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Dr.

Jalal

Superficial Parotidectomy [Kerry D. Olsen, MD]


DEFINITIONS
Superficial parotidectomy is defined as removal of all the parotid gland lateral to the facial nerve.
Partial or subtotal parotidectomy is generally a variation of this procedure.
Deep lobe parotidectomy is the removal of the gland beneath (medial to) the facial nerve, including
the retromandibular portion.
Total parotidectomy refers to the removal of the entire gland with or without sacrifice of the facial
nerve.
For certain indications, this operation can be extended to include removal of adjacent soft tissue, muscle,
or bone (or combination of these). The most frequent parotid gland operation is superficial parotidectomy.

INDICATIONS
1. The presence of a parotid gland neoplasm is the most common indication for performing
superficial parotidectomy.
[Approximately 80% of parotid tumors are benign and, of these, two thirds are pleomorphic adenomas.
Because the majority (80%) of the gland is located lateral to the facial nerve, superficial parotidectomy is
adequate treatment for most benign tumors and many low-grade malignant ones.]
2. Superficial parotidectomy is also performed for known or suspected metastatic cancer to the
parotid lymph nodes.
[Metastases to the parotid gland lymph nodes are usually from regional primary melanomas or cutaneous
squamous cell carcinomas.]
3. Superficial parotidectomy may also be performed to treat recurrent sialadenitis or sialolithiasis
refractory to medical management.
4. Rarely, superficial parotidectomy may be performed solely for cosmetic reasons.
5. Superficial parotidectomy may be necessary as the first step in removing a deep-lobe tumor.
Performing superficial parotidectomy alone without removing the deep lobe is always
contraindicated if there is metastasis to nodes in the superficial lobe or if a high-grade carcinoma
is found in the superficial lobe.

EVALUATION AND TESTING


-

Previous parotid or Head and neck operation


History of radiation
Tumour- slow or rapid growth
Pain, facial weakness, neck nodes

Mobile
FNAC
Imaging CT/MRI [helpful in determining the size and extent of the tumor, possible extension
into adjacent structures and nodal involvement]

PREOPERATIVE DISCUSSION
Consent
- The goal of surgery is safe and complete removal of the neoplasm with a surrounding margin of
normal parotid tissue and preservation of the facial nerve.
- Patients are told that if the pathologist finds a malignancy, then depending on the histologic
results, the deep portion of the gland and a modified (select) neck dissection may also be
performed.
Complications
Anesthesia risks, bleeding, and infection.
- Incision, scar, numbness, and the soft tissue depression after removal of the gland
- Facial nerve paralysis or paresis [can be partial or total, temporary or permanent.]
- Frey syndrome

SURGICAL TECHNIQUE
The surgical technique commonly used in superficial parotidectomy has been described by Beahrs.

Under General anesthesia, oral ETT


The patient is placed in a 45 reverse Trendelenburg position. The head-up position helps to
reduce bleeding during the procedure.

1 Paroti d incision in relat ion to adjacent structures

Mark, small crosshatches


It follows the normal junction of the anterior
border of the ear and face and curves gradually
beneath the lobule and horizontally into the
upper neck. This portion of the incision is
usually 1 or 2 finger widths below the angle of
the mandible, ideally in a natural skin crease.
The incision is made into the subcutaneous
tissue, and hemostasis is obtained with unipolar
cautery.

2 Parotid fl aps raised to the anterior edge of the gland. Avoid cutting any tissue in this area.

Flaps are raised at the level of the


parotid fascia, with care taken not to
enter a superficial tumor or the
substance of the gland

Flaps are raised with Jones scissors


spread open perpendicularly along the
parotid fascia

Separate the posteroinferior aspect of the parotid gland from the anterior border of the sternocleidomastoid
muscle (SCM).

4 (A) Separat ion of the parotid gland fro m the cartilaginous ear canal and identification of the cart ilag inous pointer.
(B) Division of the tissue remaining between the sternocleidomastoid muscle and the cartilaginous ear canal.
(C) The parotid gland separate along the entire area of the sternocleidomastoid muscle and ear canal.

5 Identificat ion of the posterior belly of the digastric muscle

6 The parotid gland is now separated from the cartilaginous ear canal, the sternocleidomastoid muscle (SCM ), and
the posterior belly o f the digastric muscle.

7 Identificat ion of the main trunk of the facial nerve and adjacent posterior auricu lar artery.

8 Identificat ion of the pes anserinus of the facial nerve. Usually the posterior auricular artery has been ligated.

9 (A) Separat ing the parotid gland fro m the temporal and zygo matic branches of the facial nerve.
(B) Freeing the parotid gland fro m the facial nerve branches, working fro m a superior to inferior direct ion.
(C) Freeing the parotid gland fro m the upper facial nerve branches and then from the marginal mandibu lar and
cervical branches of the facial nerve. (D) The superficial lobe of the parotid gland separated from all the facial nerve
branches and still attached to the parotid (Stensons) duct.

10 Facial nerve branches all intact, showing their relationship to the deep lobe of the parotid gland.

11 Final closure of the parotidectomy incision with hemovac drain in place.

POSTOPERATIVE MANAGEMENT
-

Wound inspection next day


Check for hematoma, facial nerve palsy
Drain removal
STO
HPE