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Salivary gland excision - parotid or submandibular, done properly.

Excision of the parotid or submandibular gland - with intra-operative facial nerve monitoring, a named consultant head and neck surgeon and a plan for the marginal mandibular branch. Not a lump-clinic detour.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private salivary gland surgery costs in the UK.

Indicative ranges across our partner UK units.

In short

£7,500–£12,500, home the next day.

Procedure Indicative range
Submandibular gland excision £4,500–£7,500
Extracapsular dissection (small superficial parotid lesion) £5,500–£8,500
Superficial parotidectomy £7,500–£12,500
Total parotidectomy with facial nerve preservation £11,000–£18,000
Sublingual gland excision £3,500–£6,000
Head and neck consultation only £280–£450
Ultrasound plus FNA (if needed) £450–£850

Prices vary by hospital, by the consultant, by extent (extracapsular, superficial, total) and by whether nerve monitoring, histology and reconstruction are included.

The problem

Parotid surgery is where a general ENT list quietly under-delivers.

Facial nerve outcomes track hard with surgeon volume. Extracapsular dissection is skipped when it would have fitted. Nerve monitoring is not always available. We fix all three.

  • Facial nerve monitoring, every case

    Real-time EMG changes the operation - you feel the nerve before you see it. Volume plus monitoring is the outcome combination.

  • Consider extracapsular dissection first

    For the right small superficial lesion, extracapsular dissection cuts nerve weakness and Frey syndrome rates. We ask the question, up front.

  • Get the histology plan right, before day one

    Ultrasound with FNA or core biopsy pre-op means fewer diagnostic surprises and a clean margin plan when the result is malignant.

When it helps

When salivary gland excision is the right step.

The situations we see most, plus one red flag that means specialist review urgently rather than a routine booking.

  • Pleomorphic adenoma of the parotid

    The commonest benign parotid tumour - needs excision because of malignant transformation risk and gradual growth.

  • Warthin tumour

    Benign, often bilateral, common in smokers. Excision where symptomatic or diagnostically uncertain.

  • Chronic submandibular sialadenitis

    Recurrent painful swelling from stones or duct scarring - where sialendoscopy has failed, gland excision is definitive.

  • Suspected salivary gland malignancy

    A firm, fixed or rapidly growing mass, with facial nerve weakness - needs MDT-guided excision with margin control.

  • Recurrent pleomorphic adenoma

    Multi-nodular recurrence after previous excision - a technically demanding re-do with high nerve-injury risk without monitoring.

  • Deep-lobe parotid tumour

    A parapharyngeal mass approached through a modified parotidectomy - planned with cross-sectional imaging.

  • Sublingual ranula (plunging)

    A cystic swelling from the sublingual gland - definitive treatment is gland excision, not repeated marsupialisation.

  • Red flag: facial nerve weakness with a parotid mass

    New facial droop with a parotid lump is malignancy until proven otherwise - a two-week head and neck referral, not a routine appointment.

Procedure options

The approach depends on the gland, the lesion and where the nerve runs.

Extracapsular dissection, superficial or total parotidectomy, submandibular or sublingual gland excision - each with different nerve-risk and cosmetic profiles.

  • Extracapsular dissection

    For small, mobile, superficial benign lesions - dissection just outside the capsule, sparing surrounding parotid tissue. Lower nerve-injury and Frey syndrome rates.

  • Superficial parotidectomy

    Removal of the parotid tissue lateral to the facial nerve - the standard approach for most superficial pleomorphic adenomas and Warthin tumours.

  • Total parotidectomy

    Superficial plus deep-lobe removal with facial nerve preservation - for deep-lobe tumours, large tumours, or selected malignancies.

  • Radical or extended parotidectomy

    Total parotidectomy with sacrifice of the facial nerve for high-grade malignancy involving the nerve - with immediate nerve grafting and MDT planning.

  • Submandibular gland excision

    Removal through a 4–5 cm neck crease incision - key steps protect the marginal mandibular branch of the facial nerve, the lingual and hypoglossal nerves.

  • Sublingual gland excision

    Transoral excision for ranula or symptomatic disease - outpatient or day-case with regional or general anaesthetic.

  • Sialendoscopy first, where possible

    For stones and duct disease - a gland-preserving alternative to excision. We say so before recommending removal.

  • Neck dissection when malignancy is confirmed

    Selective neck dissection alongside gland excision where nodal disease is confirmed or suspected on MDT review.

Safety and recovery

What to expect afterwards - honestly.

Salivary gland surgery is well established. The things worth planning are facial nerve function, Frey syndrome and scar management.

  • Facial nerve - the central conversation

    Temporary weakness in around 20–30 percent after superficial parotidectomy; permanent weakness under 3 percent in monitored, consultant-led hands.

  • Frey syndrome (gustatory sweating)

    Sweating and flushing of the cheek when eating - reported in around 10 percent after parotidectomy. Botulinum toxin controls it well when it happens.

  • Marginal mandibular nerve after submandibular

    Temporary lip weakness in 5–10 percent, permanent in under 2 percent - reduced by a low neck crease incision and careful subplatysmal dissection.

  • Salivary fistula and sialocele

    Salivary leak or collection in 5–10 percent after parotidectomy - usually settles with aspiration and pressure dressings within 2–4 weeks.

  • Numbness of the earlobe (great auricular nerve)

    Some permanent numbness of the earlobe is common after parotidectomy - the great auricular nerve is often sacrificed to reach the gland.

  • Wound infection, haematoma

    Under 3 percent with clean, drained surgery. A drain and same-day observation reduce haematoma risk after parotid surgery.

  • Cosmesis - a modified facelift incision

    A modified Blair or facelift incision hides the scar behind the ear and along the hairline. The result is discreet even in short hair.

  • Histology drives everything else

    The final pathology on the removed gland decides whether any further treatment - radiotherapy, neck dissection - is needed.

  • Red flags after surgery

    New facial weakness developing after 48 hours, spreading redness, fever, or a rapidly enlarging swelling need same-day team review, not a routine call.

Reading your notes

Your notes in four parts. Read the last one first.

Whether parotid or submandibular, extracapsular or total, the operation note the surgeon sends you keeps to the same shape.

A UK consultant head and neck surgeon reviewing a patient's operation notes

A quiet reminder

Clinical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through your notes before your review, just ask.

  1. 01 Header

    Gland, extent and side

    Parotid or submandibular, which side, and whether extracapsular dissection, superficial or total parotidectomy - and whether nerve monitoring was used.

  2. 02 Technique

    Nerve identification and preservation

    How the facial nerve trunk was identified, which branches were dissected, and whether any branch was sacrificed with grafting.

  3. 03 Findings

    Tumour, capsule and margins

    Size, capsule integrity, adjacent structures involved, and estimated blood loss. Histology follows separately.

  4. 04 Impression

    Function, Frey plan and follow-up

    Read this first: expected facial function, drain management, Frey syndrome counselling and follow-up dates including MDT if malignant.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Salivary gland excision is usually covered when a mass is symptomatic or biopsy-suspicious.

Frequently asked

Everything we get asked about salivary gland excision.

Quick answers on facial nerve risk, Frey syndrome, scarring, cost and recovery.

  • What is a parotidectomy and why is the facial nerve such a big deal?

    Parotidectomy is removal of some or all of the parotid gland, which sits over the angle of the jaw. The facial nerve runs directly through it, splitting into five branches that move the forehead, eye, cheek and lips. Injury to any branch causes weakness on that side of the face. That is why intra-operative nerve monitoring and a surgeon with routine parotid volume matter - permanent weakness rates drop below 3 percent in expert hands.

  • How is submandibular gland excision different?

    The submandibular gland sits under the jawline in the neck. Excision is through a 4–5 cm crease incision, day-case in most cases. The key nerves at risk are the marginal mandibular branch of the facial nerve (lip movement), the lingual nerve (tongue sensation) and the hypoglossal nerve (tongue movement) - all identified and preserved routinely by a head and neck surgeon.

  • Will I have a visible scar?

    For parotidectomy we use a modified Blair or facelift-style incision that runs in front of the ear and curves behind it into the hairline - well hidden even with short hair. Submandibular scars sit in a natural neck crease and fade to a fine line by 6–12 months. Silicone gel and sun protection help.

  • How much does private salivary gland surgery cost in the UK?

    Roughly £4,500–£7,500 for submandibular excision, £5,500–£8,500 for extracapsular dissection, £7,500–£12,500 for superficial parotidectomy and £11,000–£18,000 for total parotidectomy. Ultrasound with FNA runs £450–£850.

  • What is Frey syndrome and can it be prevented?

    Frey syndrome is sweating and flushing of the cheek when you eat - caused by aberrant nerve regrowth after parotidectomy. Symptomatic Frey affects around 10 percent. It is reduced by a SMAS flap between skin and gland at the time of surgery, and treated very effectively with botulinum toxin injections if it appears.

  • How long is recovery?

    Home the same day or after one night. Off work 1–2 weeks for submandibular and extracapsular dissection, 2–3 weeks for superficial parotidectomy, and 3–4 weeks for total parotidectomy. Driving when comfortable turning the head - usually 1–2 weeks. No heavy lifting for 4 weeks.

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