What is the most common complication after parotid (parotid gland) surgery or parotidectomy (surgical removal of the parotid gland)?

Most Common Complication After Parotid Surgery

The most common complication after parotid surgery or parotidectomy is skin flap anesthesia (hypo-anesthesia of the skin), which occurs in approximately 71% of cases. 1

Complications After Parotidectomy: Frequency and Impact

Parotid surgery can lead to several complications that affect patients' quality of life. The prevalence of these complications varies:

1. Skin flap anesthesia/hypo-anesthesia (71%) 1

   • Highest frequency among all complications
   • Often involves the distribution of the great auricular nerve
   • While common, it typically has less impact on quality of life than some other complications

2. Frey's syndrome (23.5-28%) 1, 2

   • Characterized by gustatory sweating, flushing, and warming over preauricular and temporal areas
   • Develops after an average of 12 months post-surgery 2
   • Only about 44% of patients with Frey's syndrome are symptomatic 2
   • Risk increases with tumor size ≥4cm 3

3. Facial nerve weakness

   • Temporary facial weakness: approximately 27% 4
   • Permanent facial weakness: 2.5-6.56% 4, 5
   • Varies by surgical technique: 4.49% temporary and 2.25% permanent with extracapsular dissection vs. 17.67% temporary and 6.56% permanent with superficial parotidectomy 5

Risk Factors and Prevention

Several factors influence complication rates:

• Surgical technique: Extracapsular dissection has lower rates of temporary facial paralysis (4.49%) compared to superficial parotidectomy (17.67%) 5
• Tumor size: Larger tumors (≥4cm) nearly double the risk of Frey's syndrome 3
• Surgical approach: Thick skin flap and partial superficial parotidectomy can minimize symptomatic Frey's syndrome 6
• Preventive measures: Free abdominal fat graft is associated with lower incidence of Frey's syndrome 1

Management of Complications

For established complications:

• Frey's syndrome: Intracutaneous injection of botulinum toxin A is effective, long-lasting, and well-tolerated 4, 6
• Facial nerve weakness: Early detection and management are critical to preventing long-term sequelae 4

Clinical Pearls and Pitfalls

• While Frey's syndrome is often discussed as a significant complication, it's important to recognize that skin flap anesthesia is actually more common
• First Bite Syndrome (FBS), though less common (11%), may have a greater impact on quality of life than both Frey's syndrome and skin flap anesthesia 1
• Surgery involving the deep lobe of the parotid increases risk of First Bite Syndrome 1
• Not all patients with Frey's syndrome require treatment - only the minority with significant symptoms need intervention 6