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, which occurs in approximately 71% of cases. 1

Complications Following Parotidectomy: Frequency and Impact

Skin Flap Anesthesia

• Hypo-anesthesia of the skin is the most frequently observed complication, affecting 71% of patients following parotidectomy 1
• This complication is related to injury or sacrifice of the greater auricular nerve during surgery
• While common, it typically has less impact on patients' quality of life compared to other complications

Facial Nerve Palsy

• Temporary facial weakness occurs in approximately 27% of cases 2
• Permanent facial weakness is less common, occurring in about 2.5% of patients with normal preoperative function 2
• Rates vary by surgical approach:
  • Extracapsular dissection: 4.49% temporary and 2.25% permanent 3
  • Superficial parotidectomy: 17.67% temporary and 6.56% permanent 3

Frey's Syndrome

• Clinical incidence ranges from 23.5% to 28% of patients 1, 4
• However, subclinical Frey's syndrome may develop in almost all patients who undergo parotidectomy due to aberrant regeneration of cut parasympathetic fibers 5
• Only a minority of patients with Frey's syndrome require treatment 5
• Incidence is significantly higher with superficial parotidectomy (18.18%) compared to extracapsular dissection (3.37%) 3
• Risk factors include:
  • Larger tumor size (≥4 cm nearly doubles the risk) 6
  • More extensive surgery 3

Other Notable Complications

• Salivary fistula: 6.18-8.58% 3
• Sialocele: 3.53-4.77% 3
• Wound dehiscence: 10.6-12.64% 3
• Pathological scarring/keloid: 7.57-7.86% 3
• First Bite Syndrome: 11% (particularly associated with deep lobe surgery) 1

Prevention and Management Strategies

• Maintaining thick skin flaps when oncologically appropriate reduces the risk of Frey's syndrome 2
• Free abdominal fat graft has been associated with lower incidence of Frey's syndrome 1
• Partial superficial parotidectomy may minimize the risk of developing symptomatic Frey's syndrome 5
• Intracutaneous injection of botulinum toxin A is an effective, long-lasting, and well-tolerated treatment for Frey's syndrome 2, 5

Clinical Pearls and Pitfalls

• First Bite Syndrome appears to have a greater negative impact on patients' quality of life than Frey's syndrome or skin flap anesthesia 1
• Symptoms of complications like Frey's syndrome may develop years after surgery, highlighting the importance of long-term follow-up 2
• While many patients develop Frey's syndrome objectively, only about 44% are symptomatic 4
• Consider preventive interventions (acellular dermal matrix, dermofat graft, muscle flaps) for high-risk patients, particularly those with tumors ≥4 cm 6