Meet Dr. Larian
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Out Of Town Patients
- Do Salivary Stones Require Surgery?
Salivary gland stones, or sialolithiasis, are small calcium deposits that block the flow of saliva, which if not removed can lead to swelling of the salivary gland, inflammation, infection, Read more >
- Why a Parotid Tumor Requires Immediate Medical Attention
Many people have experienced swollen glands at some point in their lives. However, if you have a lump close to your ear that lingers for more than a couple weeks, Read more >
- How Expert Surgeons Perform Parotid Reconstruction
If your parotid gland function has been impaired for any reason, such as a parotid tumor, you may need surgery. Read more >
Parotid & Facial Nerve Anatomy
The parotid gland is located in a very crucial location on the side of the face, just in front and below the ear. In fact, the word parotid is derived from a term that means around the ear. The parotid gland develops very early in the fetus in the mother’s womb. As it grows, the parotid gland wraps around several lymph nodes and the facial nerve. The facial nerve that is developing at this time, comes from deep in the skull and travels from underneath the ear, through the deep part of the parotid gland coming forward to go to the muscles of the face. The relationship of the parotid gland to the nerve and the lymph nodes affects how diseases develop, and is the reason why it is extremely important to have great expertise in order to perform parotid surgery.
There are many small ducts in the gland that come together to form the main parotid duct called the Stensen’s duct. These ducts bring the saliva from the substance of the gland to the main duct that empties it into the mouth at the upper cheek next to the back teeth. Salivary stones can develop in the main duct or anywhere in the smaller ducts.
The facial nerve is an extremely important nerve. Although just the fact that the movement of the face is controlled by it is in and of itself very significant, the fact we communicate our emotions and the significance of our speech by our facial movement makes this nerve incredibly important. When the facial nerve is not functioning properly, our ability to express ourselves and communicate is diminished. Additionally, the eyes wont close completely and we could develop dry eyes and vision change; and our lips wont hold tight that could lead to drooling.
The anatomy of the facial nerve is extremely intricate; the nerve starts in the brain, travels through the bone behind the ear, through a long bony canal and exits the skull just behind the ear to enter into the parotid. Inside the parotid, it travels in the deeper portion of the gland, with 3/4th of the gland being superficial to it. After a short distance in the gland it divides into two major branches, called superior & inferior divisions, which then go on to give multiple branches going to all the muscles of facial movement. The nerve also carries with it branches that go to the parotid and instruct the parotid as to when it should produce and secrete saliva.
Dr. Larian will know ahead of time if the facial nerve has a higher then normal risk of being compromised during surgery. If the facial nerve is functioning normally, then it can most likely be saved. Temporary facial nerve weakness, involving just one, two or all the branches can occur, and it usually has to do with how close the tumor is to the nerve and how hard it is to separate the tumor from the nerve. At times, this occurs because the tumor is deep to the nerve and therefore, the nerve needs to be separated even more to bring the tumor out from underneath the nerve. Permanent total paralysis can occur, but in the hands of an expert parotid surgeon it is extremely rare, especially when the tumor is benign.
If facial paralysis is present before surgery, or in the event that the facial nerve needs to be cut for the purposes of removing the cancer during a parotidectomy, Dr. Larian and Dr. Azizzadeh are are able to perform reconstructive facial reanimation surgery at the same time to optimize movement to the facial musculature and give the best possible results.
It has been shown that the chance of surgical complication and facial nerve injury decreases with the experience and expertise of the surgeon. This is why it is extremely important to ensure an expert surgeon performs your parotid surgery.
Watch Dr. Larian and Dr. Azizzadeh discuss the importance of preserving the facial nerve during a parotidectomy on The Doctors
Next, learn about parotid gland tumors.