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 how far it has grown.
Who is involved in your surgery
The National Institute for Health and Care Excellence (NICE) recommends 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 might include:
- a surgeon who specialises in operations of the face, mouth and jaw (oral and maxillofacial surgeon or maxfax surgeon)
- an ear, nose and throat (ENT) surgeon (also called an otolaryngologist)
- a plastic surgeon
- an anaesthetist
- a specialist nurse
- a restorative dentistry consultant (an expert in restoring normal function and appearance of your mouth and face following surgery)
Surgery to the 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 nerve controls the closing of your eye, the wrinkling of your nose and the movement of your lips.
A superficial parotidectomy is when the surgeon only removes the superficial lobe. You might have this if the cancer is only in the superficial lobe of the parotid gland and is a low grade cancer.
Your surgeon removes the whole of the parotid gland. You might have a total parotidectomy if the cancer is in the deep lobe or in both lobes of the gland.
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 surgery because the facial nerve runs through the middle of the gland. Your surgeon will try to remove just the gland and save your facial nerve. Occasionally they need to remove or cut part of the nerve.
If your surgeon needs to remove some or all the facial nerve, they may be able to replace the nerve using a nerve from nearby or from the calf of your leg (graft). Most people make a good recovery and have full or almost full facial movement after the operation.
As well as the parotid gland your surgeon might also remove:
- some of the surrounding tissue - to make sure all the cancer cells have been removed and lower the risk of the cancer coming back
- some of your jawbone (this is rare)
- nearby lymph nodes
Surgery to the submandibular gland
Your surgeon will remove the whole of the submandibular gland. They might also remove:
- some surrounding tissue to lower the risk of your cancer coming back
- some lymph nodes if they think there could be cancer cells in them
- some of the jawbone (this is rare)
There are 3 nerves near the submandibular gland. They control the movement of your lip and part of the tongue. Your surgeon will try to remove the gland without damaging any of these nerves. But occasionally the nerves are damaged. Most problems are temporary and people usually have full movement and feeling 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.
Surgery to the 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.
Your surgeon will remove the whole gland and some of the surrounding tissue. Occasionally, they also remove some of your jawbone. This is to lower the chance of the cancer coming back.
There is a nerve running alongside the sublingual gland, called the lingual nerve. This controls 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. When this happens, your tongue may be numb for some time. This usually lasts from a few weeks to a couple of months.
Your surgeon may also remove the nearby lymph nodes if there is a risk that there are cancer cells in them. You will have another cut (incision) on the side of your neck.
Surgery to the minor salivary glands
There are over 600 small salivary glands located throughout the lining of the mouth and throat. These are the minor salivary glands.
The type of surgery you have depends on the location of the cancer. Your surgeon removes:
- the affected gland
- some of the surrounding tissue – this may include removing the top of your mouth (palate)
- nearby lymph nodes if they think there could be cancer cells in them
Your surgeon will tell you exactly what they will remove before the operation. They will also tell you about the possible side effects of your surgery.
Most people who have salivary gland cancer only need to have the salivary gland removed. But in rare cases, the cancer grows into the 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 cancer 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.