Facial nerve morbidity following surgery for benign parotid tumours mohammad ayub musani1, abbas zafar2, zahid suhail1, shoukat malik3 and daud mirza4 abstract objective. Answers from trusted physicians on left superficial parotidectomy. To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. Partial parotidectomy versus superficial or total parotidectomy 1ibrahim abdealbare and 2mohamed a. The parotid gland is the largest of the salivary glands.
A comparative study wael alnassan md, medyan alrousan bds, msc, samer ghazawi md, zuhair mhaidat bds, msc, emil batarseh md abstract objective. After doing minor tasks, they find that they get extremely tired and need to rest or sleep. Parotidectomy for a benign tumour is demonstrated in four steps. In parotid surgery, the risk of facial nerve palsy is related to the size and extend of the tumour and hence the extend of the resection done. Your surgeon whould provide a complete list of what to expect. Facelift incision and superficial musculoaponeurotic. Graft interposition for preventing freys syndrome in. Cal technique of parotidectomy via a facelift incision is described and evaluated. Parotid surgery codes surveillance, epidemiology, and.
Microsurgical dissection of facial nerve in parotidectomy. Facial nerve morbidity following surgery for benign parotid. The operation may involve sparing or sacrifice of the facial nerve branches or trunk depending on tumor extent to the nerve. 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.
Pain, swelling, possible facial weakness or paralysis due to injury to the facial nerve. Facial nerve morbidity following surgery for benign. This gland is one of the salivary glands that produce saliva to moisten food as we eat. A squamous cell carcinoma arising in the preauricular region with documented metastasis to level i would warrant an intervening parotidectomy. Parotidectomy parotidectomy is removal of part or all of the parotid gland, a salivary gland that lies in front of and below the ear. The cost usually involves physician, hospital, anesthesia services, and a two to four day hospital day. Which surgical method is superior for the treatment of parotid tumor. Following a parotidectomy, most patients can return home within two to three days to continue the healing. The parotidectomy procedure is the modern patient choice for parotid tumor removal.
The uppermost branches were identified and preserved. Brought to you by xephyr healthcare it services 9703977769 browse more than 12,000 surgery videos and save your favorites for free. There is a wide array of uses for such products, including use as a cover for wounds related to disease processes e. This study aimed to determine the indications of partial superficial. Code 20926 is correct for dermal fat graft from left abdomen. The effect of partial superficial parotidectomy on amplitude, latency and threshold of facial nerve stimulation. Factors related to facial nerve palsy were malignant tumor, type of parotidectomy and repeated surgery. Parotidectomy procedure pdf the facial nerve is central to parotid surgery for both surgeon and patient. Aug 18, 2011 these keywords were added by machine and not by the authors. This publication is designed for the information of patients. Both procedures will be done at the same time and will involve two different entry points cuts in order to gain access to the lymph nodes that need to be removed. Accessory parotid gland tumors are located in difficult to reach areas of the face.
The extent of parotidectomy is case of a parotid malignancy is still controversial. To allow adequate monitoring of the facial nerve, paralytics should not be used beyond the induction of anesthesia. After resection of superficial lobe of the parotid gland, smas flap was rotated, advanced over the parotid bed, and sutured to anteriorly rotated scm muscle flap. Cutaneous squamous cell carcinoma cscc comprises 20% of all skin cancer of the head and neck. Superficial parotidectomy surgery video surgical oncology video. Use code 42420lt, excision of parotid tumor or parotid gland. Although superficial parotidectomy is a highly standardized and safe procedure, limited parotidectomy for proven benign parotid salivary gland neoplasms is more likely to result in patients with minimal or no displeasing complications. Autologous fat transfer was primarily used in 10 cases to. This surgery is performed through an sshaped incision starting in the crease in front of the ear, extending below the earlobe and sweeping forward onto the upper neck. Parotidectomy for parotid masses in ramathibodi hospital, benign lesion were. Oxford centre for head and neck oncology parotidectomy. Superficial parotidectomy via facelift incision article pdf available in the annals of otology, rhinology, and laryngology 1184. These transfers have been used at our institution only after the year 2010.
A an incision was made along the postauricular sulcus and hairline without a preauricular incision. The extended parotidectomy is a complex surgery reserved, generally, for the advanced parotid malignant lesions that interest several anatomical structures, with the objective of eradicating. Variations of parotidectomy indications and technique kerry d. Feb 19, 2015 total parotidectomy total parotidectomy is the total removal of the superficial and deep parotid gland. Facelift incision and dissection of smas flap were conducted in the same way with the former case. There are two of them, one on each side of the face and they produce saliva that drains into the mouth through a duct that lies next to the upper molar teeth.
The stigma of a visually prominent facial scar following parotid surgery can be. Parotidectomy is considered a clean surgical procedure. Total parotidectomy is the most frequently used approach for resection of parotid cancer. Dissection was carried well around this, and it was rotated upwards with the specimen. The role of extracapsular dissection for benign parotid tumors.
Partial superficial parotidectomy with retrograde dissection of the. The major oncologic problem is the correlation of the histologic picture of the tumor with the ultimate. This is a teaching video for residents in head and neck surgery. Tumors that extend into the deep lobe may require total parotidectomy. A melanoma on the cheek with a positive sentinel node in level i would warrant removal of intervening lymph nodes via parotidectomy in the course of performing a neck dissection. It is a sequela of parotidectomy, submandibular gland surgery, radical neck dissection, infection, traumatic injury or even radiotherapy in the parotid. The most common complication was facial nerve injury 63. Surgical procedure of partial superficial parotidectomy via the retroauricular hair line incision approach. This study evaluates the st vincents hospital, sydney experience between 1996 and 2006. The most common reasons for removal of all or part of this gland are a mass in the gland, chronic infection of the gland, or obstruction of the saliva outflow from the gland causing chronic enlargement of the gland. There was an obvious mass within the inferior lateral gland.
Identification of facial nerve during parotidectomy. Outcome, general, and symptomspecific quality of life after. The maxillary and superficial temporal veins merge into the retro mandibular vein within the parotid gland but are not responsible for drain ing the gland. Babak larian, micro parotidectomy is a revolutionary way to treat parotid tumors through the full or partial removal of the parotid gland. At present, surgical excision is the most effective treatment for parotid tumors, but controversy remains with respect to the use of superficial parotidectomy sp or partial superficial parotidectomy psp. A minority will metastasize to regional parotid lymph nodes.
Although damage to the facial nerve when transversing the gland is the main complication, gustatory sweat syndrome, also known as freys syndrome, should be. Parotidectomy under general anaesthesia a case report. Surgery in superficial lobe pleomorphic parotid adenoma. How is a neck dissection and superficial parotidectomy performed. Take as much time as you wish to read this information and ask questions of your doctor or the assistants. Larian will remove all or a portion of the parotid gland through a very small and wellhidden incision near the ear an approach that results in reduced pain, minimal scarring, and a quicker recovery. We performed a 119patient retrospective case series analysis over a 12year period 19942006 and investigated timing of postoperative complications. Left superficial parotidectomy answers on healthtap. Outcome of parotidectomies in benign disease has little impact on general qol and global health status. The major technical problem involved is related to the proximity of the gland to the facial nerve.
Professor and chair head and neck surgery mayo clinic parotidectomy 60 100 cases per year variety of neoplasms and anatomic variations minimal morbidity overall recurrent neoplasms challenging cases personal experience 32 years. N2 the facelift incision and allograft dermis implants have been used in parotid surgery to improve esthetic outcomes. There are however other glands which make saliva a s well, one on each side under the jaw bone and hundreds of tiny o nes. The majority of lesions are benign and affect the superficial parotid lobe. 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.
Cutaneous squamous cell carcinoma metastatic to parotid. Parotidectomy definition parotid relating to the parotid gland ectomy surgical removal this procedure involves removal of the portion of the parotid gland that is located in front of the ear. Informed consent for parotidectomy ent center of utah. Superficial parotidectomy under the general anesthesia was planned. Pdf sialolipoma of the superficial lobe of the parotid gland.
From an oncological point of view, the deep portion does not differ from the superficial portion apart from its smaller volume with fewer nodes present. Partial superficial parotidectomy for pleomorphic adenoma. Though in the past, the parotidectomy recovery time could be quite extensive, new procedures have made this surgery minimally invasive and recoveries very predictable. Several procedures have been described to primarily avoid or secondarily reconstruct the facial defect and treat the neurological iatrogenic syndrome. A lazy s incision is made in front of the pinna and behind the angle of the mandible some surgeons used a modified facelift incision. Postoperative infection is uncommon, and it is reported to occur in less than 3% of patients. Recurrence following parotidectomy for pleomorphic adenoma is attributed to spillage, inadequate resection, or multicentric foci. Partial superficial parotidectomy via retroauricular. Objectives the purpose of this study was to evaluate the usefulness of retroauricular hair line incision rahi in partial superficial parotidectomy by comparison with modified blair incision or facelift incision. For example, snow 28 table 1 proposed to consider five types of surgery. Both procedures will be done at the same time and will involve two different entry points cuts in order to gain access to. This involves resection of the entire parotid gland, usually with preservation of the facial. We commonly use these techniques in patients with benign parotid tumors. Informed consent for parotidectomy introduction this information is given to you so that you can make an informed decision about having parotidectomy.
Parotidectomy superficial or total adequate margin and preservation of the facial nerve. Parotidectomy patient information sheet what is the parotid and what causes parotid lumps. Rare parotid salivary fistula post superficial parotidectomy. During the first week after surgery patients feel well when they wake up in the morning but find that they get tired very easily. 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. Reconstruction of facial nerve after radical parotidectomy. Jan 30, 2019 parotidectomy is typically performed with the patient under general anesthesia. On conclusion they have reported that extracapsular dissection showed similar effectiveness and fewer side effects than superficial parotidectomy hence extra capsular dissection could also be considered as the treatment of choice for tumors located in the superficial portion of the parotid gland.
If you would like to learn about parotidectomy, the reasons for parotidectomy and the benefits of parotidectomy, the following information will help you. Superficial parotidectomy is the most applied surgical procedure in the parotid tumors. Surgical procedure of partial superficial parotidectomy openi. Use of the harmonic scalpel in superficial and total parotidectomy for benign and malignant disease. The maxillary and superficial temporal veins merge into the retromandibular vein within the parotid gland, but are not responsible for draining the gland. The study included 20 patients assigned for superficial parotidectomy with reconstruction of the parotid bed using smas flap. Whilst every effort has been made to ensure accuracy, the information contained may not be.
Surgical techniques of repair ben nageris, md, raphael feinmesser, md every surgical procedure has its price, and so does resection of parotid tumors. This study was conducted to determine whether the retrograde approach in parotidectomy is. It is also possible to combine interpositional nerve grafting and nerve transfers with or without a jump graft 12. Freys syndrome, or gustatory sweating, is named after lucja frey, who first described it as auriculotemporal syndrome in 1923. Resection of the entire superficial lobe of parotid figure 3 and is generally used for metastases to parotid lymph nodes e.
Smas advancement flap for reconstruction of superficial. Surgical operation on the parotid gland is most often performed to remove a mixed tumor. Patients were observed for the development of freys syndrome and the aesthetic outcome with mean followup period of. We evaluated the timing of complications following parotidectomy. Aim the aim of the study was to evaluate the results of extracapsular dissection ecd versus conventional superficial parotidectomy in the management of benign parotid tumors patients and methods this is a prospective study of 46 patients who were treated for benign parotid tumors. In fact, in most cases we do not remove all of the parotid, just the lump with a good border of normal tissue around it. Superficial parotidectomy versus partial superficial. Consequently, an adequate envelope of normal parotid tissue must be included with the tumor. Histopathological characteristics of pas especially of capsular alterations such as thin capsule.
During the micro parotidectomy procedure, or minimally invasive parotid surgery, dr. Parotidectomy with facial nerve dissections iowa head and. Codes 3036 are with or without superficial lobe 37 facial nerve spared. Extracapsular dissection versus superficial parotidectomy. Infection is avoided by adherence to sterile surgical technique and the careful handling of tissues intraoperatively. Deeper part of residual parotid tissues will continually secrete saliva and accumulates as sialocele. Effectiveness of facial exercise therapy for facial nerve. Typically, long facial incisions are used to gain access. The purpose of this study was to evaluate the adequacy of partial superficial parotidectomy and tumour enucleation in the surgical management of patients with pleomorphic adenoma of the parotid. This gland makes saliva, which enters the mouth through a tube duct near the back teeth. This surgery, which removes the parotid gland, helps people with nerve issues, tumors, and other gland problems. This concept has prompted many surgeons to perform a complete superficial parotidectomy for a lateral lobe tumor. Parotidectomy with facial nerve dissection iowa head and. Treatment of complications of parotid gland surgery ncbi.
Jackson ll, gourin cg, thomas ds, porubsky es, klippert fn, terris dj. Complications of parotid surgery northwestern scholars. They also produce enzymes that begin the digestive process. Parotidectomy with or without facial nerve removal is performed without delay4, 5. Superficial parotidectomy was the most common choice of treatment 71. Superficial parotidectomy superficial lobe parotidectomy describes removal of all or a portion of the parotid gland superficial to the facial nerve.
Dennis yu kim chua, mrcs, mmed, christopher hood keng goh, frcs, fams department of otolaryngology, singapore general hospital, singapore. Conservative vs superficial parotidectomy dermatology. It is important to confirm that the patient has regained full motor function as determined by twitch monitoring before attempting to dissect out the. Parotidectomy is a surgical operation to remove a large salivary gland the parotid gland located in front and just below the ear. Your enquiry will be forwarded to up to 3 private healthcare providers. Surgical management of pleomorphic adenoma of parotid. Parotidectomy is basically an anatomical dissection. A parotidectomy is the surgical removal of the parotid gland. If you have any problems or questions, please contact. Aug 27, 2016 superficial lateral parotidectomy double warthin. The incidence of facial nerve paralysis is higher with total, than with superficial parotidectomy, which may be related to stretch injury or as result of surgical.
The transoral approach eliminates all facial incisions. This approach leaves scarring and facial contour deformities. The lateral parotidectomy specimen was separated and set aside. Ward 11, and woods12, the superficial parotidectomy and or total parotidectomy with preservation of the facial nerve gives excellent results in the excision of the neoplastic mass. A parotidectomy involves locating the facial nerve the nerve that moves the muscles. In our case we made the accurate diagnosis of warthins tumor in a short period of time and performed superficial parotidectomy without delay. Lateral parotidectomy medical transcription sample report. Pdf download for partial superficial parotidectomy with retrograde.
The operation is performed under general anaesthetic and lasts four to six hours. Nov, 2014 bernie had a micro parotidectomy surgery with expert salivary gland surgeon dr. Pdf superficial parotidectomy via facelift incision. Complications after superficial parotidectomy for pleomorphic. Surgery to remove the parotid gland is called a parotidectomy.
Dissection of the facial nerve branches can be challenging even under loupe magnification, and partial, or complete injury of the nerve branches can occur during. Current management of benign parotid tumorsthe role of limited. Submit a request for further information, a quotation or indicative cost. Surgical management of pleomorphic adenoma of parotid gland in elderly patients. Parotidectomy has welldocumented postoperative complications. Please insert local department routine and emergency contact details here. You will be asked to attend a preassessment appointment before surgery where we will assess your fitness to undergo an. Benign and early stage malignant neoplasms localized in the superficial. Symptomspecific qol was assessed with the parotidectomy outcome inventory8 poi8. May 30, 2012 operative technique of superficial parotidectomy by dr. Recently, some surgeons suggest that extracapsular dissection ecd instead of superficial parotidectomy sp for treatment of benign parotid. Parotidectomy is the removal of the parotid gland, located below the ear. This process is experimental and the keywords may be updated as the learning algorithm improves. We report a case of a 38yearold woman who presented with a painless, slowly growing.
The gland is removed to treat an infection that keeps returning or to take out a tumor. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Knowledge of the surgical anatomy and the landmarks to find the facial nerve are the key to preserving facial nerve function. Partial superficial parotidectomy versus conventional superficial parotidectomy for benign parotid tumors. Parotidectomy step by step approach ravi sachidananda. In this chapter, the role of extracapsular dissection ecd will be contrasted to surgical alternatives including complete superficial parotidectomy. Foda 1health director of tanta cancer center and head of surgical oncology, egypt 2faculty of dentistry, alazhar university, assiut branch,egypt abstract. Variations of parotidectomy indications and technique. In addition, aesthetic outcome was evaluated with an ordinal scale.
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