Doc: Remove mass on parotid gland sooner than later
Dear Dr. Roach: I recently was diagnosed with a benign pleomorphic adenoma of the parotid gland. My surgeon says that the mass should be removed, and explained many of the risks. The risks terrify me: Frey’s syndrome, facial paralysis, numbness.
My mass is 11 mm. Is that considered large? Could this mass be slow-growing, with little chance of it becoming cancerous? How long could I wait before agreeing to the surgery?
Dear J.M .: I think I agree with your surgeon: Most masses like this should be removed. As with any procedure, there are risks and benefits. One risk is Frey’s syndrome (sweating around the face), which is a possible complication of the surgery.
Another risk is damage to the facial nerve, which runs through the parotid, and damage to it during surgery can cause facial weakness and numbness.
That’s the bad news. The good news is that 11 mm is a small tumor, and the risks of complications are fairly low.
For example, temporary facial nerve damage happens in 10 to 60 percent of surgeries (depending on size and proximity to the facial nerve), but 90 percent recover within one month.
Permanent facial nerve damage occurs in 0 to 8 percent of cases in different studies.
Balanced against the risks of surgery are the risks of not doing surgery. Untreated, the tumor is likely to grow, making it harder and more dangerous to remove.
However, there is always a small chance of transformation to a malignant tumor. If I had a patient in your situation, I likely would recommend surgery. If you are going to do surgery, it’s better to do so sooner.
Dear Dr. Roach: My doctor wants me to have another colonoscopy. The last time I did, I noticed some memory loss, which lasted about two weeks. I read that the anesthesia used sometimes causes memory loss.
Do you have any information?
Dear Anon: Medication usually is given to help people relax during a colonoscopy, and memory loss usually occurs — people have little recollection of the test itself (this is not a bad thing). However, some people do have additional memory loss, both of events that happened before the exam (called retrograde) and after the event (called anterograde). This is uncommon, but since it seems to have happened to you, I would talk to the doctor about the sedation plan before the planned colonoscopy.
There are several choices of anesthetic agents, each with different risks of this side effect. You should find out which one caused this effect — my guess would be midazolam (Versed) — and ask about a different one (such as propofol). Any drug can cause some degree of amnesia, but I think your risk would be lessened by avoiding the drug that caused it previously.
Alcohol interacts poorly with these agents, so it should be avoided for a day (at least) before and after the procedure.
Finally, you can have the procedure done without sedation. I don’t recommend it, but people do so and endure the discomfort.
Colonoscopy is an important tool for screening for colon cancer.
Email questions to ToYourGoodHealth@med.cornell.edu.