About surgery for salivary gland cancer

Surgery is the most common treatment for salivary gland cancer. The type of operation you need depends on which salivary gland the cancer developed in. And on how far the cancer has grown (the stage).

The National Institute for Health and Clinical Excellence (NICE) guidelines recommend that only surgeons with specialist expertise should carry out operations for salivary gland cancers.

You are likely to have treatment from a team of specialists. Exactly who is involved will depend on the surgery you need. The team may include a

• Surgeon who specialises in operations on the face, mouth and jaw (oral and maxillofacial surgeon)
• Ear, nose and throat (ENT) surgeon (also called an otolaryngologist)
• Consultant in restorative dentistry
• Plastic surgeon
• Anaesthetist
• Specialist nurse

Oral and maxillofacial surgeons are specialists trained as both doctors and dentists. They are also called maxfax surgeons.

A restorative dentistry consultant is an expert in restoring normal function and appearance of your mouth and face following surgery.

All operations for salivary gland cancer are carried out under a general anaesthetic. So you will be asleep and won’t feel anything. There is information below about operations for

• The parotid glands
• The submandibular glands
• The sublingual glands

Parotid gland

There are two parts or lobes to the parotid glands. These are the superficial lobe and the deep lobe. The facial nerve runs between these two lobes. The facial nerve is important in controlling the closing of your eye, wrinkling your nose and moving your lips.

If the cancer is just in the superficial lobe and low grade it may be possible for the surgeon to remove just this lobe. This is called a superficial parotidectomy. If it is in the deep lobe or in both lobes your surgeon will need to remove the whole parotid gland. This is called a total parotidectomy.

To do the operation the surgeon makes a cut (incision). The cut starts in front of the ear and follows the line down to the neck and under and along the jaw line.

The scar you have afterwards will be S shaped.

This is a complicated operation because the facial nerve runs through the middle of the gland. Wherever possible your surgeon will try to remove just the gland and save your facial nerve. But occasionally they need to remove or cut part of it. Even so, most people make a good recovery and have full or almost full facial movement after the operation. If your surgeon needs to remove some or all the facial nerve, they may be able to graft a nerve from nearby or from a nerve in the calf of your leg.

As well as the parotid gland your surgeon will remove some of the surrounding tissue. This is to make sure all the cancer cells have been removed. It lowers the risk of the cancer coming back. Rarely, this may include some of your jawbone.

Your surgeon may also remove some nearby lymph nodes. There is more information below about removal of lymph nodes.

Submandibular gland

If your cancer is in one of your submandibular glands, your surgeon will remove the whole of the gland. Your surgeon will also remove some surrounding tissue to lower the risk of your cancer coming back.

If your surgeon thinks there could be cancer cells in some of your lymph nodes, they will remove those as well. There is more information about lymph node removal further down this page. Rarely the surgeon needs to remove some of the jawbone.

There are 3 nerves near the submandibular gland that control movement of your lip and part of your tongue. Your surgeon will try to remove the gland without damaging any of these nerves. Occasionally the nerves are damaged. Most problems are temporary and people usually have full movement back within a few weeks. For some people it may take a few months.

Before your operation your surgeon will explain exactly what they will remove. They will also tell you about the possible side effects of your surgery.

After the operation, you will have a scar below part of your jaw line.

Sublingual gland

The two sublingual glands are underneath your tongue on either side of the floor of your mouth. Your surgeon will need to make a cut (incision) inside your mouth. They will remove the whole gland and some of the surrounding tissue. And may include some of your jaw bone. This lowers the chance of the cancer coming back.

There is a nerve running alongside the sublingual gland, called the lingual nerve. This controls movement, feeling and taste on the side of the tongue. Occasionally this nerve needs to be removed. Or it may be bruised or damaged during the operation. Afterwards, your tongue may be numb on that side. This is usually temporary and lasts from a few weeks to a couple of months.

If there is a risk that there are cancer cells in the nearby lymph nodes your surgeon will remove them. This may mean a further cut (incision) in the side of your neck.

Your surgeon may remove the lymph nodes in your neck. This is most likely if

• Your cancer is high grade
• Your lymph nodes are swollen
• Your scans show that the lymph nodes might have cancer cells in them

Your surgeon will remove a few lymph nodes from your neck. This is a selective neck dissection.

If the cancer is affecting more than one of your nodes, your surgeon will remove almost all of the lymph nodes from that side of your neck. This is called a modified radical neck dissection.

If the cancer has spread into other nearby structures your surgeon will remove the lymph nodes and these structures. This is called a radical neck dissection. The other structures include

• A muscle at the side of your neck called the sternocleidomastoid
• A nerve called the accessory nerve
• A vein called the internal jugular vein

These operations help to stop the cancer from spreading or coming back.

There is information about possible side effects of lymph node dissection in the page about what happens after salivary gland cancer surgery.

Most people who have salivary gland cancer only need to have the salivary gland removed. In rare cases, the cancer has grown into bone or deeper into the surrounding tissue. If this has happened, you may need surgery to remove the cancer and rebuild your mouth or jaw. This is called reconstructive surgery. The aim of reconstructive surgery is to maintain your appearance as much as possible and to help you eat, drink and speak normally.

The type of surgery you need depends on the position of the tumour and where it has spread. You may need to have skin or tissue taken from other parts of the body to rebuild parts of your mouth or jaw. Some people need dental implants to replace part of their jaw and teeth.

If you need reconstructive surgery your specialist will fully explain the operation to you. You will be able to ask questions. Your specialist will also tell you about the possible side effects of the operation. We have a list of suggestions for what to ask your doctor about surgery for salivary gland cancer. You can print these and note down any other questions you have. Then you can take these with you when you see your surgeon.