Dr Ameen

Article written by Dr Ameen, ENT Specialist Kuala Lumpur

A parotidectomy involves the surgical removal of all or part of the parotid gland. This is the largest salivary gland located just in front of the ear and below the earlobe. I perform this surgery to treat tumors, chronic infections or structural blockages within the gland.

The procedure begins with an incision placed in the natural skin creases in front of the ear and extending down into the upper neck (Modified Blair incision). I carefully identify and preserve the facial nerve, which runs directly through the gland and controls your facial movements. The affected glandular tissue is then removed. A superficial parotidectomy removes only the outer lobe, while a total parotidectomy removes the entire gland. The surgery typically takes two to four hours depending on the tumor size and surgical complexity.

After the operation, you will wake up with a small drain tube in your neck to prevent fluid accumulation. Mild to moderate pain and swelling around the ear and jaw are normal for the first few days. You might also experience numbness around the earlobe due to the sensory nerves in the skin. Most patients stay in a private hospital in Kuala Lumpur for two to three nights until the drain is removed and pain is well controlled.

Indications for Parotidectomy

I recommend this surgery when medical management fails or when a structural abnormality poses a long term health risk. The strongest clinical reasons include:

• Benign parotid tumors: Pleomorphic adenoma is the most common reason for surgery. We remove these growths to prevent them from continuing to enlarge and to eliminate the small risk of future malignant transformation.
• Malignant parotid tumors: Cancers such as mucoepidermoid carcinoma or adenoid cystic carcinoma require complete surgical excision and sometimes concurrent neck dissection.
• Chronic recurrent parotiditis: Severe and repeated bacterial infections that do not respond to antibiotics and significantly impair daily life.
• Salivary gland stones or strictures: Chronic obstruction causing persistent pain and swelling during meals that cannot be managed with conservative measures.
• Cystic lesions: Large branchial cleft cysts or second branchial anomalies located within the parotid space requiring complete excision.

Complications of Parotidectomy

Every head and neck surgery carries inherent risks. I discuss these thoroughly during our consultation so you understand what to expect. The overall safety profile is excellent when performed by an experienced specialist.

• Facial nerve weakness: Temporary weakness occurs in 10 to 20 percent of cases due to nerve stretching and usually resolves within months. Permanent weakness happens in less than 1 to 2 percent of superficial parotidectomies.
• Frey syndrome (gustatory sweating): Sweating and flushing over the cheek while eating occurs in 30 to 50 percent of patients. Severe cases requiring medical treatment are rare.
• Salivary fistula or sialocele: Leakage of saliva into the wound bed happens in 5 to 10 percent of cases and typically resolves with pressure dressings and temporary dietary modifications.
• Haematoma formation: Bleeding requiring surgical evacuation occurs in 1 to 3 percent of cases.
• Numbness of the earlobe: Damage to the great auricular nerve causes permanent numbness in 20 to 30 percent of patients.
• Permanent facial nerve injury: Complete loss of facial movement on the operated side is extremely rare, affecting less than 1 percent of patients undergoing surgery for benign disease.

Estimated Procedure Cost (Professional Fees)

Medical fees in Malaysia are guided by the Private Healthcare Facilities and Services Act. Based on the PHFSA 2013 regulations for a Superficial Parotidectomy (Code F4430), the maximum allowable professional fees are:

• Surgeon Professional Fee (CMO 2): RM3,600
• Anaesthetist Professional Fee (MAJOR+ 4): RM1,320
• Total Maximum Professional Fees: RM4,920

Total Estimated Cost

• Total Estimated Cost (including hospital facility fees, operating theatre charges, specialised equipment like facial nerve monitors, medications and consumables): RM15,000 to RM18,000
• Disclaimer: This is an estimated total cost only. Actual bills vary significantly depending on the specific hospital, room type and individual patient needs across Malaysia. Patients should always request a detailed itemised cost estimate from their chosen hospital or medical centre before proceeding.

Frequently Asked Questions

Will I have a visible scar after parotidectomy? Yes, the incision is placed in the natural skin creases in front of the ear and down the upper neck. The scar usually fades significantly over six to twelve months and becomes barely noticeable.

How long does facial nerve weakness last if it happens? Temporary weakness from nerve stretching or swelling typically improves within three to six months. We use facial nerve monitoring during surgery to minimize this risk and prescribe steroids to reduce inflammation.

Do I need radiation therapy after the surgery? Radiation is only recommended if the final pathology report shows a malignant tumor with high risk features like positive margins or perineural invasion. Benign tumors do not require postoperative radiation.

What is Frey syndrome and can it be prevented? Frey syndrome causes sweating and redness on the cheek when eating due to misdirected nerve regeneration. We place a tissue barrier during surgery to reduce this risk, and treatments like Botox injections are available if symptoms become bothersome.

When can I return to work after the procedure? Most patients return to desk jobs within two weeks once the surgical drain is removed and initial swelling subsides. Jobs requiring heavy physical exertion or extensive public speaking may require three to four weeks of recovery.

When to Seek Consultation

Finding a lump in your salivary gland is frightening, but the vast majority of parotid tumors are benign and highly treatable. Modern surgical techniques and facial nerve monitoring allow us to remove the disease safely while preserving your facial movement and appearance.

If you have noticed a painless swelling in front of your ear or below your jaw, do not wait. Book a consultation at my Kuala Lumpur clinic for a thorough physical examination and ultrasound evaluation. We will map out a clear, personalized treatment plan to address your concerns.

About the Author

Dr. Ameen is a Resident Ear, Nose & Throat Consultant at KPJ Ampang Puteri Specialist Hospital, situated in Selangor near the Kuala Lumpur border and serving patients from both Ampang and Kuala Lumpur.

He earned his medical degree (MB BCh BAO Hons) in Ireland and completed his Master of Otorhinolaryngology at Universiti Kebangsaan Malaysia. With comprehensive tertiary training from Hospital Kuala Lumpur and Hospital Tunku Azizah, he expertly manages complex adult and pediatric ENT conditions, including sinus, ear, throat, and vertigo disorders.

Before taking on his current role as a Resident ENT Consultant at KPJ Ampang Puteri Specialist Hospital, Dr. Ameen spent three years building extensive private center experience in Kuala Lumpur as a sessional ENT Consultant at Sunway Medical Centre Velocity and Columbia Asia Hospital Setapak.