There is no conclusive evidence that any one landmark is better than the rest. Mayo clinic, rochester, minnesota 55901 the surgical anatomy and technique of parotidectomy oliver h. To treat a parotid tumor, part or all of the gland is removed. Dec 31, 20 facial nerve paralysis is a daunting potential complication of parotid surgery and is widely reported. Optimizing the aesthetic result of parotidectomy with a face. If you have any problems or questions, please contact. Parotidectomy aftercare instructions what you need to know. Surgical anatomy of the parotid duct with emphasis on the major. Pdf superficial parotidectomy via facelift incision. Many surgical landmarks have been suggested to help the surgeon identify the facial nerve when performing parotid gland surgery. Cadaveric dissection was performed in the department of anatomy and the surgeries were done in the department of ent and head and neck surgery of r. The surgical anatomy of the parotid fascia request pdf. Facelift type incisions were used in all patients, and temporoparietal fascia flaps were.
Surgical anatomy and technic of parotidectomy edge of the following common spatial relations is helpful to the surgeon. Handson training course on surgical anatomy of the neck. Full text full text is available as a scanned copy of the original print version. The facial nerve passes through the substance of the parotid gland and therefore, surgery on this gland commonly for parotid tumours places the nerve at great risk.
The surgical anatomy of the extratemporal portion of the. Feb 03, 2020 a parotidectomy is surgery to remove a part, or all of one of your parotid glands. Knowledge of the key landmarks of the facial nerve trunk is essential for safe and effective surgical intervention in the region of the parotid gland. You need saliva to help with chewing and swallowing. Get a printable copy pdf file of the complete article 1. Aug 27, 20 identification of the facial nerve and its branches during parotidectomy courtesy dr shaji thomas mbbs ms mchplastic surgery filmed under permission of operating surgeon at regional cancer. Nursing teaching for parotidectomy iowa head and neck. Optimizing the aesthetic result of parotidectomy with a. The surgical anatomy and technic of parotidectomy sciencedirect. Surgical oncology lecturer of surgical oncology nci cairo universi slideshare uses cookies to improve functionality and performance, and to.
Place the electrodes of the nerve monitor at the corner in the muscles of the mouth orbicularis ori and eye orbicularis oculi, to facilitate preservation of the facial nerve. For many people with parotid gland tumors, surgery performed by a head and neck surgeon is the main treatment. The completion parotidectomy was done with retrograde dissection of the facial nerve following the previously identified lower division back to the main trunk followed by antegrade dissection with followup several months later after irradiation click image to open gallery of enlarged images below. Surgical anatomy of salivary glands linkedin slideshare. The parotidectomy procedure is the modern patient choice for parotid tumor removal. Identification of the facial nerve trunk is essential during surgery of the parotid gland because facial nerve injury is the most daunting potential complication of parotid gland surgery owing to the close relation between the gland and the extratemporal course of facial nerve. You can apply an antibiotic cream on the surgical site to help your body heal. You will still want a caregiver checking in on you and you will want to limit activities as much as possible. Parotidectomy is a major surgical procedure to remove the parotid gland shaded blue in the image which is one of 2 major salivary glands found in the human body. Surgical landmarks to identify main trunk of facial nerve. Thefacial nerve emerges fromthe baseof the skull at the stylomastoid foramen.
Superficial parotidectomy via facelift incision article pdf available in the annals of otology, rhinology, and laryngology 1184. Facelift type incisions were used in all patients, and temporoparietal fascia flaps were used to fill. The cut incision required to remove the tumor begins at the front of the ear and follows the line down to the neck and under and along the jawline. Currently, there are no reports in the literature of the parotid fascia suggesting that this. Surgical anatomyof the parotid gland following description ofthesurgical anatomyoftheparotid gland may prove helpful. Jun 03, 2016 tumors that extend into the deep lobe may require total parotidectomy. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. This sheet explains the surgery and what to expect. Although the incisional parotid biopsy is the diagnostic procedure of choice for systemic disease involving the parotid, the superficial parotidectomy remains the minimal biopsy of choice for a mass suspected to be a neoplasm in the parotid. The most common reason to remove this gland is due to an abnormal mass contained within. Whilst every effort has been made to ensure accuracy, the information contained may not be. In this study distances from the most frequently used surgical landmarks to the main trunk of the. She had refused prior surgical intervention because of her concern of an unsightly scar.
Parotid gland applied anatomy and surgical considerations. The tympanomastoid suture line lies between the mastoid and tympanic segments of the temporal bone and is approximately 68 mm lateral to the stylomastoid foramen. In this study distances from the most frequently used surgical landmarks. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. It takes a fresh approach to surgical anatomy by appointing two anatomists and two embryologists as the other editors and. Msks parotid gland surgeons, including ian ganly, have extensive experience in using precise techniques that help preserve the facial nerve. The mean followup time was 44 months range, 6120 months. The result of his 50 years of experience in both teaching surgical anatomy and in practicing surgery it provides an overall understanding of the bodys processes through a greater awareness of embryology and anatomy. Please insert local department routine and emergency contact details here. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a. The parotid gland is a serous secreting gland, and the largest of.
Parotidectomy parotid gland tumor surgery memorial. Surgical landmarks to the facial nerve include the tympanomastoid suture line, the tragal pointer, and the posterior belly of the digastric muscle. Your parotid glands are found in your cheeks, over your jaw and in front of your ears. We followed 11 patients who underwent parotidectomy 9 superficial and 2 total parotidectomies for a variety of parotid tumors between december 2001 and january 2018. Learn about the parotidectomy, an online 3dvideobased course, accredited by the royal college of surgeons of england. Surgical anatomy of the facial nerve and parotid gland based upon a study of 350 cervicofacial halves. The transoral approach eliminates all facial incisions. Careful blunt dissection immediately on epineurium of nerve with slow advancement and spreading action. The surgical anatomy and technique of parotidectomy. I was shocked to hear the flip attitude they all had towards the outcome of the surgery. This method then evolved to a partial superficial parotidectomy as this slightly more. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Parotidectomy with facial nerve dissection iowa head and. The basic methods described here may be applied to any situation encountered in surgical treatment of the parotid gland, whether its solution entails biopsy, superficial parotidectomy, or total parotidectomy, with or without preservation of the facial nerve.
Typically, long facial incisions are used to gain access. Outside of the antibiotic cream, you will want to keep the surgical site dry during this part of the parotidectomy recovery time. Surgical technique superficial parotidectomy deep lobe parotidectomy surgeons will spend their entire career trying to learn when it is safe or necessary to do more or less than a superficial parotidectomy 6 superficial parotidectomy indications neoplasm risk of metastasis recurrent infectionabscess surgical exposure deep lobe. Azizzadeh, as we have found that a team approach to this surgery provides. Surgical operation on the parotid gland is most often performed to remove a mixed tumor. The facial nerve needs to be preserved as it supplies the muscles of facial expression and therefore damaging it will have severe cosmetic and functional consequences. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. It is the result of a close collaboration between the.
Surgical oncology lecturer of surgical oncology nci cairo universi slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Presentation on anatomy of parotid gland and surgical approaches. Surgical anatomy of salivary glandssurgical anatomy of salivary glands dr. This publication is designed for the information of patients. Thank you for your interest in spreading the word about the bmj. Accessory parotid gland tumors are located in difficult to reach areas of the face. The micro parotidectomy is the most minimally invasive technique available and involves a minute incision near the ear to minimize scarring, recovery time and longterm complications. Sialendoscopy with duct dilation, stone removal, or steroidantibiotic insufflation extends the number of options for surgical treatment beyond parotidectomy. Jan 30, 2019 parotidectomy is typically performed with the patient under general anesthesia. Carlson, md fasciae of the neck knowledge of the fascial layers of the neck is mandatory to extirpate cancer and treat infections of the head and neck. Your surgeon may recommend a superficial parotidectomy surgery to remove all or part of the superficial lobe if the tumor is confined to the superficial lobe of the parotid gland. Parotidectomy is a surgical procedure that entails removal of all or a portion of the paroti. Request pdf the surgical anatomy of the parotid fascia unlabelled. Parotidectomy with facial nerve dissection see sample operative notes at bottom of protocol.
Parotidectomy mini incision patient success stories i spent months researching and consulting with several doctors recommended through my insurance company regarding removal of my parotid tumor. The procedure is most typically performed due to neoplasms tumors, which are growths of rapidly and abnormally dividing cells. Parotidectomy is a surgical procedure that entails removal of all or a portion of the parotid gland. It is important to confirm that the patient has regained full motor function as determined by twitch monitoring before attempting to dissect out the. Your parotid glands are one of the glands that release saliva spit into your mouth. Parotidectomy for a benign tumour is demonstrated in four steps. Full text is available as a scanned copy of the original print version. The position of the extraglandular portion of the posterior facial vein may be noted in the superficial dissection shown in figure 3. Variations of parotidectomy indications and technique. Parotidectomy parotid gland tumor surgery memorial sloan. Parotidectomy is basically an anatomical dissection. To allow adequate monitoring of the facial nerve, paralytics should not be used beyond the induction of anesthesia. Rea, paul michael 2003 the surgical anatomy of the extratemporal portion of the facial nerve in relation to parotidectomy.
Jan 07, 2020 parotidectomy is a surgical operation to remove the parotid which is a large salivary gland located in front of the ear and slightly below it. Surgical anatomy of the extraparotid distribution of the. The major oncologic problem is the correlation of the histologic picture of the tumor with the ultimate prognosis. Each chapter is a separate essay from an embryologic, anatomic and surgical viewpoint and follows the format below. This is a teaching video for residents in head and neck surgery. The most common indications for this operative procedure are a neoplasm of the parotid gland or metastases to parotid lymph nodes. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas. The surgical anatomy and technic of parotidectomy the american. The major technical problem involved is related to the proximity of the gland to the facial nerve.
Surgical anatomy of the facial nerve and the parotid gland based upon a study of 350 cervicofacial halves. Advance your surgical expertise with atlas of advanced operative surgery. The facial nerve is central to parotid surgery for both surgeon and patient. Parotid gland applied anatomy and surgical considerations free download as powerpoint presentation. Parotidectomyanatomical considerations wang 2012 clinical anatomy wiley online library clinical anatomy is the official journal of the american association of clinical anatomists and the british association of clinical anatomists. Babak larian, micro parotidectomy is a revolutionary way to treat parotid tumors through the full or partial removal of the parotid gland. Nursing teaching for parotidectomy iowa head and neck protocols. Following a parotidectomy, most patients can return home within two to three days to continue the healing. A small right angle hemostat or mccabe facial nerve dissector is helpful for initial dissection, especially in obese patients. Surgical anatomy of the parotid gland sciencedirect. A parotidectomy is the surgical excision removal of the parotid gland, the major and largest of the salivary glands. Atlas of advanced operative surgery 1st edition pdf free. In a partial superficial parotidectomy, only some branches of.
The mass itself can be found anywhere within the parotid gland. Facial nerve dissection initial course of nerve progresses from deep to superficial. Identification of facial nerve during parotidectomy. It is a complex operation and requires a sound knowledge of the 3dimensional anatomy of the neck. The microparotidectomy is the most minimally invasive technique available and involves a minute incision near the ear to minimize scarring, recovery time and longterm complications. Jun 26, 2014 surgical anatomy of salivary glandssurgical anatomy of salivary glands dr. Knowledge of the surgical anatomy and the landmarks to find the facial nerve are the key to preserving facial nerve function. Parotidectomy is a surgical operation to remove the parotid which is a large salivary gland located in front of the ear and slightly below it. Introduction a parotidectomy is the surgical excision removal of the parotid gland, the major and largest of. Kurth, ler plastic and reconstructive surgery and the transplantation bulletin. Facial nerve paralysis is a daunting potential complication of parotid surgery and is widely reported. At the center, every micro parotidectomy is performed by both dr.
At the center, every microparotidectomy is performed by both dr. Surgical anatomy of the facial nerve and parotid gland. Atlas of advanced operative surgery 1st edition pdf. Neoplasms can be benign noncancerous or malignant cancerous. Jul 24, 20 to find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Surgical landmarks for identification of facial nerve in. They stressed the importance of surgical landmarks for avoiding injury to the facial nerve and advocated complete removal of the superficial portion of the parotid gland for noninvasive lesions confined to that location. Cadaveric dissection was performed in the department of anatomy and the surgeries were done in the department of ent and head. Patientfamily will verbalize understanding of routine preoperative instructions.
The most common reasons for removing all or part of this gland are a tumor, chronic infection, or obstruction of the saliva outflow causing chronic enlargement of the gland. The second patient is a 19 year old female with a known five year history of a slowly enlarging right pleomorphic adenoma of the accessory parotid gland. To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. It helps produce and control the release of saliva. If a tumor forms in the parotid gland, it can press on the facial nerve, causing discomfort and pain. Kurthsurgical anatomy of the facial nerve and parotid gland based upon a study of 350 cervicofacial halves. This approach leaves scarring and facial contour deformities. The surgical anatomy and landmarks of the facial nerve. In 1958, beahrs and adson eloquently described the relevant anatomy and surgical technique of current parotid gland surgery.