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