis, alternatives or first-line options may include:

Conservative and Medical Management

For acute infections, treatment usually starts with antibiotics, warm compresses, good hydration, gentle gland massage, and sialogogues such as sour sweets to encourage saliva flow. Many infections settle without any surgery.

Sialendoscopy

Sialendoscopy is a minimally invasive technique in which a very fine endoscope is passed through the natural opening of the salivary duct in the mouth. The surgeon can look directly inside the duct and treat the problem from within — flushing out debris, breaking up or retrieving small stones, dilating narrow segments, or guiding stone-fragmentation devices. Many salivary stones and duct strictures can now be managed in this way, often as a day procedure. Where stones are too large or too deeply embedded, sialendoscopy may be combined with a small external or intra-oral incision (a combined approach) to preserve the gland rather than remove it.

Observation

Small, slow-growing benign lumps that have been clearly characterised on imaging and biopsy may sometimes be watched, particularly in older patients or those with significant other health problems. This is a decision made carefully with the surgeon, balancing the risks of monitoring against the risks of operating.

Radiation Therapy and Other Cancer Treatments

For salivary gland cancers, surgery is typically the central treatment, but radiation therapy — sometimes combined with chemotherapy — is used in selected cases, especially when surgery alone is not possible or when there is a high risk of recurrence. The exact plan is decided by a multidisciplinary team including head and neck surgeons, oncologists, and radiologists.

Types of Salivary Gland Surgery

The operation you have depends on which gland is involved and what is being treated. The main types are described below.

Parotidectomy (Surgery on the Parotid Gland)

• Superficial parotidectomy removes the part of the gland that lies above the facial nerve. It is often used for benign tumours such as pleomorphic adenomas.
• Partial superficial (extracapsular) parotidectomy removes a small portion of gland tissue around a benign lump, with less dissection of the nerve. It is used for small, well-placed benign tumours.
• Total parotidectomy removes the entire gland, including tissue below the facial nerve. It is usually reserved for tumours that extend deeper or for cancers.
• Radical or extended parotidectomy may involve removing the facial nerve and surrounding structures when cancer has spread into them. This is uncommon but sometimes necessary for advanced disease.

Submandibular Gland Excision

The submandibular gland is removed through a small incision in a natural skin crease in the upper neck, usually a few centimetres below the jawline. The surgeon carefully avoids three important nerves close to the gland: the marginal mandibular branch of the facial nerve (which moves the lower lip), the lingual nerve (which carries sensation and taste from the tongue), and the hypoglossal nerve (which moves the tongue). This operation is most often done for recurrent stones, chronic infection, or tumours of the submandibular gland.

Sublingual Gland Excision

The sublingual gland is removed through the mouth, with no external incision. It is most often taken out to treat a ranula (a cyst arising from the gland) or, less commonly, a tumour. The lingual nerve and the submandibular duct lie very close and are carefully protected during surgery.

Sialendoscopy and Gland-Sparing Procedures

As described above, sialendoscopy can be a stand-alone treatment for stones and duct problems. It can also be combined with a small targeted incision to remove a larger stone while keeping the gland in place. Surgeons increasingly favour gland-sparing approaches when the gland is otherwise healthy, because removing a gland is a permanent step.

Minor Salivary Gland Surgery

Lumps or tumours arising from minor salivary glands — in the lip, palate, cheek, or throat — are removed locally, often through the mouth. The size of the operation depends on the diagnosis.

Preparing for Salivary Gland Surgery

Once surgery is planned, the preparation process is similar to that for many head and neck operations:

• Pre-operative consultation: your surgeon will explain what will be removed, the expected scar location, the risks specific to your operation (especially nerve-related risks), and the likely recovery timeline. This is the right moment to ask every question you have.
• Investigations: blood tests, an electrocardiogram (ECG), and sometimes a chest X-ray are arranged to confirm fitness for anaesthesia. Your imaging (ultrasound, CT, or MRI) will be reviewed in detail.
• Medication review: blood thinners such as aspirin, clopidogrel, or warfarin may need to be adjusted or stopped temporarily. Diabetes medications, blood pressure tablets, and inhalers are usually continued, with specific instructions about the morning of surgery. Always follow your surgeon’s and anaesthetist’s instructions rather than stopping medications on your own.
• Smoking and alcohol: stopping smoking, even for a few weeks before surgery, can help wound healing and reduce chest complications. Limiting alcohol is also helpful.
• Fasting: you will usually be asked not to eat for about six hours and not to drink clear fluids for about two hours before surgery, but your hospital will give you exact timings.
• Dental check: for some operations, particularly larger ones, a dental review is helpful to treat any active infections beforehand.

Practical preparation matters too. Arrange someone to bring you home, plan soft foods for the first few days, and set up a comfortable place to rest with your head slightly raised.

What Happens During Salivary Gland Surgery

The details vary by operation, but a typical day looks like this:

Anaesthesia

Most salivary gland operations are performed under general anaesthesia, meaning you are fully asleep. Sialendoscopy alone can sometimes be done under local anaesthesia with sedation. The anaesthetist will discuss the safest option for you based on your health and the planned procedure.

Positioning and Skin Preparation

You are positioned with your head turned away from the side being operated on. The skin is cleaned with antiseptic, and sterile drapes are placed. For parotid and submandibular operations, the incision is planned to fall in a natural skin crease or behind the ear so that the scar is as discreet as possible.

The Operation

• For a parotidectomy, the surgeon makes an incision in front of and behind the ear, sometimes extending into the upper neck. The facial nerve is identified and traced through the gland. Tissue above (and, if needed, below) the nerve is removed, preserving the nerve branches.
• For submandibular gland excision, an incision is made in the upper neck. The gland is carefully separated from nearby nerves, the duct is divided, and the gland is removed.
• For sublingual gland excision, an incision is made inside the mouth on the floor of the mouth. The gland is removed while protecting the lingual nerve and the submandibular duct.
• For sialendoscopy, a very fine scope is passed into the duct through its natural opening. Tiny instruments, baskets, balloons, or laser fibres may be used through the scope to treat the problem.

During many of these procedures, a nerve monitor is used. This is a device that helps the surgeon detect the facial or other nerves during the operation and reduce the risk of injury. At the end of surgery, the wound is closed in layers, and a small drain may be placed under the skin to remove fluid for a day or two.

Length of Surgery

Operations can take anywhere from under an hour (for a simple sialendoscopy) to several hours (for a complex parotidectomy with neck dissection for cancer). Your surgeon will give you an estimate based on your specific case.

Recovery and Healing

In Hospital

After surgery, you wake up in a recovery area and are then moved to a ward. Many sialendoscopies and small intra-oral procedures are done as day cases. Parotid and submandibular gland surgery usually means a hospital stay of one to three days, sometimes longer for larger cancer operations.

You can expect:

• Some pain or tightness around the wound, controlled with pain medication
• A dressing over the incision and possibly a small drain that is removed once fluid output settles
• A soft diet, starting with sips of water and progressing as you tolerate it
• Early walking around the ward, which helps prevent blood clots and chest infections

The First Two Weeks

Once home, most people manage well with simple pain relief. Swelling and bruising around the jaw and neck are common and gradually settle. The wound is kept clean and dry as instructed. Stitches or clips, if not dissolvable, are usually removed in around seven to ten days. Eating soft, easy-to-chew foods for the first week or two is often more comfortable.

Returning to Normal Activity

Light activity, including office work, is often possible after one to two weeks. Heavier physical work, exercise, and lifting are usually held off for several weeks. Driving can resume once you can move comfortably, are off strong painkillers, and feel safe to do an emergency stop.

Nerve Recovery

If the facial nerve has been stretched or bruised during parotid surgery, some weakness of the face is common in the first days and weeks. In most cases this is temporary and gradually improves over weeks to months. Permanent weakness is uncommon when the nerve is preserved during surgery, but the risk is higher for larger, deeper, or cancerous tumours.

After submandibular gland surgery, tingling, numbness, or temporary weakness of the lower lip can occur and usually improves over time.

Follow-Up

You will be seen in clinic after surgery to check the wound, review any nerve symptoms, and discuss the pathology report — the detailed analysis of the removed tissue. For benign conditions, follow-up may be brief. For cancers, longer-term surveillance with regular clinic visits and scans is standard.

Risks and Complications

Salivary gland surgery is generally safe in experienced hands, but as with any operation it carries risks. Your surgeon will discuss the ones most relevant to your operation. Common considerations include:

Nerve Injury

• Facial nerve weakness after parotid surgery can affect the eyebrow, eyelid, cheek, or corner of the mouth. Temporary weakness is fairly common; permanent weakness is uncommon, especially with benign disease, but is more likely with larger or cancerous tumours.
• Marginal mandibular nerve weakness after submandibular surgery can cause a slightly uneven smile, usually temporary.
• Lingual nerve injury can cause numbness or altered taste on one side of the tongue.
• Hypoglossal nerve injury, which would affect tongue movement, is rare.

Bleeding and Haematoma

A collection of blood under the skin (haematoma) sometimes forms after surgery and may need drainage. Significant bleeding is uncommon.

Infection

Wound infections occur in a small number of patients and are usually treated with antibiotics and wound care.

Salivary Leak (Sialocele) and Fistula

After parotid surgery, saliva can sometimes collect under the skin (sialocele) or leak through the wound. These are usually managed without further surgery, with repeated aspiration and time.

Frey’s Syndrome

After parotid surgery, some people develop sweating or flushing of the cheek when eating. This is called Frey’s syndrome and is caused by nerve fibres regrowing into the wrong tissue. It is often mild and can be treated if it becomes bothersome.

Numbness Around the Ear or Neck

Small sensory nerves in the skin are sometimes cut during the operation, leaving an area of numbness near the earlobe or upper neck. This often improves over months but may not fully return to normal.

Scarring

Incisions are placed in natural creases where possible. Scars usually fade well, but some people heal with more visible or thickened scars (keloid or hypertrophic scars).

Dry Mouth

Removing one gland does not usually cause significant dry mouth, because many other glands continue to produce saliva. Dry mouth can be more of an issue after surgery combined with radiation therapy for cancer.

Recurrence

For benign tumours such as pleomorphic adenoma, careful removal greatly reduces the chance of the tumour coming back. For cancers, the chance of recurrence depends on the type, stage, and completeness of removal, and is monitored over time.

General Anaesthetic Risks

These include reactions to medication, chest infection, and blood clots. They are uncommon, and pre-operative assessment is designed to minimise them.

Life After Salivary Gland Surgery

For most patients with benign conditions, life after surgery returns largely to normal within a few weeks. Eating, speaking, and swallowing are usually unaffected once swelling has settled. The scar fades over months. If a stone or chronic infection was the problem, the relief from no longer having recurrent painful episodes is often substantial.

For patients with cancer, life after surgery involves a longer follow-up plan. This may include:

• Additional treatment such as radiation therapy, decided by the multidisciplinary team based on the pathology report
• Regular clinic visits with examination of the neck and operated area
• Periodic imaging
• Speech and swallowing therapy if needed
• Dental care, particularly if radiation has been part of the treatment plan

If facial nerve weakness has occurred, eye care is important. Doctors often advise lubricating drops, ointment at night, and sometimes a protective eye patch or temporary lid weight to protect the cornea while nerve function recovers. Physiotherapy and facial exercises can help during recovery. In a small number of cases where weakness does not improve, further procedures to reanimate the face may be considered.

Most people who have had salivary gland surgery describe the result as a relief from a long-standing problem. The cosmetic outcome, especially for parotid and submandibular operations, is usually good when surgery is performed by an experienced head and neck team.

Salivary Gland Surgery in Children

Children can develop salivary gland conditions, though the spectrum differs from adults. Recurrent parotid swelling in childhood (juvenile recurrent parotitis), salivary stones, ranulas, lymphatic malformations, and benign tumours are among the conditions that may need surgical assessment.

Where possible, paediatric ENT and head and neck surgeons favour gland-sparing approaches such as sialendoscopy, particularly for juvenile recurrent parotitis, because removing a gland in a child is a long-term commitment that doctors prefer to avoid unless necessary. Surgery, when needed, is performed under general anaesthesia in a paediatric setting with anaesthetists experienced in caring for children.

Considerations specific to children include:

• Smaller anatomy, which makes nerve preservation even more delicate
• Particular attention to scar placement, as the scar will be present for many years
• Age-appropriate pre-operative explanation and reassurance
• Parents’ involvement in recovery and follow-up

Outcomes in children are generally good. If your child is being considered for salivary gland surgery, the surgeon should be willing to walk you through exactly what will be done, the alternatives that have been considered, and the expected recovery in language your child can also understand.

Frequently Asked Questions

Will I still be able to produce saliva after surgery?

Yes. The other salivary glands continue to work and usually compensate well after removal of a single gland. Most people do not notice a significant change in saliva. Dry mouth is more likely when multiple glands are affected or when surgery is combined with radiation therapy.

Will I have a visible scar?

Most external incisions are placed in natural skin creases or behind the ear so that the scar is as discreet as possible. Scars fade over months. Sialendoscopy and sublingual gland surgery often involve no external scar at all.

Will my face be weak after parotid surgery?

Some temporary weakness of part of the face is common after parotid surgery and usually improves over weeks to months. Permanent weakness is uncommon when the facial nerve is preserved, but the risk is higher with larger or cancerous tumours. Your surgeon will explain the specific risk for your operation.

How long will I be off work?

This depends on the operation and your type of work. Many people return to office-based work after one to two weeks. Physically demanding work usually requires more time. Your surgeon will give you a tailored estimate.

Can salivary stones come back after surgery?

If the gland producing the stones is removed, stones cannot form in that gland again. If the gland is preserved (for example, after sialendoscopy), there is a possibility of new stones forming, particularly if there are underlying reasons such as dehydration or certain medications. Staying well hydrated and following your surgeon’s advice can help.

Is a lump in a salivary gland always cancer?

No. Most salivary gland lumps, particularly in the parotid, are benign. However, any persistent lump should be evaluated because some lumps are cancerous and earlier diagnosis tends to lead to better outcomes. The decision to operate is guided by examination, imaging, and often a fine needle biopsy.

What anaesthesia is used?

Most major salivary gland operations are performed under general anaesthesia. Some sialendoscopy procedures can be done under local anaesthesia with sedation. The anaesthetist will discuss the safest option for your situation.

Will I need further treatment after surgery?

For benign conditions, surgery is usually the end of treatment. For salivary gland cancers, additional treatment such as radiation therapy may be advised based on the pathology report and decisions made by the multidisciplinary team.

How do I look after my wound at home?

Your surgical team will give you specific instructions, which usually include keeping the wound clean and dry, avoiding heavy lifting and strenuous activity for a period, taking medications as prescribed, and attending follow-up appointments. Call the team promptly if you notice increasing redness, swelling, discharge, fever, or worsening pain.

Conclusion

Salivary gland surgery is a carefully planned, well-established treatment for conditions ranging from troublesome stones to benign tumours and cancers of the salivary glands. The right operation depends on which gland is involved, what is being treated, and the individual anatomy and preferences of the patient. Modern approaches increasingly favour gland-sparing techniques such as sialendoscopy where appropriate, while traditional operations such as parotidectomy and submandibular gland excision remain essential for tumours and certain stones.

If you are preparing for salivary gland surgery, the most useful conversation is with the ENT or head and neck surgeon who has seen your scans and examined you. They can explain exactly what will be done, what nerves are at risk in your specific operation, what the scar will look like, and what your particular recovery is likely to involve. With experienced surgical care and clear aftercare, most patients move past a long-standing salivary gland problem and back to comfortable everyday life.