A lump near the ear
A lump in front of the ear, under the lobe, or near the corner of the jaw that doesn't hurt.
CONDITION / JAWS, MOUTH AND NECK
Tumor of the parotid gland.
Tumor of the parotid gland is most often benign, and the most common of the benign ones is pleomorphic adenoma. It may not bother you for years, but it does not go away on its own, so the main treatment is an operation during which the facial nerve is preserved.
CONCEPTUAL VISUALIZATION- What it is
- Neoplasm in the salivary gland lying in front of the ear and below it.
- Most often
- Pleomorphic adenoma is the most common benign tumor of the parotid gland.
- The main risk
- The facial nerve that moves the muscles of the face passes through the gland; the operation is planned in such a way as to preserve it.
- Who treats it
- A head and neck surgeon is a maxillofacial or ENT surgeon.
01 / WHAT IS ITWhat is
What is
tumor of the parotid gland.
The parotid gland is a salivary gland in front of the ear that descends under the lobe to the corner of the lower jaw. The facial nerve passes through it, which moves facial muscles: closes the eye, raises the corner of the mouth.
Most tumors of this gland are benign. In a study of 992 patients who underwent surgery for parotid tumors, 81.9% were benign, and the most common among them was pleomorphic adenoma (also called a mixed tumor).
A pleomorphic adenoma may not bother you for years, but it does not disappear by itself. The operation is done to stop the growth and because of the possible transformation into cancer in the future. About malignant tumors of the gland - a separate page.
This is general information. The doctor will tell you what will suit you after the examination and examinations.
02 / SIGNSHow
How
a tumor presents.
It can be a lump that has not bothered you for years. But some signs occur in both benign tumors and cancer, so the diagnosis is made only after an examination.
Slow growth
With benign tumors, the symptoms before treatment lasted longer than with malignant tumors (study of 992 patients).
Alarming signs
Pain in the chest area, numbness or weakness of half of the face, difficulty opening the mouth - a reason not to postpone the examination.
Malignant tumors of the salivary glandsThe lump is back
The seal appeared again in the place of the removed one - this may be a relapse, and it is examined again.
03 / REASONSWhat increases
What increases
risks
For the treatment decision, it is important not only what kind of tumor it is, but also what increases the risk of recurrence or recurrence.
The size of the tumor
In a cohort of 260 patients with untreated pleomorphic adenoma, larger size at presentation was associated with detection of cancer in the tumor.
age
In the same cohort, the odds of finding cancer in the tumor increased with each year of age (odds ratio 1.04 per year); duration of illness was not associated with this.
Delete "by the edge"
If the tumor is excised only on its surface (enucleation), recurrences are more: in a meta-analysis of 44 studies — 14.3% versus 1.4–3.7% after other operations.
Recurrent tumor
After relapse, the risks of growth and degeneration are higher, the younger the patient (SFORL guideline); repeated operations are more often complicated by weakness of the facial nerve.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
The tumor of the parotid gland itself usually does not require emergency care - it is examined and treated as planned. But several signs, in particular after surgery, are a reason to act immediately.
103 immediately if:
- the face is suddenly crooked - the corner of the mouth or eyelid has dropped (unless it is a weakness noticed immediately after surgery on the gland);
- a person cannot raise both hands and hold them;
- speech suddenly became slurred or confused;
- it is very difficult to breathe - a person gasps for air, suffocates or cannot utter words;
- after surgery, the neck or face quickly swells and it becomes difficult to breathe;
- the bleeding from the wound does not stop, although you press the wound tightly.
See a doctor without delay if:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after surgery, pain or swelling in the wound area increases. On the same day: the wound is reddened, pus is released from it, or the temperature has risen; without surgery, half of the face or its part (corner of the mouth, eyelid) weakens - in a few days or gradually - and there are no other signs of a stroke; after surgery the face is weak or the eye does not close - tell the surgeon to evaluate the nerve and explain how to protect the eye. In the coming days: the lump grows, hurts, is hard and does not move, a part of the face is numb or it has become difficult to open the mouth - to the doctor, and if he suspects cancer, to the oncologist without delay. Planned: the lump near the ear does not hurt and remains for more than 2 weeks - make an appointment for a consultation.
05 / DIAGNOSTICSAs it turns out,
As it turns out,
what kind of tumor is this
- Review
The doctor assesses the size and mobility of the lump and checks whether all the branches of the facial nerve are working.
- MRI
The French SFORL guideline advises MRI for suspected pleomorphic adenoma, together with lymph nodes of the head and neck.
- Puncture under ultrasound
Cells are taken for analysis with a thin needle. In a meta-analysis of 35 studies, puncture distinguished malignant from benign tumors with a sensitivity of 88.0% and a specificity of 98.5%; in a separate cohort of 992 patients, the sensitivity was only 50.3%, so a "benign" finding does not invalidate surgery.
- Analysis during surgery
A piece of tissue is examined immediately (urgent histology) to change the scope of the operation if signs of cancer are found.
- Final histology
An accurate diagnosis is made after examining the entire removed tumor.
06 / TREATMENTHow we treat
How we treat
pleomorphic adenoma.
The main treatment is surgery. According to SFORL guidelines, the tumor is removed as a whole, with a border of healthy tissue around it, as far as its location allows, and preserving the facial nerve. It is not recommended to remove the tumor only on its surface.
01
Volume of operation
They are chosen according to the size and location of the tumor.
- Extracapsular dissection
- The tumor is removed along with a thin layer of healthy tissue without removing the entire nerve. The authors of the 2025 meta-analysis (2507 patients) consider it a possible choice for mobile tumors up to 3 cm in the superficial part of the gland.
- Partial and superficial parotidectomy
- Part or all of the superficial part of the gland above the nerve is removed, first finding and separating its branches.
- Total parotidectomy
- The entire gland is removed, preserving the nerve; in a cohort of 992 patients, malignant tumors were most often operated on, and benign tumors were operated on by superficial parotidectomy.
- Relapses after operations
- In a network meta-analysis of 44 studies (7841 participants): after extracapsular dissection — 3.6%, partial superficial parotidectomy — 3.7%, superficial — 2.8%, total — 1.4%. The larger the volume, the more frequent the temporary weakness of the face and Frey's syndrome.
02
Facial nerve
The most serious risk of surgery.
- Temporary weakness
- The face immediately after the operation weakens often: in various studies - from 14 to 65%. In a series of 794 parotidectomies (benign and malignant tumors), temporary weakness was 9.2%.
- Persistent weakness
- In the same series, weakness over 6 months remained in 5.2%. The risk is higher at an older age, with cancer, repeated operations, and tumors occupying the deep part of the gland.
- Neuromonitoring
- During surgery, the device signals when the surgeon is approaching the nerve. In a meta-analysis of 10 studies (1069 patients), weakness was less frequent with it, but in prospective studies no difference was found, and the quality of the evidence is low.
- If the nerve is crossed
- The British guideline advises to consider suturing it immediately, with the insertion of a nerve graft if necessary.
03
Other consequences
- Frey syndrome
- During eating, the skin in front of the ear sweats and reddens: the cut nerve fibers of the gland sprout to the sweat glands of the skin. In a meta-analysis of 1882 patients, 4.5% after extracapsular dissection versus 26.1% after superficial parotidectomy. They are treated with antiperspirants or botulinum toxin, but it is not known which method is better.
- Relapse
- According to the SFORL instructions, the recurrent tumor is completely removed under neuromonitoring, first performing an MRI; radiation therapy is considered for multiple recurrences or incomplete removal.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Tumors of the parotid gland are part of maxillofacial surgery. In the direction "New face" of Dr. Valikhnovskyi's Institute of Surgery, facial expressions and facial contours are restored if they have changed after tumor removal. Whether an operation is needed on the gland itself and which one, the surgeon decides after an MRI and a puncture.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Exercises for the face — physical therapy for facial muscle weakness after surgery; according to a review of 15 studies, probably useful and not harmful.
- Cross-facial nerve plasticity — a nerve graft from the lower leg connects a branch of the healthy facial nerve to the affected side.
- Transplantation of striated muscle — part of the muscle from the thigh is transferred to the face to reverse the lifting of the corner of the mouth.
- Static operations — improve the symmetry of the face at rest, when the movement does not return.
- Lipofilling and local flaps — own fat or adjacent tissues of the face and neck align the cavity or defect after tumor removal.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Pictures onlineSend a photo of your face, results of MRI, puncture or histology, if any - the doctor will pre-evaluate the situation.
- ConsultationExamination, checking of all branches of the facial nerve, conversation about how long the lump has been there and whether it has changed.
- PlanWhat is needed first — examination, operation on the gland or restoration of facial expressions and contour after it.
- Restoration of mimicryExercises, and if movement does not return, nerve or muscle surgery.
- SupervisionExaminations after treatment to detect the return of the tumor in time.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is a parotid tumor cancer?
Mostly no. In a study of 992 operated patients, benign tumors were 81.9%. But it is impossible to distinguish them by eye - MRI, puncture and histology are required.
Is it necessary to operate pleomorphic adenoma?
Surgery is the main treatment, because the tumor grows and can regenerate. In a cohort of 260 patients who had not been operated on for years, cancer in the tumor was subsequently found in 3.2%. You make the decision together with the surgeon.
Will the facial nerve be damaged during the operation?
The nerve is preserved, but there is a risk. Temporary weakness of the face occurs frequently and usually passes; in a series of 794 parotidectomies (among them there were also malignant tumors), weakness over 6 months remained in 5.2%. The risk is higher with repeated operations and tumors occupying the deep part of the gland.
Can the tumor come back?
Perhaps, most often — if it was removed on the surface: 14.3% of recurrences against 1.4–3.7% after operations with a border of healthy tissue (meta-analysis of 44 studies).
What is Frey syndrome?
Sweating and redness of the skin in front of the ear while eating after surgery on the gland. The larger the volume of the operation, the more often it happens. It can be relieved with antiperspirants or botulinum toxin.
Why puncture, if to operate anyway?
The scope of the operation and whether an oncologist is needed depends on the result. However, the puncture may not notice the cancer, so the final diagnosis is given by the histology of the removed tumor.
What to do if the face is weak after surgery?
Tell the surgeon. Often this is temporary; exercises for the face help, and the eye, if it does not close, is protected with drops and ointment. If the movement has not returned, there are operations to restore facial expressions.
Sources
21 sources · clinical guidelines, meta-analyses, Cochrane reviews, cohorts, NHS and Cancer Research UKshowCollapse
- Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part I: Primary treatment of pleomorphic adenomaEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2021doi:10.1016/j.anorl.2020.09.002 ↗
- Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part II: Management of recurrent pleomorphic adenoma of the parotid glandEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2021doi:10.1016/j.anorl.2020.08.009 ↗
- Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary GuidelinesThe Journal of Laryngology & Otology, 2016doi:10.1017/S0022215116000566 ↗
- Surgical interventions for management of benign parotid tumors: Systematic review and network meta-analysisHead & Neck, 2021doi:10.1002/hed.26813 ↗
- Extracapsular dissection for benign parotid tumors: a meta-analysisThe Laryngoscope, 2012doi:10.1002/lary.23396 ↗
- Pleomorphic Adenoma: Extracapsular Dissection vs. Superficial Parotidectomy — An Updated Systematic Review and Meta-AnalysisMedical Sciences, 2025doi:10.3390/medsci13030104 ↗
- Meta-analysis of surgical approaches to the treatment of parotid pleomorphic adenomas and recurrence ratesJournal of Cranio-Maxillofacial Surgery, 2015doi:10.1016/j.jcms.2015.03.017 ↗
- Incidence of postoperative facial weakness in parotid tumor surgery: a tumor subsite analysis of 794 parotidectomiesBMC Surgery, 2019doi:10.1186/s12893-019-0666-6 ↗
- Comparative analysis of benign and malignant parotid gland tumors: A retrospective study of 992 patientsAmerican Journal of Otolaryngology, 2023doi:10.1016/j.amjoto.2022.103690 ↗
- Risk of Carcinoma in Pleomorphic Adenomas of the ParotidJAMA Otolaryngology–Head & Neck Surgery, 2023doi:10.1001/jamaoto.2023.3212 ↗
- Facial nerve monitoring during parotid gland surgery: a systematic review and meta-analysisEuropean Archives of Oto-Rhino-Laryngology, 2021doi:10.1007/s00405-020-06188-0 ↗
- Application of the Milan System for Reporting Salivary Gland Cytopathology: A systematic review and meta-analysisCancer Cytopathology, 2022doi:10.1002/cncy.22604 ↗
- Physical Therapy for Iatrogenic Facial Paralysis: A Systematic ReviewJAMA Otolaryngology–Head & Neck Surgery, 2020doi:10.1001/jamaoto.2020.3049 ↗
- Interventions for the treatment of Frey’s syndromeCochrane Database of Systematic Reviews, 2015doi:10.1002/14651858.CD009959.pub2 ↗
- Auriculotemporal Syndrome (Frey Syndrome)Otolaryngologic Clinics of North America, 2016doi:10.1016/j.otc.2015.10.010 ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
- Bell’s palsyNHS, 2023nhs.uk/conditions/bells-palsy ↗
- Stroke: SymptomsNHS, 2024nhs.uk/conditions/stroke/symptoms ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- Symptoms of salivary gland cancerCancer Research UK, 2026cancerresearchuk.org/about-cancer/salivary-gland-cancer/symptoms ↗
The figures on the page are from these sources.
Lump
near the ear?
Send photos and test results, if any. The doctor will tell you what to do next and where to start.