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

Most Common Complication After Parotidectomy

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 of Parotidectomy: Frequency and Impact

Parotid surgery can result in several complications that affect patients to varying degrees:

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

   • Affects the majority of patients
   • Often involves the distribution of the greater auricular nerve
   • While common, it typically has less impact on quality of life than other complications

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

   • Characterized by gustatory sweating, flushing, and warming over preauricular and temporal areas
   • Develops on average 12 months after surgery 2
   • Only about 44% of patients with Frey's syndrome are symptomatic 2
   • More common after superficial parotidectomy (18.18%) than extracapsular dissection (3.37%) 3
   • Almost all patients develop some degree of Frey's syndrome, but only a minority need treatment 4

3. Facial nerve weakness

   • Temporary facial weakness: approximately 27% of cases 5
   • Permanent facial weakness: 2.5-6.56% of patients 5, 3
   • Higher rates with superficial parotidectomy (17.67% temporary) compared to extracapsular dissection (4.49% temporary) 3

Risk Factors and Prevention

For Frey's Syndrome:

• Tumor size is a significant predictor - incidence nearly doubles in patients with tumors ≥4cm (33%) compared to <4cm (18%) 6
• Superficial parotidectomy carries higher risk than extracapsular dissection 3

Preventive Measures:

• Thick skin flap and partial superficial parotidectomy are important techniques to minimize symptomatic Frey's syndrome 5, 4
• Free abdominal fat graft has been associated with lower incidence of Frey's syndrome 1
• Sternocleidomastoid flap has not shown significant benefit in preventing Frey's syndrome 2

Management of Complications

For Frey's syndrome:

• Intracutaneous injection of botulinum toxin A is effective, long-lasting, and well-tolerated 5, 4
• Treatment can be repeated if symptoms recur 4

Clinical Implications

When counseling patients about parotid surgery:

• Inform them that skin flap anesthesia is the most common complication
• Explain that while Frey's syndrome and facial nerve issues are less common, they may have greater impact on quality of life
• First Bite Syndrome (FBS), while less common (11%), appears to have a greater influence on quality of life than both Frey's syndrome and skin flap anesthesia 1
• Complications may develop with delayed onset, sometimes years after surgery 5

Surgical Approach Considerations

The choice of surgical approach significantly affects complication rates:

• Extracapsular dissection has lower rates of temporary facial paralysis and Frey's syndrome compared to superficial parotidectomy 3
• Surgery of the deep lobe is associated with higher risk of First Bite Syndrome 1
• Careful facial nerve handling is essential to minimize risk of permanent weakness 5