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This surgery constantly flirts with the facial nerve.

It is done by a surgeon qualified in head and neck surgery.



The knowledge of salivary glands relation to the facial nerve enables us to avoid the risk of possible iatrogenic injuries or at least to minimize it during the parotid and submandibular glands removal.

The following two pictures will help you to understand the connection of all the elements –the glands, the nerve, the arteries and veins.
The Right parotid gland on the horizontal slice :


The yellow arrow represents the facial nerve which crosses the parotid gland in the middle like a bookmark. This bookmark will guide the surgeon during parotid gland operation.

The submandibular gland: the number 6 represents a branch of the facial nerve (marginal mandibular branch of facial nerve) which can be in a low position.


Parotid and submandibular glands consist of 4 salivary glands : 2 on the right side and 2 on the left side.

They produce saliva necessary for digestion.

They ensure the lubrification of the oral cavity and pharynx.

There are other salivary glands:

The paired sublingual glands (one on each side of the tongue).

Accessory salivary glands (lips, palate).



Clinical examination will show the surgeon not only the affected salivary gland but also the possible nature of the lesion– benign or malignant.

The two following examinations are fundamentally important in establishing the nature of the lesion:

-MRI with Gadolinium contrast agents;

- fine needle aspiration biopsy.

80% of the tumors are benign ( pleomorphic adenoma  and Warthin's tumor)



The operation is performed under general anesthesia with either a direct approach or a lifting type incision; with the use of magnifying surgical glasses and under endoscopic control.

The facial neuromonitoring system is systematically used.

Robotic surgery can be done for submandibular glands: the operation will be longer.

Two possible scenarios:

1: The tumor is benign – partial, subtotal or total removal of the parotid gland can be done.

2: The tumor is malignant – the gland will be totally removed. Neck lymph nodes removal might be necessary at the same time.



It`s the same as descrobed for the thyroid gland surgery.