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Types of surgery for salivary gland cancer

Surgery is often the main treatment for salivary gland cancers. Your cancer will probably be treated with surgery if the doctor believes that it is resectable (removable by surgery). Whether a cancer is resectable depends on how far it has grown into nearby structures and on the skill and experience of the surgeon.

In most cases, the cancer and some or all of the surrounding salivary gland will be removed. Nearby soft tissue might be taken out too. The goal is to have no cancer cells on the margins (outside edges) of the tissue removed by surgery.

Possible risks and side effects of salivary gland surgery

All surgery has some risks, including complications from anesthesia, bleeding, blood clots, and infections. These risks are generally low but are higher with more complicated operations.

Pain: For any salivary gland cancer surgery, the surgeon might need to cut through your skin or cut inside your mouth. Most people will have some pain afterward, but this can usually be controlled with medicines.

Damage to part of the facial nerves: Symptoms of damage to the facial nerve or its branches might include:

• Drooping on one side of the face
• Trouble closing your eye completely, leading to dry eye
• Trouble closing your mouth, chewing, or changes in expressions like your smile
• Trouble speaking or swallowing

If an injury to the facial nerve is related to retraction (pulling) of the nerve during surgery and/or swelling from the operation, the damage might heal over time, and the facial nerve function usually returns over a few months.

If the nerve does not start working after a certain period of time, there are some rehab exercises and types of surgery that might help, such as nerve grafting. It is a good idea to ask about possible treatments for this side effect.  

Frey syndrome: Sometimes, nerves cut during surgery grow back abnormally and become connected to the sweat glands of the face. This condition, called Frey syndrome or gustatory sweating, results in flushing or sweating over areas of your face when you chew. Frey syndrome can be treated with medicines or with additional surgery.

First bite syndrome: This is a rare problem after surgeries that require deeper tissues in the neck to be removed or explored. After these surgeries, people can experience pain and cramping of the jaw, worst with the first bite of a meal and improving over time. These symptoms can be treated with medicine.

Change in how you look or how your mouth works: Depending on the extent of the surgery, your appearance and how your mouth works might be changed as a result. This can range from a simple scar on the side of the face or neck to more extensive changes if nerves, parts of bones, or other structures like the tongue muscles need to be removed.

It’s important to talk with your doctor before the surgery about what changes in appearance or other side effects you might expect. This can help you prepare for them. Your doctor can also give you an idea about what corrective options might be available afterward, such as skin grafts, nerve grafts, and reconstructive surgery.

Neck dissection (lymph node removal)

Salivary gland cancers sometimes spread to lymph nodes in the neck (cervical lymph nodes), and these might need to be removed as a part of treating the cancer.

Lymph nodes might be removed in an operation called a lymph node dissection, lymphadenectomy, or neck dissection.

A neck dissection might be done if:

• Lymph nodes in the neck are enlarged, which might be felt or seen on a CT or MRI scan
• A PET (positron emission tomography) scan suggests the lymph nodes might contain cancer
• The cancer is high grade (looks very abnormal in the lab) or has other features that mean it has a high risk of spreading
• A biopsy of one of the abnormal lymph nodes in the neck shows cancer

The removed lymph nodes are looked at closely in the lab to see if they contain cancer cells. Taking out the lymph nodes can help ensure all the cancer is removed. It can also be important for staging and deciding if more treatment is needed.

Types of neck dissections

There are many types of neck dissections. They differ in how much tissue is removed from the neck. The amount of tissue removed depends on the primary cancer’s size and how much it has spread to lymph nodes.

• In a partial or selective neck dissection, only a few lymph nodes are removed.
• For a modified radical neck dissection, most lymph nodes on one side of the neck between the jawbone and collarbone are removed, as well as some muscle and nerve tissue.
• In a radical neck dissection, nearly all nodes on one side, as well as even more muscles, nerves, and veins are removed.

This type of surgery is usually done through an incision (cut) across the side of the neck, but sometimes a longer incision going down the neck might be needed.

Possible risks and side effects of lymph node removal

The general risks of a neck dissection are much like those with any other type of surgery, including problems with anesthesia, bleeding, blood clots, infections, and poor wound healing.

Pain: Most people will have some pain afterward, but this can usually be controlled with pain medicines.

Nerve damage: The most common side effects of any neck dissection are numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. These side effects can happen when nerves that supply these areas are damaged during the operation.

After a selective neck dissection, the nerve might only be injured and can heal over time. Nerves heal slowly, and the weakness of the shoulder and lower lip might go away after a few months. If a nerve is removed as part of a radical neck dissection or because of involvement with a tumor, the weakness will be permanent.

Change in how you look: Depending on the extent of the surgery, your appearance might be changed as a result. This can range from a scar on the side of the neck to more extensive changes if nerves, muscles, or other tissues need to be removed.

After any neck dissection procedure, physical therapy can help improve neck and shoulder movement and might rebuild some muscle tissue that might be lost after surgery.

Supportive surgery

Sometimes, if salivary gland cancer has spread widely to nearby tissues, these cancers or the treatment might keep you from swallowing enough food to stay well-nourished. This can make you weak and make it harder to complete treatment and heal.

Feeding tubes

A gastrostomy tube (G-tube) is a feeding tube that's put through the skin and muscle of your abdomen (belly) and right into your stomach. Sometimes this tube is placed during an operation, but often it's put in endoscopically. While you are sedated (given drugs to put you in a deep sleep), the doctor puts a long, thin, flexible tube with a camera on the end (an endoscope) down the throat to see inside the stomach. The feeding tube is then guided through the endoscope and to the outside of the body.

When the feeding tube is placed through endoscopy, it's called a percutaneous endoscopic gastrostomy, or PEG tube. Once in place, it can be used to put liquid nutrition right into the stomach. People with PEG tubes can still eat by mouth if they want and are able.

PEG tubes can be used for as long as needed. Sometimes these tubes are used for a short time during treatment. They can be removed when you can eat enough by mouth.

If the swallowing problem is likely to be only short-term, another option is to place a nasogastric feeding tube (NG tube). This tube goes in through the nose, down the esophagus, and into the stomach. These can be placed without surgery or sedation. Again, special liquid nutrition is given through the tube. Some people dislike having a tube coming out of their nose and prefer a PEG tube.

In any case, the patient and family are taught how to use the tube. After you go home, home health nurses usually visit to make sure you are comfortable with how to do tube feedings.

Managing your emotional health after surgery

Many people also worry about the physical differences they will have after surgery and how this might affect their social or emotional health.

When you experience changes to the way your body looks and functions, this can have a big impact on your daily life. As you navigate life after treatment, your cancer care team can give you resources for support when you need them. Keeping a positive outlook is important for your overall health.