We have 3 paired major salivary glands – the parotid, sublingual and submandibular glands. We also have thousands of small minor salivary glands in the upper aerodigestive tract.

The large majority of tumours are in the parotid gland (70%) followed by the submandibular gland (8%) . 60% of salivary gland tumours are benign. Most salivary gland tumours will need to be confirmed by CT or MRI imaging. Fine needle aspirate cytology (FNAC) is done for the majority though a strong argument can be made for not doing it routinely as the majority of the tumours will need surgical excision in any case. In my practice, I will do FNAC in patients in whom I am wanting to avoid surgery e.g benign tumours in the elderly, or those where I am suspecting the swelling is due to a lymphoma.

Patients with tumours of the parotid gland will require a formal superficial parotidectomy. In the majority of cases, 90% of parotid tumours are found superficial to the facial nerve which divides the parotid salivary gland into a superficial and deep lobes. The operation of superficial parotidectomy preserves all the 5 branches of the facial nerve running through the gland and this is important because these branches provide the motor innervation to the side of the face (fig 1,2,3). However, in about 25% of the patients even with the careful preservation of these 5 branches, there is facial weakness most of which will go away after 2 to 3 months. It is unusual to require sacrifice of the facial nerve in parotid tumours unless if the face is already paralysed. Some of the tumours may require concurrent lymph node dissection and in others additional postoperative radiotherapy.