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Parotidectomy Surgery

Division of Surgery & Critical Care

This booklet has been design to give you useful information about this procedure and to answer some commonly asked questions you may have.

Contents:

What is the Parotid Gland? Are their any alternatives to Surgery? The Operation What are the Risks/possible complications? Your visit to the Pre-assessment Clinic What happens on the day of your admission? What happens at the operating theatre? What will happen after my operation? Advise at hospital discharge Do you need any further information? References used in this compilation leaflet Concerns and Queries Confidentiality Zero tolerance policy Risk management strategy Telephone Contact Numbers 4 4 4 5 6 6 7 7 8 9 9 10 10 11 11 Back Cover

What is the Parotid Gland?

This is a gland, which makes saliva to wet the food in your mouth. It is shaped like a wedge and fits behind the back you jaw bone just in front of your ear. The saliva runs from the parotid gland along a tube that opens into your mouth near your back teeth. The nerve to all your face muscles runs through the parotid gland and the nerve to the skin of your ear runs past the back of the parotid. If a swelling grows in the parotid gland, that part of the parotid has to be removed.

What are the risks or possible complications?

Most people have some numbness of the ear, this gets better over 2 to 3 months but may take up to a year, or may always be there slightly. Straight after the operation about 1 in 10 patients notice some weakness of the side of the mouth or some difficulty in closing the eye properly. Stretching or bruising of the nerve fibres causes this; recovery takes an average of 2 ­ 4 months. Haematoma ­ reactionary haemorrhage may occur in the first 2 to 3 hours post operatively Infection is an unusual problem and settles down with antibiotics in a week or two. Frey's syndrome is were you get sweating over the temple area, facial flushing when eating due to dilatation of blood vessels and secretion from the sweat glands ­ the onset is usually within 18 months of surgery but may not develop until years later. This is rarely troublesome but can be treated. Salivary fistula results in leakage of saliva through the wound from exposed salivary gland tissue. This usually resolves spontaneously within one month of the operation. Wound dimple ­ parotidectomy always leaves a depression behind the jawbone this may be quite pronounced immediately post operatively (after surgery) but may fill to some degree over the course of the following months. The swelling in the parotid will be examined under a microscope to find out the exact type/cause; sometimes x-ray treatment is needed after the operation.

Are their any alternatives to surgery?

The swelling could be treated by X-ray (Radiotherapy) and drugs but this on its own is not as good as an operation. Some patients may need a combination of Radiotherapy, drugs and surgery. If you do nothing the problem in your parotid will slowly get worse. The bigger the swelling the more difficult it is to take out safely and the greater the risk of nerve damage. Sometimes the parotid needs extra treatment, the swelling needs to be taken out to find out if this is needed.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation. An S-shaped cut is made down the skin crease in front of your ear, under your ear lobe, and down onto the side of your neck. The swelling together with some of the parotid gland is cut out. A small plastic tube is placed in the wound called a drain. This is connected to a small bottle and stops blood collecting under the skin. The skin is closed up using stitches or clips. The wound is designed to heal leaving only a faint scar.

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Your visit to the pre-assessment Clinic

You will receive an appointment to attend the pre-assessment clinic which is nurse led. The nurse will see you and take a medical history from you and fill in documentation needed for your admission for surgery. He/She will make sure appropriate tests are carried out at this visit such as Blood tests, ECG, xrays etc. The nurse will explain about anaesthetics and check you have received correct fasting instructions. You need to bring any medication you are taking with you to this appointment or bring a copy of your repeat prescription. The nurse will explain admission procedure and talk you through your pathway from admission to discharge home. This is an opportunity for you to ask any questions/queries you have regarding your operation and recovery process.

What happens at the operating theatre?

Once you are taken up to the operating theatre you will be met by the anaesthetist in the anaesthetic room where you will be put to sleep. A small needle is placed in the back of your hand, which is used to administer the anaesthetic to you. You will be asleep within a few seconds of this happening. You will wake up in the recovery area of theatre where the nurses and theatre team are caring for you (many patients do not remember this as they are so sleepy).

What will happen after my operation?

Some patients feel a bit sick for up to 24 hours after the operation, but this passes off and you may be given some medication to help stop this. You may be given some oxygen from a facemask for a few hours depending on the anaesthetist's instructions. A general anaesthetic may make you slow, clumsy and forget for about 24 hours do not make any important decisions during that time. There is usually some discomfort on moving rather than severe pain; you will be given medication to control this as required. You will be asked to close your eyes, smile to observe that there is no trauma to the facial nerve; this will be carried out a few times during your stay in hospital. By the end of the week you should be virtually pain free. Any drain tubes are removed after 1-2 days. The wound dressing may show some staining with old blood in the first 24 hours. The dressing will be changes when needed. Stitches or small metal clips will hold the wound together.

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What happens on the day of your admission?

You will have received instructions as to which ward you are to go to and at what date and time (the nurse in preassessment will confirm this for you). On arrival at the ward you will be shown to your bed and the nurse will check your details. A member of the surgeon's team will come to see you and discuss your operation with you and get your written consent for treatment. He/she will also mark the side of your neck that is to be operated on. An anaesthetist will visit you and discuss your anaesthetic with you. If you are very anxious the anaesthetist may prescribe some medication to help you relax. Please bring any medication you are taking into hospital with you in there original boxes/containers.

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There may be some bruising around the wound site, which may spread downwards by gravity, this will fade and disappear like any other bruising does. There may be swelling of the surrounding skin which improves in 2 ­ 3 days. All clips/stitches are removed after 5 to 7 days either back at clinic or via your GP. The physiotherapist may visit and give you some facial exercises if you need them due to facial nerve bruising.

Do you need any further information?

If you have any further questions, please ask the nurse or doctor who is looking after you.

References used in the compilation of this leaflet:

Ruckley R.W. (1998) Diseases of the Salivary Glands, chapter14 in: Burnard k. &Young A. (eds) (1998); Roland N. McRae R. & McCombe A. (1995) Key topics in Otolaryngology, Bios Scientific Publishers

Advise at hospital discharge

You are allowed to shower/bath after 24 hours or on instructions from your surgeon. You will be allowed home usually 24 ­ 48 hours after your operation day by then you will be able to eat, walk and go to the bathroom. Recovery will take a little while and you should not over do things for the first two weeks. During this time you may feel rather tired but this will improve over the next two weeks You should be able to return to work after two weeks. The hospital can provide you with a sick note, please ask for one on admission to the ward. Driving can be resumed after 48 hours providing you feel well enough to drive.

Concerns and Queries

If you need further assistance, the Patient Advice and Liaison Service will be able to help. They can be contacted on: Diana Princess of Wales Hospital, Grimsby PALS Manager 01472 875403 Scunthorpe General Hospital PALS Officer 01724 290132 Goole & District Hospital PALS Administration Manager 01724 290172 or by email: [email protected]

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Confidentiality

Information on NHS patients is collected in a variety of ways and for a variety of reasons (e.g. providing care and treatment, managing and planning the NHS, training and educating staff, research etc.) It is stored on paper and on computerised systems in line with the Data Protection Act 1998. Everyone working for the NHS has a legal duty to keep information about you confidential. Information will only ever be shared with people who have a genuine need for it (e.g. your GP or other professionals from whom you have been receiving care) or if the law requires it, for example, to notify a birth. Please be assured however that anyone who receives information from us is also under a legal duty to keep it confidential.

Risk Management Strategy

The Trust welcomes comments and suggestions from patients and visitors that could help to reduce risk. Perhaps you have experienced something whilst in hospital, whilst attending as an outpatient or as a visitor and you felt at risk. Please tell a member of staff on the ward or in the department you are attending/visiting.

Zero Tolerance - Violent, threatening and abusive behaviour

The Trust and its staff are committed to providing high quality care to patients within the department. However, we wish to advise all patients/visitors that the following inappropriate behaviour will not be tolerated: · Swearing · Threatening/Abusive Behaviour · Verbal/Physical Abuse The Trust reserves the right to withdraw from treating patients whom are threatening/abusive/violent and ensuring the removal of those persons from the premises. All acts of criminal violence and aggression will be notified to the Police immediately.

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Contact Telephone Numbers:

Ward 27, Scunthorpe General Hospital: Ward 25, Scunthorpe General Hospital: Ward 28, Scunthorpe General Hospital: Ward 6, Goole and District Hospital: Or Your own GP practice 01724 290195 01724 290106 01724 290108 01724 290030

Northern Lincolnshire and Goole Hospitals NHS Trust Scunthorpe General Hospital Cliff Gardens Scunthorpe DN15 7BH 01724 282282 www.nlg.nhs.uk

Issue Date: July 2006 Review Date: July 2008 Author: Division of Surgery & Critical Care © NLGHT 2006

IFP 354

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