Parotid gland surgery
Surgery to remove part or all of the parotid salivary gland in front of and below the ear, usually to remove a lump.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Parotid surgery removes part or all of the salivary gland in front of the ear, usually to remove and identify a lump.
- The facial nerve runs through the gland, so temporary facial weakness is common and a small risk of permanent weakness exists.
- Most parotid lumps are not cancerous, but the removed tissue is sent for analysis, which guides any further treatment.
- Choose a surgeon experienced specifically in parotid surgery, and ask how they protect the facial nerve.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Removes the lump and allows it to be examined under the microscope
A clearly harmless lump that can safely be watched, where surgery and its nerve risk may not be justified yet.
Expect swelling, bruising and a drain that is usually removed after a day or two. Any facial weakness will be assessed. Most people stay one or two nights.
Assessment of facial nerve function after surgery and a plan if weakness occurs.
Expect swelling, bruising and a drain that is usually removed after a day or two. Any facial weakness will be...
Swelling settles and the wound heals. Many people take about two weeks off work. The laboratory result on the...
Temporary facial weakness, if present, usually improves over this period. Numbness around the ear may persist...
The scar continues to fade. Frey's syndrome, if it develops, often appears at this stage and can be treated. The...
What is parotid gland surgery?
The parotid glands are the largest salivary glands. There is one on each side, in front of and just below the ear, and they make saliva that drains into the mouth. The facial nerve, which controls the muscles that move your face, runs through the middle of the parotid gland and divides into branches there.
Parotid gland surgery (parotidectomy) removes part or all of the gland, most often to remove a lump. Most parotid lumps are not cancerous, but they are usually removed to confirm what they are, to stop them growing, and because some can change over time. The amount of gland removed depends on the size, depth and nature of the lump.
The central challenge of this operation is protecting the facial nerve. The surgeon carefully finds and preserves the nerve while removing the gland tissue around it. Because of this, parotid surgery should be done by a surgeon experienced specifically in this area.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Partial / superficial parotidectomy
Removes the part of the gland (usually the outer, superficial lobe) that contains the lump, while finding and preserving the facial nerve. The most common operation for a...
Total parotidectomy
Removes the whole gland, including the deeper part, used for larger or deeper lumps or some cancers. Carries a higher risk to the facial nerve.
Extracapsular dissection
Removes a clearly benign lump with a margin of normal tissue while disturbing less of the gland and nerve, used in selected cases by experienced surgeons.
Surgery with facial nerve monitoring
Many surgeons use a nerve monitor during the operation to help identify and protect the facial nerve, although it does not remove the risk entirely.
Preparing for your surgery
- See a surgeon experienced specifically in parotid surgery, often a head and neck or maxillofacial surgeon.
- Expect tests before surgery, such as an ultrasound scan, a needle sample of the lump (fine needle aspiration) and sometimes an MRI.
- Ask whether part or all of the gland is being removed, and what this means for the facial nerve risk.
- Tell your surgeon about all medicines and supplements, especially blood thinners.
- If you smoke, stopping beforehand helps healing.
- Arrange about two weeks off work, a lift home, and support for the first day or two after a general anaesthetic.
What happens
The operation is done under general anaesthetic. The surgeon makes a cut in front of and below the ear, often extending into the upper neck, designed to heal as discreetly as possible.
The key step is finding the facial nerve and carefully working around its branches while removing the gland tissue that contains the lump. Many surgeons use a nerve monitor to help. The removed tissue is sent to the laboratory for analysis.
A small drain is often placed to collect fluid and is removed after a day or two. Most people stay one or two nights, although some partial removals are done as a day case. There is no need to operate inside the mouth.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A clearly harmless lump that can safely be watched, where surgery and its nerve risk may not be justified yet.
- An untreated bleeding problem or unfit-for-anaesthetic state that needs addressing first.
- Cases where a needle test and scan strongly suggest a diagnosis better managed in another way, after specialist discussion.
- Expecting surgery to have no effect on facial movement, sensation or sweating, when these risks are real.
Delay surgery if…
- You have an active infection of the gland or overlying skin.
- You are on blood thinners that need to be reviewed before surgery.
- Important results, such as the needle test or scan, are not yet available.
- You are unwell or have uncontrolled medical conditions that increase anaesthetic risk.
Alternatives to discuss
- Watchful waiting with scans for some small, clearly benign lumps after specialist advice.
- A repeat or image-guided needle test if the diagnosis is unclear.
- Less extensive surgery (such as extracapsular dissection) in selected benign cases.
- For cancers, a combined plan that may include surgery, radiotherapy and specialist team input.
- Managing symptoms differently if the problem is stones or infection rather than a tumour.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Removes the lump and allows it to be examined under the microscope
- Confirms whether the lump is benign or cancerous
- Stops a benign lump growing larger or, in some cases, changing over time
- Removes a cancer as part of treatment when one is present
- Can relieve symptoms caused by a large or troublesome gland or lump
Risks & complications
- Temporary weakness of part of the face (for example the corner of the mouth) while the facial nerve recovers
- Numbness of the skin around the wound and the earlobe, which is often long-lasting
- Swelling, bruising and a collection of fluid under the wound
- A scar in front of and below the ear
- Frey's syndrome — sweating or flushing of the cheek when eating, due to nerve rewiring
- A salivary leak (saliva collecting under the skin or leaking from the wound)
- Bleeding or a blood collection (haematoma) needing further treatment
- Infection of the wound
- Permanent weakness of part, or rarely all, of the face on that side
- A pulled-down or asymmetric smile if a nerve branch is affected
- Long-term salivary fistula needing further treatment
The main risk is to the facial nerve. Some temporary facial weakness is common because the nerve is handled during surgery, and it usually recovers over weeks to months. Permanent weakness is much less common but is more likely with total removal, larger or deeper lumps, cancer and repeat surgery. Frey's syndrome (cheek sweating when eating) and numbness near the ear are also common. Ask your surgeon about your individual risk and how they protect the nerve.
Published figures to discuss
Facial nerve risk is the most studied outcome of parotid surgery. Reported rates vary with the extent of surgery, the type and depth of the lump, whether it is cancer, surgeon experience and use of nerve monitoring. Temporary weakness is common and usually recovers; permanent weakness is much less common. The figures below are cautious ranges drawn from patient-information and published sources, not guarantees.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Temporary facial nerve weakness | Roughly 1 in 5 after partial removal and up to around 2 in 5 after total removal | Usually recovers over weeks to months; more likely with deeper or larger lumps and total parotidectomy. | Risk of facial nerve palsy after benign parotidectomy — J Laryngol Otolcambridge.orgPublished figure |
| Permanent facial nerve weakness | Up to around 7 in 100 for partial and up to around 9 in 100 for total parotidectomy in patient-information figures | Less common overall; higher with cancer, recurrent tumours and more extensive surgery. | Risk of facial nerve palsy after benign parotidectomy — J Laryngol Otolcambridge.orgSource-linked context |
| Frey's syndrome (cheek sweating when eating) | Common, reported in a large proportion of patients, more so after total removal | Often mild; can be treated with antiperspirant or injections if troublesome. | Guide sourcesClinical context |
| Salivary leak / fistula | Uncommon, around a few in 100 for partial and higher for total removal | Often settles on its own; persistent leaks can be treated. | Risk of facial nerve palsy after benign parotidectomy — J Laryngol Otolcambridge.orgSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from parotid surgery usually takes around two weeks for everyday life. Most facial weakness, if it happens, is temporary, but numbness near the ear and some sensations can take longer to settle or be long-lasting.
- Swelling and bruising in front of and below the ear
- Numbness of the earlobe and skin around the scar, which can be long-lasting
- A firm, slightly raised scar that softens and fades over months
- Mild facial weakness that gradually recovers, if it occurs
Aftercare
- Keep the wound clean and dry as advised, and follow instructions about the dressing and any drain.
- Take pain relief as needed; discomfort is usually manageable.
- Report any worsening facial weakness so it can be assessed.
- Watch for, and report, swelling that comes up after eating (a possible salivary leak).
- Avoid strenuous activity and heavy lifting until your surgeon says it is safe.
- Attend the appointment to discuss the laboratory result on the removed tissue.
- Know who to contact for bleeding, spreading redness or signs of infection.
- Time off work booked (about 2 weeks)
- Lift home and support for the first day or two arranged
- Pain relief obtained
- Awareness that some facial weakness or numbness can occur
- Appointment to receive the laboratory result understood
- Clinic's contact number saved for bleeding or concerns
Scars and how they heal
The cut is placed in front of and below the ear, often curving into the upper neck or a skin crease, so it heals as discreetly as possible. It is firm and slightly raised at first and usually fades over several months to become a fine scar. Numbness of the earlobe and skin near the scar is common and may be long-lasting.
⚠ Get urgent help if…
- Sudden or worsening weakness of the face, such as a drooping mouth or inability to close the eye
- Heavy bleeding or a rapidly expanding swelling at the wound
- Spreading redness, heat, swelling or discharge (signs of infection)
- High temperature or feeling generally unwell
- A swelling that builds up after eating or fluid leaking from the wound
- Severe pain not controlled by your pain relief
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result is removal of the lump with the facial nerve preserved, a discreet scar, and a clear laboratory diagnosis. Most parotid lumps turn out to be benign. The result of the tissue analysis guides whether any further treatment is needed.
Some temporary facial weakness is common and usually recovers. Numbness near the ear and, in some people, Frey's syndrome can persist, but both can be managed. If the lump was cancerous, further treatment such as neck surgery or radiotherapy may be discussed by a specialist team, and follow-up is arranged.
Once a benign parotid lump is fully removed, it usually does not come back, although certain lump types and incomplete removal carry a higher chance of recurrence. For cancers, long-term outlook depends on the type and stage and is guided by the specialist team, with ongoing follow-up. The gland on the other side continues to make saliva, so a dry mouth is unusual after removing one gland.
Combining with other procedures
Parotid surgery is sometimes combined with removal of nearby lymph nodes (neck dissection) if cancer is present or suspected. Reconstruction or a small tissue flap is occasionally used after larger removals. Any cancer treatment, such as radiotherapy, is planned by a head and neck cancer team.
Follow-up & long-term care
You will be seen to check the wound and facial nerve and to discuss the laboratory result. For benign lumps, follow-up may be brief; for cancer or certain lump types, longer-term surveillance is arranged. Report any new facial weakness, swelling after eating or signs of infection.
- Attend any planned follow-up, especially after cancer or certain lump types.
- Report any new lump or swelling in the area promptly.
- If Frey's syndrome develops, ask about antiperspirant treatment or injections to manage it.
- Protect the scar from strong sun while it is fading.
Revision and secondary surgery reality
- Certain benign lump types, and incomplete removal, carry a higher chance of the lump coming back.
- Repeat parotid surgery is more difficult and carries a higher facial nerve risk because of scarring.
- If the final result shows cancer, further surgery or radiotherapy may be needed, planned by a specialist team.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Assessment of facial nerve function after surgery and a plan if weakness occurs.
- A clear process for receiving and discussing the laboratory result.
- A named contact for bleeding, infection or a swelling that builds up after eating.
- Appropriate follow-up, including longer surveillance for cancer or certain lump types, and treatment of Frey's syndrome if it develops.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether part or all of the gland is removed and how complex the lump is
- Tests before surgery, such as ultrasound, needle sampling and MRI
- Surgeon, anaesthetist and theatre or facility fees
- Use of facial nerve monitoring during surgery
- Length of hospital stay and drain care
- Laboratory analysis, follow-up appointments and any further cancer treatment
- The surgeon's fee and whether part or total removal is planned
- Cost of pre-operative scans and needle tests
- Anaesthetist, theatre and overnight stay fees
- Laboratory analysis of the removed tissue
- Follow-up appointments and management of complications such as a salivary leak
- What happens, and how care is arranged, if the lump turns out to be cancer
On the NHS? Parotid gland surgery is commonly done on the NHS when there is a lump or tumour; private care may be used for speed, choice or a second opinion, but cancer care is normally led by an NHS head and neck team.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being given an individual estimate of facial nerve risk based on the lump and the planned extent of surgery.
- No clear explanation of the difference between temporary and permanent facial weakness.
- Frey's syndrome, numbness near the ear and salivary leak not being mentioned.
- No plan for what happens if the final laboratory result shows cancer.
Marketing red flags
- Promising no meaningful risk to the facial nerve or a guaranteed scar-free result.
- Downplaying the importance of surgeon experience in parotid surgery.
- Suggesting a lump can be removed without any chance of facial weakness or numbness.
- Offering surgery without proper scans and a needle test to assess the lump first.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Are you removing part or all of the gland, and why?
- What is my individual risk of temporary and permanent facial weakness?
- Do you use facial nerve monitoring during the operation?
- What do my scan and needle test suggest the lump is, and what if the final result differs?
- What is the chance of Frey's syndrome or a salivary leak, and how are they managed?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will my face be paralysed after parotid surgery?
Are most parotid lumps cancer?
What is Frey's syndrome?
Will there be a visible scar?
Will I have a dry mouth afterwards?
How long will I need off work?
Find a verified surgeon for parotid gland surgery
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: ENT UK — Parotidectomy (surgery to remove a lump) NHS — Salivary gland stones and problems Facial weakness after parotid surgery — subsite analysis (PMC) Risk of facial nerve palsy after benign parotidectomy — J Laryngol Otol Facial nerve integrity with and without monitoring — PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Submandibular gland removal · Snoring and sleep apnoea surgery · Tongue base / palate surgery (UPPP) · Tonsil removal (tonsillectomy) · Branchial cyst removal