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.
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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