Information on Ear, Nose and Throat Surgeries Parotidectomy
Parotidectomy & Facial Nerve Dissection
Parotidectomy & Facial Nerve Dissection
 
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Parotidectomy:
 The parotid gland is located in front and below of the ear.  It is the largest of the major salivary glands.  Tumors may arise in this gland at any age.  They are rare in children, but when they occur over 50% are cancers.  In  the adult, 90% are benign (non-cancerous growths).  The most common tumor is a plemorphic adenoma, which comprises 75% of all parotid tumors in the adult.  Although benign, over many years 5% of these tumors may turn into a cancer.

The picture on the right shows the surgical defect in a patient who has undergone a lateral parotidectomy for a pleomorphic adenoma.  Note that the facial nerve enters and divides in the center of the gland.  The course of the nerve and number of branches are different in each patient.  In this patient, the upper division of the nerve is dominant and seven branches were identified.


Parotidectomy (Parotid Surgery) Technique

  
 

Mouse-over picture to outline facial nerve.  Click-on picture to enlarge.
 
The video on the right shows the surgical technique used to preserve the facial nerve using the Starion ENTcepts.










The Flash Presentation below illustrates the surgical steps in a Parotidectomy.  


  • 1.  Skin Incision
  • 2.  Skin Flap Elevation
  • 3.  Digastric Muscle
  • 4.  Tragal Pointer
  • 5.  Tumor Laying Over VII Nerve
  • 6.  Facial Nerve Dissection
  • 7.  Facial Nerve Dissection
  • 8.  Facial Nerve Dissection
  • 9.  Facial Nerve Dissection
  • 10.  Facial Nerve Dissection
  • 11.  VII Nerve - Lower Division Dissection
  • 12.  VII Nerve - Final Dissection
  • 13.  Placement of Drain
  • 14.  Placement of Drain
  • 15.  Closure of Facial Flap Usng a Chromic Stitch
  • 16.  Final Closure

 
Complications of surgery include, facial nerve injury with resultant facial paralysis.  If severe, paralysis will cause the face to droop, drooling, and the inability to close the eye.  The latter, if untreated, can cause drying of the eye and even blindness. 

Electromonitoring of the Facial Nerve helps to identify it at surgery and prevent injury.  This technique was first described in 1961 by Dr Thomas W Kavanagh - Read Article

Patients can also develop a salivary fistula, where saliva drains through the skin incision or a sialocele when a pocket of saliva forms under the skin flap.  Both of these complications are treated with the insertion of a drainage catheter and medications to decrease salivary flow.

Many months or years after the operation, the cut nerves to the salivary gland may grow into and innervate the skin's sweat glands.  This is called Frey's Syndrome and produces annoying sweating when one eats or salivates.

All patients develop numbness of a part of the outer ear and appear mildly sunken-in where the gland has been removed.


The picture on the right shows the operative incision.  It extends from in front of the ear, loops below the ear, over the mastoid tip, and then forward below the mandible (jaw bone).

 

The CT Scan on the right shows the location of the patient's tumor, lying directly over the facial nerve.

 


  
 

One of the complications of a parotidectomy is the formation of a sialocele or saliva under the skin flap.  To prevent this, drains are left in the wound for three days.  If a sialocele forms, treatment consists of the placement of an angiocatheter from behind the ear into the pocket of saliva. A scopolamine patch is also placed to decrease salivary gland flow. 
 
 

 

  
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