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Parotidectomy


Medical editor Vera Mahler MD
Otolaryngologist
Oslo University Hospital

General

The most common salivary gland tumor is pleomorphic adenoma, which is primarily benign, but about 4% become malignant over time. 

Parotid tumors are in some cases difficult to classify. It is not always straightforward to determine whether the tumor is malignant or benign. In cases where an assumed benign tumor turns out to be malignant, a lymphadenectomy of applicable lymph nodes will be performed.

Malignant tumors make surgery more difficult due to invasion of surrounding tissue. There is greater risk of injury to the 7th cranial nerve which runs directly through the gland. Injury to the 7th cranial nerve causes facial paralysis. In some cases, the injured nerve can be removed and replaced with a nerve segment from another localization of lesser consequence.

Tumors in the parotid gland often have microscopic diffuse borders. The entire surface content of the gland is therefore included with the specimen.

Indication

  • Tumor in the parotid gland

Goal

  • Resection of tumor with margin.

Equipment

  • Large basic tray
  • NIM or single nerve stimulator

Preparation

  • The operation is performed under general anesthesia.
  • The patient lies supine with their head tilted to the side. 

Implementation

  • The incision is marked on the skin.
  • Xylocain med adrenaline is injected.
  • An S-shaped parotid incision is made.
  • The skin flap is lifted.
  • The surgeon resects along the ear cartilage, down to the mastiod process and down along the anterior edge of the sternocleidomastoid muscle to the posterior cavity of the digastric muscle. 
  • The main stem of the facial nerve is located. Branches of this are followed peripherally with continued resection of tumor. 
  • The resected tissue is removed.
  • During this process, the facial nerves are stimulated with a nerve stimulator and electrodes register muscle response in the face. This ensures that nerve strands are not cut. 
  • A suction drain is inserted.
  • Skin and subcutaneous tissue is adapted in layers with interrupted or consecutive sutures. 

Follow-up

  • Observe facial function. The nerves may be sluggish after too much stimulation and fraction. 
  • The sutures are removed after 10 days. 
  • The result from the pathologist will be available after about one week. 

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