Clinical Indicators: Parotidectomy

1. History (one or more required)
   1. Parotid mass.
   2. Chronic parotitis.
   3. A neck mass with histologic findings of metastatic parotid tumor.
   4. Parotid duct stone.
   5. Malignancy of overlying skin extending into parotid.
   6. Malignancy metastatic to parotid.
   7. Evidence of acute infection and/or abscess (to cover the need for incision and drainage of abscess.
   8. Recurrent salivary obstruction not relieved by conservative measures.
2. Related Symptoms
   1. Facial nerve paralysis.
   2. Pain of parotid region.
3. Physical Examination (required)
   1. Complete physical examination of the head and neck with emphasis on inspection and palpation of the parotid gland, oropharynx and neck.
   2. Examination of facial nerve function.
4. Tests (required)
   1. Pre-operative tests as required by institutional guidelines
5. Tests (optional)
   1. Fine needle aspiration biopsy.
   2. Ultrasonography.
   3. CT scan of neck.
   4. MRI of neck.

Postoperative Observations

1. Facial nerve function
2. Bleeding – check for expanding hematoma; notify surgeon
3. Gustatory sweating

Outcome Review

1. One Week
   1. Facial nerve function and need for eye protection to avoid corneal irritation
   2. Wound healing
   3. Pathology report
   4. Discuss symptoms with patient, such as any ear numbness, pain, and facial function, and gustatory sweating
2. Beyond One Month
   1. If pathology report has revealed malignancy:
      1. Low-grade malignancy, completed excised: Observation
      2. Intermediate-grade malignancy or low-grade incompletely excised: Consider Radiation Oncology referral
      3. High-grade malignancy: Consider Medical and Radiation Oncology referrals
   2. If benign with tumor at margin, assess need for surveillance, additional testing, and/or
      therapy
   3. Facial nerve function and possible need for ongoing management of eye protection
      and additional rehabilitation if function not normal
   4. Gustatory sweating and need for treatment
3. Beyond One Year
   1. Malignancy or incompletely excised benign tumor, assess further surveillance, testing, and therapy
      1. Malignancy: Consider repeat baseline imaging at 12 months
   2. Facial nerve function and possible need for additional rehabilitation if function not
      normal
   3. Gustatory sweating

Associated ICD-10-CM Diagnostic Codes (Representative, but not all-inclusive codes)

• B26.9 Mumps without complication
• C07 Malignant neoplasm of parotid gland
• D11.9 Benign neoplasm of major salivary gland, unspecified
• D11.0 Benign neoplasm of parotid gland
• D11.7 Benign neoplasm of other major salivary glands
• D18.00 Hemangioma unspecified site
• D18.1 Lymphangioma, any site
• D00.00 Carcinoma in situ of oral cavity, unspecified site
• D00.01 Carcinoma in situ of labial mucosa and vermilion border
• D00.02 Carcinoma in situ of buccal mucosa
• D00.03 Carcinoma in situ of gingiva and edentulous alveolar ridge
• D00.04 Carcinoma in situ of soft palate
• D00.05 Carcinoma in situ of hard palate
• D00.06 Carcinoma in situ of floor of mouth
• D00.07 Carcinoma in situ of tongue
• D00.08 Carcinoma in situ of pharynx
• D37.030 Neoplasm of uncertain behavior of the parotid salivary glands
• D37.031 Neoplasm of uncertain behavior of the sublingual salivary glands
• D37.032 Neoplasm of uncertain behavior of the submandibular salivary glands
• D37.039 Neoplasm of uncertain behavior of the major salivary glands, unspecified
• G51.0 Bell’s palsy
• K11.0 Atrophy of salivary gland
• K11.1 Hypertrophy of salivary gland
• K11.20 Sialoadenitis, unspecified
• K11.21 Acute sialoadenitis
• K11.22 Acute recurrent sialoadenitis
• K11.23 Chronic sialoadenitis
• K11.3 Abscess of salivary gland
• K11.4 Fistula of salivary gland
• K11.5 Sialolithiasis
• K11.6 Mucocele of salivary gland
• K11.7 Disturbances of salivary secretion
• R68.2 Dry mouth, unspecified
• K11.8 Other diseases of salivary glands
• K11.9 Disease of salivary gland, unspecified

Additional Information

Assistant Surgeon – Sometimes

Patient Information

Parotidectomy is a surgical operation to remove a large salivary gland (the parotid gland) located in front and just below the ear. The most common reasons for removal of all or part of this gland are a mass in the gland, chronic infection of the gland, or obstruction of the saliva outflow from the gland causing chronic enlargement of the gland. Masses in the parotid are most commonly benign, but about 20% are malignant. The physician will discuss with you the need for parotidectomy based on your medical history, the results of a physical examination of the head and neck, and results of other tests if indicated. The most common tests to determine whether a parotidectomy is necessary include a fine needle aspiration biopsy (withdrawing a small amount of fluid from the parotid to see if malignant cells are present), CT scan (an x-ray test that helps to determine the size and position of the parotid tissues), and MRI (an imaging test that does not use x-rays and helps to determine the size and position of parotid tissues). In some cases no additional testing may be needed prior to surgery.

The procedure is usually done under general anesthesia. The amount of parotid gland to be removed is often determined at the time of surgery based on the size and location of the diseased parotid tissue. The extent of surgery may also depend on pathological examination of tissues removed during the surgery.

The nerve that controls motion to the face (the facial nerve) runs through the parotid gland. This nerve is important in closing the eyes, wrinkling the nose, and moving the lips. Most often the parotid gland can be removed without permanent damage to the nerve, however, the size and position of the diseased tissue may require that the nerve, or small branches of the nerve, be cut to assure complete removal. Even if the nerve is not permanently injured, there may be decreased motion of the facial muscles as the nerve recovers from the surgical procedure. If facial motion does not fully return your physician will discuss with you ways to rehabilitate facial movement.

Other possible short term complications include bleeding and infection. Although rare in parotid surgery, some patients may develop a thick scar or keloid. Many patients experience numbing of the earlobe and outer edge of the ear after parotid surgery. This generally resolves slowly over time. In a small proportion of patients, the face on the side of the parotidectomy sweats at mealtimes, (“gustatory sweating”). Most often this goes essentially unnoticed, however, if it should become bothersome medication and sometimes surgery are available.

Depending on the final diagnosis after the tissue is reviewed by a pathologist, additional diagnostic tests and follow-up examinations may be needed. Most often masses of the parotid are benign, and complete removal is the only treatment needed.

Important Disclaimer Notice (Updated 8/7/14)

Depending on the pathology, it is possible that additional surgery or other treatment may be necessary.

Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical indicators will not ensure successful treatment in every situation. The AAO-HNS/F emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. The AAO-HNS/F is not responsible for treatment decisions or care provided by individual
physicians. Clinical indicators are not intended to and should not be treated as legal, medical, or business advice.

CPT five-digit codes, nomenclature and other data are copyright 2016 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

Updated November 2016

© 2016 American Academy of Otolaryngology-Head and Neck Surgery.