Parotid Tumour Treatment in Sydney

A parotid tumour is an abnormal growth in the parotid gland, the largest salivary gland located just in front of and below the ear. While approximately 80% of parotid tumours are benign, all parotid lumps require specialist assessment to determine the type and whether surgical removal is needed.

What Is a Parotid Tumour?

The parotid gland produces saliva and sits in the cheek area, just in front of each ear. Tumours can develop within this gland as either benign (non-cancerous) or malignant (cancerous) growths. The most common benign parotid tumour is a pleomorphic adenoma, which typically presents as a slow-growing, painless lump. Warthin tumour is the second most common benign type, occurring more frequently in smokers.

Malignant parotid tumours are less common but include mucoepidermoid carcinoma, adenoid cystic carcinoma, and acinic cell carcinoma. Distinguishing between benign and malignant tumours is essential because the surgical approach and need for additional treatment differ significantly.

Symptoms of Parotid Tumours

The most common presentation is a painless lump in the cheek or jaw area, just in front of or below the ear. Many patients notice the lump incidentally or when it becomes visible. Key symptoms include:

A firm, painless swelling in front of or below the ear
Gradual enlargement of the lump over months or years
Numbness or tingling in the cheek or ear
Facial weakness or asymmetry (a warning sign for malignancy)
Pain in the parotid region (more common with malignant tumours)
Difficulty opening the mouth fully
Rapid growth of a previously stable lump

A lump that is growing rapidly, painful, or associated with facial weakness should be assessed urgently, as these features raise concern for malignancy.

Causes and Risk Factors

The exact cause of most parotid tumours is unknown. However, several factors may increase the risk:

Previous radiation exposure: particularly to the head and neck region, including childhood radiotherapy
Smoking: increases the risk of Warthin tumour specifically
Age: most parotid tumours occur in adults aged 40 to 70
Occupational exposure: workers in rubber manufacturing, woodworking and nickel plating may have increased risk
Family history: rarely, salivary gland tumours can run in families

Diagnosis

At Central Sydney ENT, our head and neck surgeons use a structured approach to diagnose and characterise parotid tumours:

Clinical examination: Your surgeon will examine the lump, assess its size, mobility and consistency, and test facial nerve function. The examination also includes the neck to check for any associated lymph node enlargement.

Ultrasound: An ultrasound scan provides detailed imaging of the parotid gland and helps distinguish solid tumours from cysts. It also guides fine needle aspiration.

Fine needle aspiration biopsy (FNAB): A thin needle is used to extract cells from the tumour for laboratory analysis. This minimally invasive test helps determine whether the tumour is benign or malignant and identifies the specific tumour type in most cases.

MRI scan: MRI provides the most detailed imaging of the parotid gland, showing the tumour's size, exact location, relationship to the facial nerve, and whether it extends into deep structures. MRI is essential for surgical planning.

CT scan: May be used if there is concern about bone involvement or to assess the neck and chest for malignant tumours.

Treatment Options

The primary treatment for most parotid tumours is surgical removal. The type of surgery depends on the tumour's location within the gland, its size, and whether it is benign or malignant.

Superficial Parotidectomy

Most benign parotid tumours are located in the superficial lobe of the gland (the portion of the gland outside the facial nerve). A superficial parotidectomy removes this portion along with the tumour while carefully preserving the facial nerve. The incision is placed in the natural skin crease in front of the ear and extends into the upper neck, healing to a well-concealed scar.

Total Parotidectomy

When a tumour involves both the superficial and deep lobes, or when malignancy is confirmed, a total parotidectomy may be necessary. This involves removing the entire parotid gland. The facial nerve is preserved whenever oncologically safe. In rare cases where the nerve is directly involved by cancer, nerve grafting techniques can be used to restore function.

Facial Nerve Monitoring

All parotid surgery at Central Sydney ENT is performed with continuous intraoperative facial nerve monitoring. This technology provides real-time feedback to the surgeon, helping to identify and protect every branch of the facial nerve throughout the procedure. Our head and neck surgeons, including Dr Alexander Zhang, Dr Arjuna Ananda and Dr Philip Yeung, have subspecialty training in parotid and salivary gland surgery.

Additional Treatment for Malignant Tumours

For confirmed malignant parotid tumours, additional treatment may include neck dissection (removal of lymph nodes) and post-operative radiotherapy. The need for adjuvant treatment is determined by the tumour type, stage, grade, and margin status, and is discussed at a multidisciplinary head and neck tumour meeting.

Recovery After Parotid Surgery

Most patients stay one night in hospital after parotidectomy. A small drain is usually placed to prevent fluid collection and is removed the following day. Patients can expect:

Mild to moderate pain managed with simple analgesia
Swelling and numbness around the ear and cheek, which gradually improves
Return to desk work within one to two weeks
Full recovery over four to six weeks

Frey syndrome (gustatory sweating, where the cheek sweats during eating) can occasionally develop months after surgery but is usually mild and manageable.

When to See an ENT Specialist

You should seek a referral to an ENT specialist if:

You notice a new lump in front of or below your ear
A parotid lump is growing or changing
You develop facial weakness or numbness alongside a parotid lump
You experience pain in the parotid or jaw area that does not resolve
Your GP has identified a parotid mass on examination or imaging

Related Conditions

Parotid tumours are closely related to several other conditions managed at Central Sydney ENT:

Neck Lumps: parotid tumours can present as upper neck masses and must be distinguished from other causes
Head and Neck Cancer: malignant parotid tumours are managed within the broader head and neck oncology framework
Thyroid Nodules: another common head and neck lump requiring specialist assessment and potential surgery

Common Questions

Parotid Tumour FAQ

Are most parotid tumours cancerous? +

No. Approximately 80% of parotid tumours are benign. The most common type is a pleomorphic adenoma, which is a slow-growing, painless lump. However, all parotid lumps require specialist assessment because benign tumours can occasionally transform into malignancy over time if left untreated.

What does parotid surgery involve? +

Parotid surgery (parotidectomy) involves removing part or all of the parotid gland through an incision in front of the ear and down into the neck. The facial nerve, which controls movement of the face, runs through the gland and must be carefully identified and preserved during surgery. Continuous facial nerve monitoring is used throughout the procedure.

Will parotid surgery affect my face? +

The facial nerve runs through the parotid gland, and there is a small risk of temporary facial weakness after surgery. In experienced hands with facial nerve monitoring, permanent facial nerve injury is rare, occurring in fewer than 2% of cases for benign tumours. Temporary weakness, if it occurs, usually resolves within weeks to months.

How is a parotid tumour diagnosed? +

Diagnosis typically involves clinical examination, ultrasound of the parotid gland, fine needle aspiration biopsy (FNAB) to determine the tumour type, and MRI to assess the extent of the tumour and its relationship to the facial nerve. Your ENT surgeon will coordinate these investigations.

Does Central Sydney ENT perform parotid surgery? +

Yes. Central Sydney ENT has fellowship-trained head and neck surgeons who perform parotidectomy with intraoperative facial nerve monitoring. We assess and treat both benign and malignant parotid tumours across seven Sydney locations including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda.