The parotid gland is a key pathway for the facial nerve and can have a significant role in facial nerve disorders.

What is the parotid gland?

figure1 salivary glands The Parotid Gland is an important salivary gland in the body.  This gland pumps saliva through the Stensen’s duct, into the mouth. This helps keep the mouth wet and helps with swallowing. Infections, trauma and tumors can potentially cause facial nerve problems. The longer it takes to correct a problem, the more surgery will be needed.

What causes the problems?

The most common causes of facial nerve disorders as a result of the parotid gland is tumors (pleomorphic adenoma), malignancy (adenoid cystic carcinoma, adenocarcinoma), trauma, and infectious process.  Even though the mumps have all been eliminated with routine vaccinations, this viral infection will give you an idea of how serious an infection of the Parotid gland can be.

Parotid tumors are typically benign and can be treated with surgery.  The most common parotid tumor is pleomorphic adenoma which usually presents with a pain-less lump at the jaw line in front of the ear.  Other tumors are typically more concerning and can be malignant such as adenoid cystic carcinoma, adenocarcinoma, and squamous cell carcinoma.

figure2 salivary glands Staphylococcus (Staph infections) aureus is the most common reason the Parotid gland becomes infected and usually if can be contained with antibiotics and anti-inflammatories. Bacteria that create tuberculosis are another factor that can cause Parotid infections. Another bacteria, which causes “Acute suppurative parotitis” is also a painful and similar infection. These can usually be treated by drugs.

Diabetes, bulimia and alcoholism may cause enlarged parotid glands but usually these are not painful and there is a small group of AIDS victims that have experienced parotitis.

figure3 salivary glands However, any blockage to the parotid duct such as a tumor, mucous plug, salivary stone is usually the cause of painful and deadly parotiditis. Calcium is what forms salivary stones. Usually they can be detected by X-ray about 80% of the time.

Chronic inflammation of the parotid gland may be caused by Sjogren’s syndrome. This is caused by an autoimmune disease and can be a serious problem. There is no known cause for Sjogren’s syndrome at this time. Dryness in the eyes, nose, skin and mouth in the facial area along with swelling is an indication of Sjogren’s syndrome.

facial nerve monitor

Where is it?

figure4 salivary glands The parotid gland sits under the skin, and wraps around the back of the jaw at the mandibular ramus. The gland sits in an area which is anterior to the ear. This gland is palpated bilaterally and there is one on each side of the head behind the ear. The facial nerve, although it does not control the gland, it runs through it.


incisions before and after


Surgery remains the gold-standard for treating parotid tumors.   Old methods of surgery include taking the gland out completely leave scars around the face and usually a dent in the area on the face, making it a more obvious problem.

salivary At the Facial Paralysis Institute, Dr. Azizzadeh and Dr. Larian use a multi-specialty approach to address parotid tumors.  Dr. Larian, is a renowned head and neck surgeon and the director of the Cedars-Sinai Head and Neck Cancer Center.  He uses cutting-edge techniques to safely remove the tumor with the highest rate of facial nerve preservation.  Dr. Azizzadeh, a facial plastic and reconstructive surgeon, helps to plan the surgical incision and reconstruction of the region so that a scar-free and dent-free results can be obtained.  Furthermore, given Dr. Azizzadeh's facial nerve expertise - the rate of facial nerve preservation and outcome is safely guarded.

Please call us anytime for a free consultation on how we may be able to treat your condition. The Facial Paralysis Institute is one of the most advanced centers of its kind in the world dealing with such problems.

If you are actively considering parotidectomy, schedule a consultation with Beverly Hills facial paralysis expert Dr. Azizzadeh by calling 888.470.6432 today!

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Director, The Facial Paralysis Institute - Associate Clinical Professor - Facial Plastic & Reconstructive Surgery David Geffen School of Medicine at UCLA

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Dr. Azizzadeh’s facial nerve textbook is the preeminent textbook for doctors on the subject.